A dilated aortic root is often associated with bicuspid aortic valve disease and may be caused by higher pressure gradients or defective collagen matrix.

“but there was a third problem that was probably even more frightening on the MRA which is the portion of the study that looks at the vasculature which was the size of your aortic root was very dilated and this also tends to go hand-in-hand with a Genesis and it turns out it's not entirely clear why one thought is the higher pressure gradient going across just stretches it out but I actually think the literature is pointing to the fact that whatever congenital factors lead to the remodeling or the defective valve leaflets and the remodeling also speak to not having the right collagen mixture or matrix within the a sending aorta”