A curious case of bicuspid aortic valve in adulthood

A 38-year-old man was evaluated for heart palpitations and chest pain diagnosed with atrial fibrillation, left ventricular ejection fraction 30%, and moderate aortic insufficiency. On echocardiographic control, evidence of aortic bicuspid valve and aortic coarctation on the isthmus with dilated epiaortic vessels. Computed tomography angiography confirmed the presence of aortic coarctation of the descending portion of the arch with supply of the thoracic aorta by collateral vessels originating from the brachiocephalic vessels. The patient underwent two surgical procedures, the first to correct the aortic coarctation in left posterior lateral thoracotomy, the second to repair the aortic valve with valvuloplasty. At the remote re-evaluation, the patient presented in good general and compensatory conditions, in stable sinus rhythm and with a left ventricular systolic function at the lower limits. Aortic coarctation accounts for about 8% of all congenital heart diseases, and bicuspid aortic valve is associated with congenital heart disease in 85% of cases. The peculiarity of the case is the type of vessel malformation considered as an aortic "atresia". The late presentation in a patient previously in substantial well-being is also unusual. Finally, the near normalization of cardiac function after surgery is important.