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Bicuspid Aortic Valve Stenosis and Postaortotomy Calcified Saccular Aortic Aneurysm

A 27-year-old male, who had undergone surgical aortic valvotomy in 1991, presented with breathlessness, chest pain, and palpitations. His chest X-ray revealed two calcified masses adjacent to the ascending aorta (Fig. 1). Echocardiography demonstrated severe aortic stenosis, moderate aortic regurgitation, and dilated ascending aorta. His computerized tomographic (CT) angiogram showed two large saccular aneurysms with the anterior sac measuring 7.7 cm and the posterior one measuring 7.9 cm (Figs. 2A–C), probably arising from the previous aortotomy site. A bicuspid aortic valve (BAV) with severe aortic stenosis (systolic aortic valve area – 0.5 cm2) was also seen. The patient underwent redo surgery during which two saccular aneurysms with calcified walls involving the ascending aorta were confirmed. The aneurysmal sacs were removed subtotally, the aortic valve was excised, and Bentall’s procedure was completed with a 26-mm aortic allograft and a 23-mm St. Jude mechanical valve (St. Jude Medical, Sylmar, CA, USA). The patient made an uneventful recovery. Ascending aortic aneurysm associated with BAV is usually fusiform. Saccular aneurysms are rare. Presence of extensive calcification is also unusual. Previous surgery and altered flow dynamics of aortic stenosis