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Clinical data: The patient is followed-up since birth with diagnosis of mild stenosis of bivalved aortic valve. Remained until two years with aortic transvalvular pressure gradient between 30 and 40 mmHg and without physical limitation. Fatigue with exertion is observed for two years, coinciding with increased aortic transvalvular pressure gradient to 60 mmHg in addition to the evidence of mild left ventricular hypertrophy on echocardiogram (interventricular septum and posterior wall = 12 mm).  Physical examination: Eupneic, acyanotic, normal pulse. Weight: 86 Kg, Height: 180 cm, BP: 120/80 mmHg, HR: 82 bpm, saturation O2 = 96%. Aorta was mildly palpable in suprasternal notch.  In precordium, ictus cordis was not palpable and there were no systolic impulses. Heart sounds were normophonetic and mild systolic murmur was auscultated, +/++ of intensity, rough, on aortic area, furcula, neck vessels and on the left sternal border, with thrill. There was a distinct protosystolic snap across the precordium. Liver was not palpable.

Case 5 / 2014 - 26-year-old Male with Moderate Stenosis of Bivalved Aortic Valve and Dilation of Ascending Aorta