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\begin{document}

\title{Unicuspid Unicommisural Aortic Valve in a Septuagenarian}



\author[1]{Sankalp P. Patel}%
\author[1]{Gaston A. Cudemus}%
\author[1]{Elsy V. Navas}%
\author[1]{Robert J. Cubeddu}%
\author[1]{Robert D. Pascotto}%
\author[1]{Stephen E. D’Orazio}%
\author[1]{Brian J. Solomon}%
\affil[1]{NCH Healthcare System}%


\vspace{-1em}



  
  \date{May 21, 2024}


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\selectlanguage{english}
\begin{abstract}
A 75-year-old woman presenting with dyspnea and chest pain underwent
cardiac catheterization revealing three-vessel coronary artery disease
with severe calcific aortic stenosis and dilated aortic root (Figure 1).
A multi-gated acquisition scan (MUGA) was performed revealing LVEF to be
50\%, reassuring consensus to proceed with aortic valve replacement and
concomitant coronary artery bypass grafting. She was brought to the
cardiovascular operating room (CVOR) in stable condition. Routine
cardioplegia ensued after placement on cardiopulmonary bypass and
grafting was performed to the obtuse marginal, posterior descending, and
left anterior descending arteries. Upon successful grafting, attention
shifted to the aorta. A transverse incision was made 2cm above the
annulus, exposing the valve. A severely thickened, unicuspid,
unicommisural aortic valve was observed (Figure 2) and replaced with a
23mm Edwards \selectlanguage{ngerman}\textsuperscript{®} Inspiris \textsuperscript{TM} valve.
Unicuspid unicommisural aortic valves are rare manifestations with a
prevalence of 0.02\% \textsuperscript{1}. They precipitate congenital
aortic stenosis in patients within the first 4th-6th decades of life
\textsuperscript{2}. Outcomes are promising with aortic valve
replacement \textsuperscript{3}. Herein, we showcase this anomaly
manifesting symptomatically in a septuagenarian, with successful
surgical replacement and coronary bypass grafting.%
\end{abstract}\selectlanguage{ngerman}%



\sloppy


\textbf{Unicuspid Unicommisural Aortic Valve in a Septuagenarian}

Sankalp P. Patel D.O.\textsuperscript{1}, Gaston A. Cudemus
M.D.\textsuperscript{1}, Elsy V. Navas M.D.\textsuperscript{1}, Robert
J. Cubeddu M.D.\textsuperscript{1}, Robert D. Pascotto,
M.D.\textsuperscript{1}, Stephen E. D'Orazio M.D.\textsuperscript{1},
Brian J. Solomon M.D.\textsuperscript{1}

Acknowledgements/Disclosures/Funding: None

1. NCH Heart Institute, Naples, FL

A 75-year-old woman presenting with dyspnea and chest pain underwent
cardiac catheterization revealing three-vessel coronary artery disease
with severe calcific aortic stenosis and dilated aortic root (Figure 1).
A multi-gated acquisition scan (MUGA) was performed revealing LVEF to be
50\%, reassuring consensus to proceed with aortic valve replacement and
concomitant coronary artery bypass grafting. She was brought to the
cardiovascular operating room (CVOR) in stable condition. Routine
cardioplegia ensued after placement on cardiopulmonary bypass and
grafting was performed to the obtuse marginal, posterior descending, and
left anterior descending arteries. Upon successful grafting, attention
shifted to the aorta. A transverse incision was made 2cm above the
annulus, exposing the valve. A severely thickened, unicuspid,
unicommisural aortic valve was observed (Figure 2) and replaced with a
23mm Edwards\selectlanguage{ngerman}\textsuperscript{®} Inspiris\textsuperscript{TM} valve.

Unicuspid unicommisural aortic valves are rare manifestations with a
prevalence of 0.02\%\textsuperscript{1}. They precipitate congenital
aortic stenosis in patients within the first 4th-6th decades of
life\textsuperscript{2}. Outcomes are promising with aortic valve
replacement\textsuperscript{3}. Herein, we showcase this anomaly
manifesting symptomatically in a septuagenarian, with successful
surgical replacement and coronary bypass grafting.

\textbf{References:}

\begin{enumerate}
\tightlist
\item
  Novaro G. M., Mishra M., Griffin B. P. Incidence and echocardiographic
  features of congenital unicuspid aortic valve in an adult population.
  J Heart Valve Dis 2003;12(6):674--8.
\item
  Ingason, A.B., Sigfusson, G. \& Torfason, B. Congenital aortic
  stenosis due to unicuspid unicommissural aortic valve: a case
  report.~\emph{J Cardiothorac Surg} ~13,~61 (2018).
  https://doi.org/10.1186/s13019-018-0755-0
\item
  Slostad BD, Witt CM, O'Leary PW, et al. Unicuspid Aortic Valve:
  Demographics, Comorbidities, Echocardiographic Features, and Long-Term
  Outcomes.~\emph{Circulation} . 2019;140(22):1853-1855.
  doi:10.1161/CIRCULATIONAHA.119.041835
\end{enumerate}\selectlanguage{english}
\begin{figure}[H]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/Fig-1/Fig-1}

\end{center}
\end{figure}\selectlanguage{english}
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\includegraphics[width=0.70\columnwidth]{figures/Fig-2/Fig-2}

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\end{figure}

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