Bicuspid Aortic Valve
What to Image in Patients Considered for Transcatheter Aortic Valve Replacement?
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A 78-year-old patient presented with New York Heart Association functional class II dyspnea complaints and suspected aortic stenosis. The patient was referred for transthoracic echocardiography which confirmed the presence of severe aortic stenosis secondary to a calcified (probably) bicuspid aortic valve (BAV) with a mean gradient of 22 mm Hg, peak gradient of 40 mm Hg, and calculated aortic valve area of 0.9 cm2 (Figure 1). The stroke volume was 34 mL/m2 (body surface area, 1.68 m2), and the left ventricular ejection fraction was 39%. On computed tomography (CT), the diagnosis of BAV was confirmed, whereas the aortic root and tubular part of the ascending aorta were slightly dilated (sinus of Valsalva, 42 mm; sinotubular junction, 39 mm; tubular ascending aorta, 42 mm; Figure 1). The logistic EuroSCORE II was 16%. Invasive coronary angiography excluded obstructive coronary artery disease needing revascularization. With the diagnosis of classical low-flow, low-gradient, severe aortic stenosis, the patient was referred for transcatheter aortic valve replacement (TAVR) after discussion in the Heart Team.