Cardiovascular Imaging

Bicuspid aortic valve

a congenital anomaly of the aortic valve consisting of only two fully developed cusps. It is the most common congenital cardiac malformation with an incidence of about 1-2% in the population. Bicuspid valves may become stenotic or regurgitant. While valvular dysfunction can occur in infancy, significant haemodynamic lesions usually ensue in the fourth or fifth decade. It constitutes the most frequent pathology in isolated valvular aortic stenosis. Stenosis occurs through progressive degeneration, fibrosis and calcification of the bicuspid valve. Bicuspid aortic valves are associated with other congenital anomalies especially coarctation of the aorta and aortic arch interruption. Plain radiography may reveal enlargement of the ascending aorta due to eccentric flow even in the absence of a transvalvular pressure gradient.

Plain radiography or fluoroscopy may identify calcification of the aortic valve. Aortography usually displays two cusps with restrictive opening producing the "fish mouth" deformity and a disproportionately large posterior sinus of Valsalva. Two-dimensional echocardiography demonstrates two cusps with variable degree of deformity, stenosis or insufficiency of the valve.

CBH