The angiographic features of bicuspid and unicommissural aortic stenosis

Abstract

Stenosis of a congenitally bicuspid aortic valve results in a characteristic angiographic appearance: In systole the valve leaflets are domed, and there is a central jet that corresponds to the orifice of the stenotic valve. In diastole the sinuses of Valsalva reflect the morphologic features of the 2 aortic cusps. In contrast, the anatomic derangement of unicommissural aortic stenosis is reflected in an angiogram which can be differentiated from that of bicuspid aortic stenosis. In this case, the stenotic orifice visualized by the jet in systole can be seen in contact with the posterior wall of the aorta; leaflet tissue and valve motion are seen only anteriorly. The diastolic appearance differs from that of the bicuspid valve by the presence of a deep sinus of Valsalva anteriorly and a very shallow posterior sinus, also resulting from the lack of leaflet tissue posteriorly. This differentiation is important since extensive valvulotomy on the unicommissural valve will result in significant aortic regurgitation postoperatively.