BAV/aortic stenosis

nurse inquiring about husband: 60 , pmh well controlled HPB since early 20's; severe G/S pancreatitis  4 years ago; type II Diabetes 2nd to above. Echo year ago  probable BAV; AR 3. 43 cm; ACS 2. 06 cm; LA  5. 0 cm; LVIDES 3. 9 cm; ED5. 6; IVAd 1. 05 cm; LVPWd 2. 05 cm; M-mode AR & A cusp calicification; systolic excursion somewhat limited; M leaflets some sclerosis  calcif of M  annulus; IV Sep/pw contracting fairly well. 2-D - LV norm size with LV hypertrophy/adqdeqate EF. moderate/marked LA dilitation; RA norm; ; TV norm; considerable AR/cusp calcification somewhat limited systolic excursion Doppler: mild MV & TV regurg; SFV across AV 282 cm/s correspond to max. gradient around 32 mmHg and V area 1. 4 cm2. Conc:  concentric LVH, ; mod to marked atrial dilatation; possible BAV  considerable AR/cusp calcification; moderate AV stenosis/ insuff. Mild TR; My husband asymptomatic stress test 78% max; 48%EF - where do we go from here; should children be tested; signif of calcification.  Thanks

Where do you think we stand at this point? Sees an internist regularly. In past few months, BS's have been increasing and I believe he will be starting oral meds at next visit this week. How significant is "considerable" aortic cusp and root calcification. I know the root dimensions are WNL but does the calcification have any implications? Should Echo be repeated annually? Should my daughter and son be screened for BAV? Thanks so much for your time.

[Cleveland Clinic]

He has moderate aortic stenosis which means he needs medical therapy but no surgery yet. Also the ascending aorta is within normal limits, so this does not need surgical intervention. How severe is the aortic regurgitation: if it is severe than he may need valve replacement, but it does not sound like it from the LV dimensions
His EF of 48%is low however, without any good explanation. His stress test was likely non diagnostic because of insufficient heart rates. But he may still benefit from a left heart catheterization because of his diminished ejection fraction and diabetes and age.
Does he have atrial fibrillation? With the enlarged left atrial size he is at risk for this, and if not rate controlled this condition can cause a cardiomyopathy.

[francie12]

I'm looking forward to reading your answer.  On the subject of screening BAV relatives...  Because of my 15 yr old son's BAV, mod/severe AI and dilated asc AO, we had immediate family screened and younger son and husband came up with dilated asc aortas  It can run in families.  There is a convincing study that you can find at The Bicuspid Aortic Foundation's website.  Good luck to your husband.