When would be the appropriate time to refer an asymptomatic young adult with unicuspid AV s/p valvuloplasty during adolescence for AVR following exercise stress TTE findings demonstrating increase in aortic valve mean gradient from 40mmHg to 70mmHg (achieving 15 METS)?   

Great question and the correct answer is: ALWAYS feel free to refer a complex case like this to advanced pedi/ACHD centers. In terms of whether the patient will need or get a prompt AVR… it DEPENDS!First, we need to prove severe aortic stenosis (mean of 70 mmHg seems legit). As is often the c...

In a 30-year career, as a very busy Board-certified general cardiologist and Board-certified adult congenital cardiologist, I have seen patients with profound heart failure due to initially unrecognized aortic stenosis diurese 50 pounds after hospitalization and go on to have AVR with normalization ...