A 58-year-old man has exertional syncope and a crescendo-decrescendo systolic murmur radiating to the carotids. The aortic valve shows nodular masses of calcium heaped up within the sinuses of Valsalva, with commissural fusion absent. Which underlying condition best explains this valve?
- A Rheumatic fever in childhood
- B Infective endocarditis healed with fibrosis
- C Congenital bicuspid aortic valve ✓
- D Syphilitic aortitis
Correct answer: C. Congenital bicuspid aortic valve
Explanation
Calcific aortic stenosis of a congenitally bicuspid valve typically presents in the fifth to sixth decade, decades earlier than calcific stenosis of a normal three-cusp valve, and produces calcified cusps without fusion of the commissures. Commissural fusion is the hallmark of rheumatic aortic stenosis, healed endocarditis causes leaflet distortion and perforation rather than nodular sinus calcification, and syphilitic aortitis dilates the aortic root causing regurgitation rather than stenosis.
Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.