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A 50 year old asymptomatic lady presents with a bicuspid aortic valve with a mean
gradient of 25mmHg. a dilated ascending aorta odf 4cm, and a coarctation of the
aorta with a gradient of 28mmHg. This was all discovered when her GP heard a murmur. What would you do?
The aortic valve, the ascending aorta and the coarctation need no intervention
individually.
Surgical Options include:
Perform AVR , ignore ascending aorta - not a good idea as bicuspid aortic valve is associated
with aneurysmal formation of the ascending aorta.
Perform a root replacement - but does not need doing at moment
Repair coarctation, but nor severe enough for surgical intervention at moment.
Other surgical options include:
Performing the AVR / root replacement and then the repair of the coarctation
Repairing the coarctation and then performing the AVR / root replacement
With regard to repairing the coarctation two options exist:
Left thoracotomy, and correction
Median sternotomy and extra anatomical bypass.
Hybrid procedure options include:
Stenting / angioplasty of the coarctation, not within the NICE guidelines, and gradient
too small at moment, either before or after AVR ./ root replacment.
The best option at the moment would be to monitor her symptoms, blood pressure, aortic valve
gradient / regurgitation, size of ascending aorta, and gradient of the coarctation
/ area as assessed by CT scan.
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