Bicuspid aortic valve with aortic coarctation

Case contributed by Dr Yune Kwong

Presentation

Early adulthood onset of hypertension.

Patient Data

Age: 20-25 years
Gender: Male
Modality: MRI

Cine-SSFP images demonstrate an associated bicuspid aortic valve (only 2 commissures are seen, instead of the usual 3). On MRA, there is short segment abrupt narrowing of the aorta in the juxta-ductal region, consistent with adult-type aortic coarctation. Note the markedly dilated intercostal vessels and the internal mammary vessels (anteriorly).

Case Discussion

The most common association of adult-type aortic coarctation is bicuspid aortic valves. Cardiac MRI is advantageous for imaging aortic coarctation as it can directly demonstrate an associated bicuspic aortic valve, any accompanying valve dysfunction, and secondary effects upon the left ventricle eg concentric hypertrophy.

It is important to recognise that patients with bicuspid aortic valves have an associated aortopathy of the ascending aorta, irrespective of whether the latter is dilated. The media is abnormal and is a predisposing factor for dilatation and dissection. Other complications of bicuspid aortic valves are aortic stenosis, aortic regurgitation and endocarditis.

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Case Information

rID: 29895
Case created: 30th Jun 2014
Last edited: 16th Dec 2015
System: Cardiac
Inclusion in quiz mode: Included

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