Image Question-58
Image Question – What is the Diagnosis?
A. Bicuspid aortic valve
B. Parachute mitral valve
C. Mitral valve prolapse
 D. Aortic regurgitation development
1. What is the most common congenital cardiac anomaly in adults?
Explanation: Bicuspid aortic valve (BAV) is the most common congenital cardiac anomaly in adults, occurring in 1–2% of the population.
2. Bicuspid aortic valve is most commonly associated with which of the following conditions?
Explanation: BAV is frequently associated with coarctation of the aorta and other aortopathies.
3. What murmur is typically heard in patients with bicuspid aortic valve?
Explanation: The classic murmur of BAV is a systolic ejection murmur due to aortic stenosis.
4. What complication is most commonly associated with bicuspid aortic valve in adulthood?
Explanation: Aortic stenosis is the most common complication of BAV in adulthood due to progressive calcification and fibrosis.
5. What is the recommended follow-up imaging modality for patients with known bicuspid aortic valve?
Explanation: TTE is the standard imaging modality to monitor valve function and aortic root dimensions in BAV patients.
6. Which aortic abnormality is commonly seen in patients with bicuspid aortic valve?
Explanation: Aortic root dilation is a common vascular abnormality in patients with BAV due to connective tissue abnormalities.
7. What genetic syndrome is frequently associated with bicuspid aortic valve?
Explanation: Turner syndrome has a high incidence of BAV and coarctation of the aorta.
8. Which of the following best describes the embryological cause of bicuspid aortic valve?
Explanation: BAV results from the failure of normal separation of the aortic valve leaflets during development.
9. What is a late clinical manifestation of untreated bicuspid aortic valve?
Explanation: Without treatment, progressive aortic stenosis or regurgitation from BAV can lead to heart failure in adulthood.
10. What valve dysfunction is also common in BAV patients aside from stenosis?
Explanation: Aortic regurgitation can occur in BAV patients due to leaflet prolapse or root dilation.
11. What is the most common age range when bicuspid aortic valve complications typically manifest?
Explanation: Many BAV complications such as stenosis and regurgitation typically become symptomatic between 30–50 years of age.
12. Which complication of bicuspid aortic valve carries a risk for sudden cardiac death?
Explanation: Aortic dissection can occur in BAV patients with aortic dilation and is a life-threatening emergency.
13. What finding on echocardiogram confirms the presence of a bicuspid aortic valve?
Explanation: The hallmark echo finding in BAV is visualization of only two cusps and commissures in systole.
14. What is the role of MRI in bicuspid aortic valve evaluation?
Explanation: Cardiac MRI is excellent for evaluating the thoracic aorta and for quantifying regurgitant volume.
15. Which of the following is a key feature of BAV-related aortopathy?
Explanation: Medial degeneration leads to weakening of the aortic wall, predisposing BAV patients to dilation and dissection.
16. In bicuspid aortic valve, which leaflet fusion pattern is most common?
Explanation: The most frequent fusion pattern in BAV is between the right and left coronary cusps.
17. Bicuspid aortic valve is best evaluated using which echocardiographic view?
Explanation: The parasternal short-axis view allows visualization of aortic valve leaflets and can show bicuspid morphology.
18. What is the first-line management strategy for an asymptomatic patient with BAV and mild aortic stenosis?
Explanation: Asymptomatic patients with mild disease are monitored with periodic echocardiography to track progression.
19. When is surgical repair indicated in bicuspid aortic valve patients?
Explanation: Surgery is recommended when patients have severe valve dysfunction and symptoms or progressive left ventricular dilation.
20. Which of the following is NOT a typical complication of bicuspid aortic valve?
Explanation: Pulmonary artery stenosis is not typically associated with BAV, unlike aortic valve disease or endocarditis.
| # | Key Point |
|---|---|
| 1 | BAV is the most common congenital cardiac anomaly in adults (1–2% prevalence). |
| 2 | Strongly associated with coarctation of the aorta and aortopathies. |
| 3 | Classic murmur: Ejection systolic murmur at right upper sternal border. |
| 4 | Most common adult complication: Progressive aortic stenosis. |
| 5 | Transthoracic echocardiography (TTE) is the primary imaging for monitoring. |
| 6 | Aortic root dilation frequently accompanies BAV. |
| 7 | Turner syndrome is commonly associated with BAV. |
| 8 | Embryologic cause: Incomplete separation of aortic valve leaflets. |
| 9 | Untreated BAV can lead to adult-onset heart failure. |
| 10 | Aortic regurgitation is a frequent secondary lesion in BAV. |
| 11 | Clinical complications typically present in early adulthood (30–50 years). |
| 12 | Aortic dissection is a life-threatening complication linked with BAV aortopathy. |
| 13 | Parasternal short-axis echocardiographic view confirms bicuspid morphology. |
| 14 | MRI helps evaluate aortic dimensions and regurgitant volume. |
| 15 | Medial degeneration of the aortic wall is a hallmark of BAV-related aortopathy. |
| 16 | Most common cusp fusion: Right and left coronary cusps. |
| 17 | Parasternal short-axis view is ideal for echocardiographic diagnosis. |
| 18 | Asymptomatic mild BAV is managed with regular echo monitoring. |
| 19 | Surgery indicated for symptomatic severe stenosis/regurgitation or LV dysfunction. |
| 20 | Pulmonary artery stenosis is not a typical BAV complication. |
