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Old 05-31-2011
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Heart Diagnose this valvular heart disease!

A 17 year old patient has come to your office with HTN. his right arm BP was 170/110 mmHg with diminished and delayed both femoral arteries pulse. which valvular abnormalities below is the most probable cause?
C. bicuspid aortic valve
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Old 05-31-2011
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this patient has coarctation of aorta and more than 2/3 cases have bicuspid aortic valve
so the answer is C
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Old 05-31-2011
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Yes. Bicuspid aortic valve indeed.

Here are some useful associations from emedicine-

  • Associated cardiac defects
    • These are observed in approximately 50% of patients with coarctation.
    • The most commonly reported defects are left-sided obstructive or hypoplastic defects and ventricular septal defects. Bicuspid aortic valve is observed in 85% of patients. Also, aortic arch hypoplasia is commonly found in coarctation associated with intracardiac defects.
    • Right-sided cardiac obstructive lesions, such as pulmonary stenosis, pulmonary atresia, or tetralogy of Fallot, are observed rarely.
  • Extracardiac vascular anomalies
    • These commonly occur in patients with coarctation. A right subclavian artery that arises aberrantly from the descending aorta distal to the coarctation occurs in 5% of patients. Rarely, both subclavian arteries originate distal to the coarctation.
    • Berry aneurysms of the circle of Willis occur in 3-5% of patients and may result in subarachnoid bleed.
    • After years of coarctation, large collateral arteries develop from the upper to lower body (ie, internal mammaries connecting to external iliac arteries and spinal and intercostal arteries connecting to the descending aorta).
    • Hemangiomas also have been reported with coarctation.
  • Extracardiac nonvascular anomalies
    • Extracardiac nonvascular anomalies occur in 25% of patients with coarctation of the aorta. Coarctation of the aorta occurs in 35% of patients with Turner syndrome.
    • Abnormalities of the musculoskeletal system, genitourinary system, gastrointestinal system, or respiratory system may be observed in as many as 25% of children with coarctation. In addition, an increasing number of children have head and neck abnormalities observed by ultrasonography.
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Cardiology-, Internal-Medicine-, Step-2-Questions

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