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Bicuspid aortic valve with severe aortic regurgitation

Authors : Dr. Julia Grapsa, Dr. Andreas Kalogeropoulos, Dr. Grigorios Karamasis, Mr. Benjamin F Smith, Mr. David Dawson, Prof. Petros Nihoyannopoulos.

Hammersmith Hospital, Imperial College NHS Trust

Contact : Julia Grapsa - EACVI ambassador for Greece

On behalf of the EACVI club 35 for Greece


52 years old male patient in evaluation after atrial fibrillation diagnosis. An end-diastolic murmur was audible on auscultation and therefore the patient underwent a transthoracic echocardiogram.

Clinical case information

Parasternal long axis view : Left ventricle within normal size and with moderate impairment of systolic function. Right ventricle is normal in size with mild systolic impairment. Left atrium is dilated. The aortic valve is structurally abnormal – the motion of the leaflets raises the suspicion of bicuspid valve .

Parasternal short axis at the level of the aortic valve: the aortic valve is bicuspid with two symmetric leaflets.

Parasternal short axis of the left ventricle at the level of the body of the ventricle (video 3). The left ventricle within normal size with moderate global impairment of systolic function.

Apical 4 chamber view: Moderate global impairment of left ventricular systolic function. The left atrium is dilated. Right ventricle is normal in size with mild systolic impairment. Right atrium is mildly dilated.

Apical 5 chamber view focused on the aortic valve.There is a severe eccentric jet of aortic regurgitation, filling in more than 80% of the left ventricular outflow tract.

Continuous wave assessment of aortic regurgitation : Pressure half time is 169 msec which indicates severe aortic regurgitation.

Apical 4 chamber view :This view has a focus on the right ventricle. There is mild systolic impairment of right ventricular function. Right atrium is dilated.

Tissue Doppler imaging of the right ventricular free wall : It is very useful in identifying the isovolumic contraction and relaxation times of the right ventricle as well as the systolic wave. On this patient the systolic wave is 9 cm/sec which demonstrates impairment of right ventricular systolic function.

Tissue Doppler Imaging of the left ventricular septal wall : The systolic wave is 4 cm/sec which demonstrates significant impairment of the left ventricular systolic function.

Real time 3D echocardiography of the left ventricle. Assessment of left ventricular volumes and ejection fraction. Ejection fraction of the left ventricle is estimated in 40%.


The patient underwent an angiogram which demonstrated an 80% Cx lesion.The degree of biventricular impairement is clearly disproportional to the degree of coronary artery disease.Cardiac MRI failed to demonstrate any fibrosis or any evidence of cardiomyopathy.LV dysfunction was attributed to valve diease.The patient underwent aortic valve replacement + CABG with one graft.