You are incorrect - the best diagnosis in our patient is coarctation of the aorta, bicuspid aortic valve and aortic regurgitation.


Your choice: Coarctation of the aorta, discrete subvalvular aortic stenosis and aortic regurgitation

Discrete subvalvular aortic stenosis usually is caused by a fibrous membrane in the left ventricular outflow tract just proximal to the aortic valve. It does not cause an aortic ejection sound unless the valve is also bicuspid, an unusual association. Significant stenosis causes a longer and louder murmur than is present in our patient. Aortic regurgitation does occur commonly. It does not cause higher systolic pressures in the arms than in the legs.