Case #1 Bicuspid Valve Dilated Aortic Root

Mod AI/Mild AS - RW

RW is a 52 year old male referred for evaluation of ascending aortic aneurysm and bicuspid aortic valve.

Echo and cardiac CTA 8/06 revealed aortic dilation to 5.1cm, moderate aortic insufficiency, and mild aortic stenosis with mean gradient 20mm Hg, AVA 2.1cm2. No evidence of mitral regurgitation. LV EF preserved at 71%. Right heart pressures are normal.

PMH significant for sleep apnea (uses CPAP mask at night), cervical disc disease, bicuspid aortic valve, and hyperlipidemia

Aortic Root: Surgical Annulus 2.8cmSinus of Valsalva 4.2cmSTJ 4.0cmAscending Aorta 5.2cm

RW06

RW2

RW3

Case #1 Bicuspid Valve Dilated Aortic Root

Mod AI/Mild AS - RW

Aortic valve, aortic root and ascending aortic aneurysm replacement using #29mm St. Jude Valsalva conduit and mechanical valve. Brief circulatory arrest.

Case #2Ascending Aortic Aneurysm

Bicuspid Aortic Valve

55 year old man with known enlarging ascending aortic aneurysm 4.8-5.0 cm.

Known to have trivial –mild aortic regurgitation Presents for repair ascending aortic aneurysm. Aortic Root: Surgical Annulus 2.7cm

Sinus of Valsalva 3.8cmSTJ 3.1cm

JH 11

JH 09

RN 01

RN 02

RN 06

Case #2

Underwent replacement of ascending aortic aneurysm with #26 Dacron tub graft and repair of bicuspid aortic valve.

JH 35

Post Repair Bicuspid Valve

Case #3

SP Ross - WJ

11/06 52 year old male status post Ross procedure 5/1997

(Bicuspid valve) Followed by serial echo which has revealed significant ascending

aortic dilation up to 5cm. Confirmed by CT scan. Aortic valve leaflets appeared thin and mobile. Cardiac cath revealed no coronary disease confirmed modest pulmonary stenosis.

Meds: Toprol, Pepcid, ASA Blood pressure 102-120/66 HR 48 Scheduled for Ascending aortic aneurysm repair, assess aortic

root/valve intraoperatively with TEE with further intervention as needed.

SP Ross - WJ

Pre op diagnosis: Status post Ross procedure nine years ago with

presumed dilation of the residual aorta and subsequent autograft with mild insufficiency

Mild pulmonic homograft stenosis Post op diagnosis

1) Dilation primarily of the autograft with minimal dilation of the native ascending aorta.

2) Mild pulmonic homograft stenosis

wj 11-14-06

wj

wj 1

wj 3

Case #3Surgery Performed

Surgery: Aortic root replacement with #29 mm freestyle root.

wj 9

Wj 8

Case #4

Case #4

39 y/o man presenting with hypertension (systolic 210 mmHg) and murmur. Increased shortness of breath, orthopnea resolved with control of blood pressure.

Echo: Bicuspid Aortic ValveAortic Root Annulus 3.0 cmSinus of Valsalva 4.1 cmAscending Aorta 5.0 cmLVEF 60%

MF 7

MF 22

MF 53

MF 54

MF 55

MF 11

MF 14

MF 76

Surgical Procedure

Aortic root and ascending aorta replaced with #25 mm Homograft Re-implantation of coronaries.

MF 83

MF 100