A 52-year-old man presents with exertional syncope. Auscultation reveals a harsh crescendo-decrescendo murmur radiating to the carotids. At surgery, the aortic valve is bicuspid with heavy calcification. Compared with calcific aortic stenosis of a normal tricuspid valve, stenosis of a congenitally bicuspid valve characteristically:
- A Occurs two to three decades earlier in life ✓
- B Is always accompanied by rheumatic commissural fusion
- C Produces pure regurgitation without stenosis
- D Seldom requires surgical intervention
Correct answer: A. Occurs two to three decades earlier in life
Explanation
A bicuspid aortic valve subjects its cusps to abnormal mechanical stresses that accelerate degenerative calcification, producing symptomatic stenosis around ages 50 to 60, whereas stenosis of a normal tricuspid valve typically appears in patients in their seventies and eighties. Bicuspid valves can also become insufficient, and they carry increased risk of ascending aortic dilation, but their hallmark is earlier onset.
Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.
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Written and medically reviewed by the StethoPrep medical team.