Pediatric Heart Expert Forum
BAV and latest echo
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BAV and latest echo

I would like to hear your opinion on my son's latest echo as I would like to understand what this means.  He is an 11 year old boy who is 46 kg (101lbs) and 151 cm tall (5'1").  his echo is in cm's.  The interpretation at the top of the echo report reads like this  - Mild left atrail enlargement. Borderline concentric left ventricular hypertropy. LV appears globular. BAV. Doming Aortic valve leaflets. Post stenotic ascending aorta dilatation. Normal left ventricular systolic function. trivial tricuspid valsve insufficiency. There is 1 mmHg tricuspid regurgitation. Normal mitral valve velocity. No mitral valve insufficiency. Normal pulmonic valve velocity. Mild pulmonic valve insufficiency. 23 mmHg peak aortic valve gradient. 9. mmHg mean aortic valve gradient. Moderate aortic valve insufficiency.
Ao root diameter 2.8 cm                                  IVsd 1.1cm
FS:36%                                                         IVSs0.94 cm
EF:66%asc Aorta 3.5 cm                                LVIDd 5.1 cm
Aortic arch 2.8 cm (4.1 cm Z score)                 LVIDs 3.3 cm
Ascending Aorta 3.5 cm (6.7 Z score)              LVPWd0.57cm
Descending aorta 1.6 cm                                lVPWs 1.3 cm
RVDd 2.3 cm                                                 LVOT diam 2.1 cm
PV annu diam 2.3cm                                      RPA diam 1.5 cm
I know some of the measurements are increased from his last echo in particular with the aortic arch and the ascending aorta.  My son is playing hockey 3 hours a week but it is house league with no contact.  He has had 1 episode of feeling SOB in the last 3 months otherwise no complaints.  at the above appointment he also has an exercise stress test that was normal.
Thanks for your time.
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It sounds like your son has a bicuspid aortic valve where the primary abnormality is leakage (moderate aortic regurgitation) with only mild blockage (aortic stenosis).  Although your child's heart function is good, the left ventricle is enlarged (5.1 cm) likely due to the backflow through the aortic valve.  This makes extra work for the heart.  Patients with bicuspid aortic valves routinely have dilation of the aorta, but we usually just track that. If the z-score is > 5, he should not be doing weight lifting or other isometric or contact sports.  You need to talk to your cardiologist regarding how much change there is in the size of the left ventricle over the past couple of years (ie: how the z-scores compare).  If the valve leakage is increasing, he may need medicaton in the form of afterload reduction.  It is good to hear that his exercise performance is normal.
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