A 37-year-old man has been experiencing increasing exertional dyspnea and fatigue. A transthoracic echocardiogram performed for murmur showed severe aortic insufficiency, left ventricular dilation to 6.5 cm, mildly depressed left ventricular function (ejection fraction 50%), and dilated sinus segment. Transesophageal echocardiogram showed a Sievers Type I (L/R) bicuspid aortic valve with very asymmetric commissural orientation, thickened raphe, and eccentric jet of aortic insufficiency. Computed tomographic angiography (CTA) of the aorta showed aortic root measuring 4.9 cm in maximum diameter and a dilated aortic annulus measuring 26.5 mm (min) x 31.1 mm (max). Coronary CTA showed no anomalous coronary anatomy, calcification, or stenoses. He was referred for cardiac surgical consultation. In discussing options for aortic valve repair or replacement, he expressed being accepting of a mechanical aortic valve prosthesis, and associated life-long anticoagulation, if needed.

Clinical Topics: Anticoagulation Management, Congenital Heart Disease and Pediatric Cardiology, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Valvular Heart Disease, Congenital Heart Disease, CHD and Pediatrics and Imaging, CHD and Pediatrics and Interventions, Interventions and Imaging, Interventions and Structural Heart Disease, Angiography, Nuclear Imaging, Cardiac Surgery

Keywords: Aortic Valve, Bicuspid Aortic Valve Disease, Constriction, Pathologic, Dilatation, Stroke Volume, Ventricular Function, Left, Aorta, Anticoagulants, Angiography, Coronary Angiography, Prostheses and Implants, Dyspnea, Fatigue

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