Interactive Case Study Companion

Aortic lumen
Calcific nodules

3 - Heart, bicuspid aortic valve - Gross  
This aortic valve has two uneven cusps. Dense calcific nodules have distorted the cusps of the valve. As in degenerative calcific aortic stenosis (in normal three-cusp valves), the primary process is progressive dystrophic calcification of the dense fibrous tissue of the valve. The process is accelerated in bicuspid valves by the abnormal hemodynamics of the two uneven cusps. Aortic stenosis associated with degenerative changes in bicuspid valves is generally seen in younger patients compared to the usual form of degenerative calcific aortic stenosis. The cusps shown are somewhat thickened by fibrosis, but the commissures of the valve are not fused. Note calcification of the raphe where the third commissure should have formed. A bicuspid aortic valve is found in 1-2% of the population, and thus could be considered the most common form of congenital heart disease, depending on how congenital heart disease is defined. Bicuspid valves are generally not stenotic or symptomatic at birth, but because they are hemodynamically abnormal, they are more prone to calcification and endocarditis. They may have some degree of incompetence.  


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