[HSF] Aortic Aneurysms and Bicuspid Valves

[Hgrmd at aol.com]

Dear Members,
  I did an interesting case 3 days ago in which a 50 yo man had  atypical 
chest pain.  A CT revealed a 10 cm aortic root!  That's the  biggest root I can 
recall seeing. There was a well-functioning Starr-Edwards  aortic valve that 
had been implanted in '87 for bicuspid stenosis.  Even 20  years ago, I thought 
no one was using the Starr-Edwards in the aortic  position.  Anyway, I did an 
uneventful Bentall, and the patient is  currently doing well.
  My question for the aortic experts of HSF (I certainly don't  consider 
myself one) is what minimum aortic diameter would you now recommend  Bentall 
instead of simple AVR for symptomatic bicuspid stenosis?  I've  heard and read that 
the bicuspid aorta has the same biology as Marfan's.   Comments?
Hal