Case #1
Bicuspid Valve Dilated Aortic Root
Mod AI/Mild AS 
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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
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 #2
Ascending Aortic Aneurysm
Bicuspid Aortic Valve
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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
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.
Post Repair Bicuspid Valve
JH 35
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 #3
Surgery 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 Valve
Aortic Root Annulus 3.0 cm
Sinus of Valsalva
4.1 cm
Ascending Aorta
5.0 cm
LVEF 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