MMP2 and endothelial dysfunction: It has been demonstrated that genetic factors affect the different behavior of aortic aneurisms in BAV and TAV cases [62], as in BAV there is a reduction in endothelial nitric oxide (NO) tissue endothelium levels, lower NO production, and increased release of MMP-2 and -9, determining endothelial dysfunction, activation of stretch and stress pathways, increased hypertension, increased apoptosis of smooth muscle cells, and weakening ECM.