Recognition of bicuspid aortic valve by plain film calcification

Differentiation of bicuspid aortic valve from other causes of calcific aortic stenosis is not possible by echocardiography or, in many cases, by aortography. This report describes newly recognized patterns of calcification on plain films that are diagnostic for a bicuspid aortic valve. These are based on identification of the calcified raphe and/or the calcified conjoint leaflet. In 120 patients who underwent surgical repair of calcific aortic stenosis, 40 were found to have bicuspid valve. Examination of the plain films retrospectively allowed a correct recognition of 26 (65%) of these valves. In contrast, only 10 (25%) could be recognized by aortography. Patterns of calcification on plain films represent an important tool for detection of calcified cogenital bicuspid aortic valve.