Abstract
Congenitally malformed aortic valves are more susceptible to valve injury due to rheumatic fever, mechanical stress of altered flow patterns, atherosclerotic risk factors and degenerative changes. Rheumatic involvement usually occurs in childhood and it is progressive leading to diffuse thickening and fibrosis at leaflet edges and thus differentiated from other patterns of valve damage. Background of this case report revealed the bicuspid nature of the aortic valve due to rheumatic commissural fusion and analysis of echocardiographic parameters in combined lesions of both aortic and mitral valves with severe LV (left ventricular) dysfunction. Left ventricular (LV) and left atrial (LA) dilations predisposing to the formation of smoke (SEC-spontaneous echo contrast) in LV and LA as a consequence of mitral and aortic valve disease are illustrated by 2D echocardiographic imaging in this 41-year-old male.
Highlights
Rheumatic heart disease (RHD) is the long-term consequence of acute rheumatic fever (ARF) and continues unabated in tropical nations
Malformed tricuspid aortic valves with unequally sized cusps and commissural fusion called as “functionally bicuspid valves”, can cause turbulent flow leading to fibrosis and, to calcification and stenosis
There is a propensity for premature fibrosis, stiffening, and calcium deposition resulting in significant stenosis and cusp prolapse, fibrotic retraction, or dilatation of the Sinotubular Junction resulting in Regurgitation in abnormally functioning congenital bicuspid aortic valves as “valvulopathy”
Summary
Rheumatic heart disease (RHD) is the long-term consequence of acute rheumatic fever (ARF) and continues unabated in tropical nations. Less common than mitral valve involvement, disease of the aortic valve is a recognized manifestation of RHD. The nonseptal (posterior) leaflet cusp normally forms from additional conotruncal channel tissue. Abnormalities of this area lead to the development of a bicuspid valve, often through incomplete separation (or fusion) of valve tissue [13]. Rheumatic involvement of aortic valve results in progressive fibrosis of the leaflets with varying degree of commissural fusion, often with retraction of leaflet edges and in certain cases with calcification. The rheumatic aortic valve is often regurgitant and stenotic [22] and a coexistent mitral valve disease is almost always present and so this case had been reported
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