Case #1 Bicuspid Valve Dilated Aortic Root Mod AI/Mild AS - RW

1. Case #1 Bicuspid Valve Dilated Aortic RootMod 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 2.8cm Sinus of Valsalva 4.2cm STJ 4.0cm Ascending Aorta 5.2cm

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7. Case #1 Bicuspid Valve Dilated Aortic RootMod 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.

8. 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 3.8cm STJ 3.1cm

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14. Case #2 • Underwent replacement of ascending aortic aneurysm with #26 Dacron tub graft and repair of bicuspid aortic valve.

15. Post Repair Bicuspid Valve JH 35

16. Case #3

17. 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.

18. 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 • Dilation primarily of the autograft with minimal dilation of the native ascending aorta. • Mild pulmonic homograft stenosis

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28. Case #3 Surgery Performed • Surgery: Aortic root replacement with #29 mm freestyle root.

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31. Case #4

32. 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%

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

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