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This next case,

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we're gonna look at a typical appearance of a bicuspid aortic valve

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due to fusion of two of the cusps. I'm gonna start in a typical way,

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which is I'm gonna look at the, um, valve in the short axis plane.

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So going off this cornal plane,

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I'm going to place my crosshairs on the middle of the valve and reorient my

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axial plane such that it's parallel to the aortic valve plane.

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And then repeat the process on the sagittal image here.

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And now we get a nice look at the aortic valve.

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You can see already there's a really big calcification in this patient.

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And then as I scroll upward, these images are obtained in diastole.

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You can see that there's this big calcification located right at the junction

0:48

of the right cusp and the left cusp in this patient. Um,

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and it goes all the way top to bottom and there's no separation,

0:57

both two cupps. Now you also wanna check this as a diastolic image,

1:01

so I also wanna check systole to see what this looks like when the valve is

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open. So here I am in systole,

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and actually let's go to an even earlier phase of systa.

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I'm going to the 20% phase and here the 20% phase of

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systole, this is when you should see a valve opening.

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And you can see actually that you have one commissure here and another

1:24

commissure here, and in these two cusps with the commissure,

1:28

but there's no opening between those two commissures. There's this,

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this heavy calcification and you can see that the leaflet itself

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is heavily calcified with the calcification of this ridge here

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between the leaflets, also known as a ra.

1:45

And that basically what you've got is opening in the midline and no opening over

1:50

here, uh, between these two commissures.

1:52

So just this what's known as a fish mount opening,

1:56

which is characteristic o bicuspid valve.

1:59

I'm gonna try to play this so you can see it in a sene imaging.

2:03

Some of these acquisitions are a little grainy because we used, uh,

2:06

dose modulation and lemme just reorient a little higher.

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There we go.

2:13

And I think you can see that there is that sort of characteristic fish mouth

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opening,

2:18

like right about this part right there of the caric cycle.

2:23

You can see it and then the valve moves up and down again. So this is a,

2:28

uh,

2:28

typical appearance of a bicuspid valve with right left fusion and

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a calcified ra. And like we said in the video before,

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this is actually the most common type of bicuspid valve you're gonna encounter.