A 52-year-old man presents with exertional syncope and a harsh systolic ejection murmur best heard at the right second intercostal space radiating to the carotids. Echocardiography shows a bicuspid aortic valve with severe calcification. Compared with calcific stenosis of a structurally normal tricuspid aortic valve, his condition characteristically:
- A Presents two to three decades earlier in life ✓
- B Is caused by rheumatic commissural fusion
- C Shows vegetations rich in neutrophils
- D Is associated with carcinoid syndrome
Correct answer: A. Presents two to three decades earlier in life
Explanation
Congenital bicuspid aortic valves develop calcific degeneration and clinically significant stenosis typically in the fifth to sixth decade, whereas calcific stenosis of a normal trileaflet valve usually presents after 70 years of age. The histology is identical in both, showing heaped-up calcium nodules within cusps. Rheumatic aortic stenosis features commissural fusion and is almost always accompanied by mitral involvement, ruling out B.
Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.
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Written and medically reviewed by the StethoPrep medical team.