ABSTRACT
Describe the valve in detail. Look at the number of cusps, pattern of thickening and mobility on zoomed views. These may give a clue to the aetiology (Table 7.1 A bicuspid aortic valve may only be obvious in systole (Figure 7.1). Clues to the aetiology in aortic stenosis
Systolic bowing
Closure line
Associated features
Calcific disease
No
Central
Calcification of mitral annulus or aorta
Bicuspid
Yes
Eccentric
Ascending aortic dilatation, coarctation
Rheumatic
Yes
Central
Mitral involvement
Bicuspid aortic valve in systole and diastole.In diastole (a) the valve may look tricuspid if there is only mild fusion and no raphe. Only in systole (b) with the valve open will it be obvious that two cusps are partly fused. The fusion may affect only a small length of the cusp edge adjacent to the commissure.
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