Progression to Critical Stenosis in an Unmonitored Bicuspid Aortic Valve: Case Report

Bicuspid aortic valve (BAV) is the most common congenital heart defect, but it can remain undiagnosed until adulthood. This case study concerns a 36-year-old male who underwent a transthoracic echocardiogram (TTE) to evaluate systolic murmur, without any symptoms. The patient vaguely recalled a diagnosis of BAV in his childhood but had not received any cardiac evaluation for over 2 decades. He had no documentation of an underlying diagnosis in his medical record. Echocardiography confirmed a BAV with cusp fusion and revealed critical aortic stenosis, moderate aortic regurgitation, mild dilation of the ascending aorta, and severe left ventricular hypertrophy. The severity of these diagnostic findings in an otherwise asymptomatic patient underscores the silent progression of BAV, when left unmonitored. This case study illustrates the consequences of inadequate surveillance and poor medical record continuity. It reinforces the critical role of echocardiography in detecting structural valve abnormalities and the importance of accurate documentation and routine surveillance to enable earlier detection and management of complications.