Severe Asymptomatic Unicuspid Aortic Stenosis, Myocardial Fi
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A 39-year-old man collapsed while participating in a running event. Advanced life support was administered along with two electrical cardioversions for ventricular fibrillation. Medical history was relevant for severe asymptomatic bicuspid aortic valve stenosis. Results of a treadmill test 1 year prior were normal and the patient had remained free of symptoms until the acute presentation. Following his sudden death episode, coronary angiography showed normal arteries. On a transesophageal long-axis view of the aortic valve, the coaptation line appeared eccentric, with a hypermobile leaflet posteriorly and heavy calcification and restriction anteriorly. Prolapse of the belly of the cusp in the left ventricular (LV) outflow tract was also apparent. Color Doppler showed a turbulent aortic jet with trivial aortic regurgitation. On a short-axis view, there was a single commissure between the left and noncoronary cusps, a posteriorly located orifice, two visible anterior raphes, and heavy leaflet calcification. These findings were diagnostic for unicuspid aortic valve....

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