A case of isolated bicuspid pulmonary valve

We present a 73 years old woman who presented with pelvic cancer, ongoing sepsis and presumably a new diastolic murmur. Her transthoracic echocardiogram, as part of a sepsis screen, showed an abnormal pulmonary valve with moderate regurgitation. Trans-oesophageal echocardiography using 3D imaging showed a bicuspid pulmonary valve as the cause for the moderate regurgitation, but with no clear source of infection. Bicuspid pulmonary valve as an isolated clinical entity is a rare finding in clinical practice. Bicuspid pulmonary valves tend to be more commonly associated with other congenital cardiac anomalies. Whereas, the incidence of bicuspid aortic valve is estimated to be about 1-2%, the incidence of bicuspid pulmonary valve is thought to be much lower at around 0.1%. This could be an underestimate due to difficulty in visualising the pulmonary valve en-face on standard two-dimensional echocardiography. The true prevalence of the condition may be uncovered by the routine use of 3D echocardiography.