IS Case 167: Aortic stenosis secondary to bicuspid aortic valve

Chandler Shyu, MD, MPH

Imaging Sciences URMC 2008
Publication Date: 2009-05-21

History

Patient is an 52-year-old male with chest pain.

Findings

Chest radiograph demonstrated a widened superior mediastinum with prominent right paratracheal bulge. Subsequent chest CT revealed an enlarged ascending aorta. Cardiac MR demonstrated bicuspid aortic valve with aortic stenosis and post-stenotic dilatation.

Diagnosis

Aortic stenosis secondary to bicuspid aortic valve

Discussion

Aortic stenosis can be divided into congenital and acquired forms. The most common acquired causes are rheumatic heart disease or degenerative from old age. The congenital forms can be further subdivided into supravalvular, valvular, or subvalvular.

Bicuspid aortic valve shown in this case is an example of valvular etiology of aortic stenosis. Common findings on plain film include left ventricular hypertrophy and post-stenotic aortic root dilatation from turbulent flow. Coarctation is commonly associated with bicuspid aortic valve and can be appreciated on plain film if present.

MRI is the best modality to image the valve itself and is able to evaluate the gradient with phase contrast imaging at the same time. The fish mouth appearance of the aortic valve as shown above is typical.

References

Bogaert J, Dysmarkowski S, Taylor AM. Clinical Cardiac MRI. Springer, 2005:364-366.