Bicuspid Aortic Valve and Aortic Stenosis

Incidental Finding on CT Chest • Xray of the Week 2016 • Week #34

What is the clinical significance of this finding?

Fig. 1 CT scan demonstrating marked calcification of the aortic valve.

The patient later had an aortic valve replacement.

Fig. 2 Image from intra-operative trans-esophageal cardiac echo on this patient demonstrating aortic valve stenosis with marked calcification.

Bicuspid aortic valve is an uncommon congenital condition, usually due to fusion of 2 of the 3 leaflets of the aortic valve. High pressure across the valve results in calcification. One of the most common causes of aortic stenosis, bicuspid aortic valve may be present in up 2% of the population. [1,2]

Visualization of dense calcification of the aortic valve on imaging studies should prompt the reader to think of bicuspid aortic valve and aortic stenosis. [3] Definitive treatment is aortic valve replacement. Due to dilation of the proximal aorta related to high pressures, aortic root replacement is required in 30% of patients undergoing valve replacement. [4]

References:

1. Ko SM, Song MG, Hwang HK. Bicuspid aortic valve: spectrum of imaging findings at cardiac MDCT and cardiovascular MRI. AJR Am J Roentgenol. 2012;198 (1): 89-97.

2. Spindola-franco H, Fish BG, Dachman A et-al. Recognition of bicuspid aortic valve by plain film calcification. AJR Am J Roentgenol. 1982;139 (5): 867-72.

3. Chen JJ, Manning MA, Frazier AA et-al. CT angiography of the cardiac valves: normal, diseased, and postoperative appearances. Radiographics. 29 (5): 1393-412.

4. Siu SC, Silversides CK. Bicuspid aortic valve disease. J. Am. Coll. Cardiol. 2010;55 (25): 2789-800.

Kevin M. Rice, MD is the president of Global Radiology CME

Dr. Rice serves as the Medical Director of the Radiology Department of Valley Presbyterian Hospital in Los Angeles, California and is a Member of Renaissance Imaging Medical Associates. Dr. Rice has made several media appearances as part of his ongoing commitment to public education. Dr. Rice's passion for state of the art radiology and teaching includes acting as a guest lecturer at UCLA. In 2015 Dr. Rice launched Global Radiology CME to provide innovative radiology education at exciting international destinations, with the world's foremost authorities in their field.

Follow Dr. Rice on Twitter @KevinRiceMD

All posts by Kevin M. Rice, MD