From Presyncope to Recovery: Echocardiography-guided Transcatheter Aortic Valve Implantation for Severe Bicuspid Aortic Stenosis

Abstract Bicuspid aortic valve (AV) is the most common congenital cardiac valvular anomaly and often progresses to severe calcific aortic stenosis (AS). Although surgical AV replacement has been the conventional treatment, transcatheter AV implantation (TAVI) is emerging as a viable alternative, especially in patients with high surgical risk or complex anatomy. This case report demonstrates the crucial role of echocardiography in the management of TAVI in a patient with bicuspid AS. A 66-year-old male with a 3-year history of palpitations and recurrent presyncope underwent a comprehensive evaluation for suspected AV disease. Transthoracic echocardiography (TTE) revealed severe bicuspid AS with preserved left ventricular function. Coronary angiography and computed tomography angiography were performed for anatomical and procedural assessment, confirming suitability for TAVI. The procedure was conducted through a transfemoral approach using a 24-mm self-expanding bioprosthetic valve under echocardiographic guidance. TEE provided real-time imaging during valve deployment, while serial TTE was used for postprocedural and follow-up evaluations at 1 and 6 months to assess valve function and complications. This case underscores the central role of echocardiography in the comprehensive management of TAVI for bicuspid AS, from patient selection and intraprocedural guidance to postimplantation monitoring, ultimately optimizing clinical outcomes.