Author: Anna Hartzog MD and Chinwe Unegbu MD – Children’s National Hospital


A 16-year-old male with a BMI of 60.1 kg/m2 presents for sleeve gastrectomy. During his preoperative exam, a III/VI systolic ejection murmur is auscultated. He indicates that he has been having chest pain and dyspnea on exertion. A transthoracic echocardiogram demonstrates a bicuspid aortic valve, moderate aortic stenosis, mild aortic insufficiency, mild left ventricular (LV) dysfunction, and a LV ejection fraction (EF) of 52%. What is the STRONGEST indication for aortic valve repair prior to sleeve gastrectomy in this patient?