A sign of calcific stenosis of a congenitally bicuspid aortic valve is:

A sign of calcific stenosis of a congenitally bicuspid aortic valve is:

• A. Larger cusp with a midline raphe
• B. Absence of raphe
• C. Symmetric cusp thickening
• D. Calcification limited to the annulus

Answer: (A)

Calcific stenosis of a congenitally bicuspid aortic valve typically shows an asymmetric valve with a line of fusion known as a raphe. The fusion of two cusps leaves a midline raphe, and this deformity often makes one cusp larger than the other. Calcification tends to localize at or around the raphe due to abnormal stress at the fused commissure, causing stiffness and narrowing of the valve opening. That combination—one enlarged cusp and a midline raphe—is a classic gross sign of bicuspid morphology undergoing calcific degeneration. Absence of a raphe would point toward a true bicuspid without a fusion line, symmetric cusp thickening isn’t characteristic of bicuspid degeneration, and calcification limited to the annulus would suggest a different pattern of valve disease rather than the leaflet/raphe-centered changes typical of bicuspid calcific stenosis.

Calcific stenosis of a congenitally bicuspid aortic valve typically shows an asymmetric valve with a line of fusion known as a raphe. The fusion of two cusps leaves a midline raphe, and this deformity often makes one cusp larger than the other. Calcification tends to localize at or around the raphe due to abnormal stress at the fused commissure, causing stiffness and narrowing of the valve opening. That combination—one enlarged cusp and a midline raphe—is a classic gross sign of bicuspid morphology undergoing calcific degeneration.

Absence of a raphe would point toward a true bicuspid without a fusion line, symmetric cusp thickening isn’t characteristic of bicuspid degeneration, and calcification limited to the annulus would suggest a different pattern of valve disease rather than the leaflet/raphe-centered changes typical of bicuspid calcific stenosis.