[HSF] Bicuspid aortic valve and replacement

[Nasser F. Abou'Seada]

Nice Prasanna .... the rest of the discussion of the thread is magnificent
and very informative as well 
What is your point ?
NFA

> From: prasannasimha
> This is a conversation on Pediheart.9Regarding Bicuspid aortic valves)
> Prasanna
> This is a recently developed problem, leading to an entirely unwarranted
guideline
> based on opinion, not evidence. The assumption that post-stenotic
dilatation
> associated with a bicuspid aortic valve would lead to aortic dissection,
extrapolates
> from the "limits" for aortic dimensions for Marfan Syndrome. The
International
> Registry for dissections has a total of >1000 cases of dissection, only 3%
of which had
> a bicuspid aortic valve (approximately the rate of occurrence in the
general
> population), 55% had hypertension and 35% had atherosclerosis. I cannot
find
> whether the first group also had hypertension, etc.
> 
> The number of operations replacing an aorta will blossom when you consider
that
> most tetrad of Fallot have large ascending aortas as part of their
embryology, and
> many Ross procedures. Someone in our institution recently sent a 46 year
old, many
> years post tet repair, to have his aorta replaced. He expired immediately
post-op!
> 
> At the present, I find no convincing DATA that would compel restrictions
of your
> patient.
> 
> Warren Guntheroth, Seattle
> 
> 
> On Wed, 13 Dec 2006, ANITHA parthiban wrote:
> 
> 
> > Hi,
> >
> > I would like to get some opinions on this patient.
> >
> > A 17.5 year old with recently diagnosed bicuspid aortic valve with mild
aortic
> > stenosis (peak gradient 25mmHg) and trace aortic insufficiency. His
aortic root
> > dimension is normal but the ascending aorta is dilated at and just
distal to
> > the sino-tubular junction measuring 3.7cm by echocardiogram. He was
complaining
> > of constant chest pain that increased with exertion.  A CT Angiogram
confirmed
> > the finding with maximum dimension of ascending aorta being 3.6cm; no
> > dissection was present.  Exercise stress test was normal with no ST-T
wave
> > changes. He had some chest wall tenderness and the chest pain has
resolved with
> > NSAID treatment.  He is a cross country runner and stands to get a
college
> > scholarship. He has no features of Marfan or Loeys- Dietz syndrome.
> > 1) What is your experience with beta - blockers in this situation?
> > 2) Would you let him participate in competitive sports (running)?
> 
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