Case Image
A 28-year-old man admitted our outpatient cardiology clinic with
exertional dyspnea. He has been diagnosed with bicuspid aortic valve for
five years ago, however, he did not go routine follow-up. Â Cardiac
examination revealed regular pulse (90 beats/min) with normal blood
pressure and a 3/6 systolic crescendo-decrescendo murmur loudest at the
right upper sternal border. Electrocardiography revealed normal sinus
rhythm with left ventricular hypertrophy. Transthoracic echocardiography
showed bicuspid aorta with aortic aneurysm and severe aortic
regurgitation. Interestingly, severe calcification of the valve was
extending to subvalvular area and causing severe left ventricular
outflow tract obstruction (subaortic stenosis)(Figure 1, Video 1).
Transesophageal echocardiography and computed tomography revealed that
calcification was starting from coronary cusp and extending to the
interventricular septum and caused severe septal hypertrophy (Figure 2,
Video 2). The patient underwent aortic valve replacement with mechanical
prosthesis and thoracic aorta replacement with a Dacron graft after
heart team discussion. The patient was well after surgery and discharged
without any problem (Figure 3, Video 3).
BAV is the most common congenital cause for the development of aortic
valve calcification 1 . Calcification of BAV has
different genetic tendency in contrast to tricuspid valves2. BAV mostly undergo strain, and wall shear stress on
their edges of the leaflets during opening 3, however,
in this case calcification started from annularly and extending to LVOT
and basal septum. Besides the valve calcifications and stenosis,
subaortic stenosis caused patient’s symptoms.
Funding : None
Acknowledgement: Informed consent was obtained from the patient
to use of images for academic purposes.
Conflict of interest : None
References