Bicuspid Aortic Valve & Mild Stenosis

May 29th, 2022
Pages 1 – 5

A case of bicuspid aortic valve with diastolic prolapse, mild stenosis and 3D analysis of stenotic area

See the follo-up pre-CPB TE images here.

Figure 1. 2D parasternal long axis
Figure 2. 2D parasternal long axis, zoom on aortic valve

A 72 year old male (BSA= 1.8 m2; HR= 82 bpm; BP= 130/80 mmHg) was admitted because of aortic valve stenosis (Figures 1-3) and dilatation of the ascending aorta (48 mm; ST junction= 32 mm)). LV end-diastolic volume was normal (51 ml/m2), with normal wall thickness and biplane ejection fraction (64 %). Longitudinal systolic function (GE AFI analysis) was reduced (GLS= -14.5 %) (see below). LV filling pressures were estimated normal with grade I diastolic dysfunction. There was mild mitral regurgitation with normal anatomy (PISA method, EROA= 0.1 cm2; regurgitant volume= 18 ml) and the left atrium was moderately dilated (47 ml/m2). There was a mild tricuspid regurgitation with mildly increased estimated pulmonary systolic pressure (40 mmHg).
The aortic valve was bicuspid (Figures 4-5) with a prevalent antero-lateral cusp and a prolapsing postero-medial cusp. There were nodular calcifications. There were no signs of significant stenosis (Max gradient= 26 mmHg, mean gradient= 16 mmHg, valve area at continuity equation= 1.8 cm2; 2D planimetry= 2.3 cm2) (Figure 4), with a mild regurgitation.

Figure 3. Color Doppler parasternal long axis, aortic valve
Figure 3. Color Doppler parasternal long axis, aortic valve
Figure 4. 2D parasternal short axis, aortic valve
Figure 4. 2D parasternal short axis, aortic valve
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