Splenic Infarct, Atrial Fibrillation

MKSAP
Because a bicuspid valve is subject to higher mechanical and shear stress than
a tricuspid valve, the disease process of progressive calcification is
accelerated, and clinical presentation tends to be earlier—in the fourth or fifth
decades of life. This patient has a bicuspid aortic valve with moderate aortic
regurgitation. Echocardiography demonstrates normal left ventricular size and
systolic function. Pulmonary pressures are in the normal range, and there is no
evidence of adverse hemodynamic effects of valve regurgitation on the
ventricle (ventricular size and function are normal). No specific treatment is
needed at this time. However, because worsening of aortic regurgitation can be
insidious, routine clinical follow-up is indicated in at least yearly intervals,
typically with repeat transthoracic echocardiography to monitor for disease
progression. The presence of a bicuspid aortic valve is associated with
ascending aorta dilation, and TTE can also monitor for aortic enlargement.
Most patients with bicuspid valves will eventually develop significant
abnormalities—aortic stenosis, regurgitation, or aortic root dilation or
dissection—that require surgery.