Severe Aortic Stenosis and Regurgitation in a Young Athletic Doctor With Bicuspid Aortic Valve Managed With On-X® Mechanical Valve Replacement

We present the case of a 28-year-old athletic male physician with asymptomatic bicuspid aortic valve (BAV), diagnosed with severe aortic stenosis (AS) and moderate aortic regurgitation (AR) following self-auscultation prompted by nocturnal palpitations and chest vibrations. Echocardiography and computed tomography (CT) confirmed severe AS (peak gradient 79 mmHg, aortic valve area 0.6 cm²), moderate AR, and left ventricular hypertrophy. Due to an aortic annulus size mismatch, the Ross procedure was deemed unsuitable, and an On-X® (Artivion, Inc., Kennesaw, Georgia, United States) mechanical aortic valve was implanted. Postoperative echocardiography demonstrated a peak gradient of 11 mmHg and an ejection fraction of 55%. The patient was discharged on warfarin, aspirin, statins, beta-blockers, and calcium channel blockers with counseling on anticoagulation management. This case highlights the challenges of managing BAV in young, active patients and the role of mechanical valve replacement when anatomical constraints preclude other options.