aortic stenosis

Follow up to previous post about husband (am RN). Year ago (59 yrs) echo showed:  ARoot 3.43 cm ACS 2.06 cm LA 5 cm LVPWs 5.6 ES 3.0; LVPWd 2.06; conclusions:cannot r/o BAV, flow across AV 282 max grad 32 AVA 1.4 cm2; concentric LVH; considerable aortic root/cusp calcification; somewhat limited systolic excursion; mod. AI; stress test "normal" reached 78% max HR, LVEF 48%; calculated EDV 139 ESV 72.      Echo now shows following progression:  AV peak syst. flow 3.4 M/s, max grad. 47 mmHg/mean 28; AVA .9 cm; conc LVH, normal size; cons. AR/Acusp calc. limited sys. excursion consitent w/ calcific AS;moderate AS
and AI; mild MV sclerosis mild regurg. norm EF PMhx:  diabetes II 2nd gallstone pancreatits; long standing HBP well controlled
QUESTIONS: 1.  Internist thinks this is not BAV - what is your think on AS with this much calcification not being BAV - isn't this a young age to have this much progression for normal valve?  My understanding is that often difficult to identify on echo.  Concerned about children being evaluated if BAV 2.  This seems like rapid progression to me - at this time there are no SX; what is your impression. How fast will this continue to progress? 3.  Obviously headed for surgery sooner rather than later - what recommendations/interpretation do you have including what steps to take next.  4.  When would you recommend next echo?  Should a cath be done at some point.      Have been followed by internist but I now feel we need a cardiologist's involvement.               Thank you so much for your time and providing this service.  My hope would be to use Cl. Clinics but we live in E. PA, so we will have to see what husband agrees to.  

[Cleveland Clinic]

1.  I agree with you that this may be due to BAV.  Your kids should be at least examined by a cardiologist.
2.  It seems that he is progressing rapidly, however, as long as there is no symptoms, and he remains active, watchful waiting is the way to go.  Difficult to say how fast this will progress, he's only had two echos,  there is quite a bit of variability.  
3.  When he develops symptoms, surgery becomes indicated,  he will need to have a left heart catheterization to rule out CAD.
4.  6 months but sooner is symptoms develop.
  

[sue1949]

forgot to include:  LV end diastolic 5.6 cm and end systolic now 4.5 cm; Thanks again.