Abstract
The prevalence of a congenital bicuspid valve (BAV), 1–2 % of the general population, is high enough to warrant attention during auscultation of the heart. BAV occurs as a result of the congenital fusion of the coronary cusps, with the right and left coronary cusps most commonly fused. BAV is most commonly asymptomatic. However, symptoms of BAV are related to the pathologies closely associated with the anomaly, including aortic regurgitation (AR), aortic stenosis (AS), and other aortopathies. An ejection click associated with S1 is most frequently associated with BAVs. In general, clicks that are late, loud, non-varying, and/or apical are likely to be BAV. AR can result and is associated with younger age (less than 40 years of age), while AS is more likely as a patient ages, especially after 50 years of age. To definitively diagnose a BAV, the patient requires an echocardiogram. First degree relatives of an affected individual should be screened for BAV and other thoracic aorta abnormalities.
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Video 6.1
Bicuspid aortic valve showing an ejection click, with a mild (15 mmHg) gradient (Provided by Robin Winkler Doroshow, MD, Medstar Georgetown University Hospital, Washington, DC) (MP4 1141 kb)
Video 6.2
Ejection sound as described by Dr. W. Proctor Harvey (File 305 from Clinical Cardiology by W. Proctor Harvey, MD, MACC, Jules Bedynek, MD, and David Canfield and published by Laennec Publishing Inc., Fairfield, NJ. Used with permission and copyrighted by Laennec Publishing, Inc. All rights reserved) (MP4 3537 kb)
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Johnson, P.C., DeLuca, M. (2015). Bicuspid Aortic Valve. In: Taylor, A. (eds) Learning Cardiac Auscultation. Springer, London. https://doi.org/10.1007/978-1-4471-6738-9_6
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DOI: https://doi.org/10.1007/978-1-4471-6738-9_6
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