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2012-11-20-10 Bicuspid aortic valve ©Moshe Bronshtein

Bicuspid aortic valve

Moshe Bronshtein, MD
Department Obstetrics Gynecology, Rambam Medical Center, Haifa, 31096 Israel

The normal  aortic valve has 3 cusps which can demonstrated in the short axis view, it has a "Mercedes" sign appearance.  
Video clip 1: Demonstrating the "Mercedes sign"

A bicuspid aortic valve is most commonly a congenital condition of the aortic valve where two of the aortic valvular leaflets fuse during development resulting in a valve that is bicuspid instead of the normal tricuspid configuration. 

Bicuspid aortic valves are the most common cardiac valvular anomaly, occurring in 1- 2% of the general population. it is twice as common in males as in females.

Bicuspid aortic valve is an inheritable condition, the incidence of bicuspid aortic valve can be as high as 10% in families affected with the valve problem. 

Figure 1: The sketch of the bicuspid aortic valve and text of Leonardo da Vinci. In the text, da Vinci describes the optimal geometric properties of the tricuspid aortic valve in comparison to a quadricuspid valve. 

These are 2 cases of early pregnancy with different clues to the anatomical variant in which the diagnosis was suspected in the early stage of pregnancy.

Case 1: 15 weeks, normal low risk pregnancy.

Normal heart with normal sizes of the vessels.

It was not possible to visualize the cusps (technically), however, there was a high flow through the valve-120 cm/sec (figure 2).
Figure 2: High flow through the valve-120 cm/sec 

The outcome was normal newborn with asymptomatic bicuspid aortic valve. 

Case 2: 15 weeks, normal low risk pregnancy. The outcome was normal newborn with bicuspid aortic valve

Video clip 215 weeks, the cusps are in linear orientation in the same fetus.

Video clip 3: in the V connection the diameter of the aorta is smaller than of MPA/ductus. 

The outcome was normal newborn with asymptomatic bicuspid aortic valve. 

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