Fetal echocardiography performed on a late second trimester fetus shows an anomaly. The arrows point to the aortic valve. What’s your diagnosis?
Images courtesy of Jordan Jordanov, MD
Bicuspid aortic valve disease
The aortic valve normally has 3 cusps, which allow the flow of blood from the left ventricle to the aorta. In this case, the fetal aortic valve shows only 2 cusps, or is bicuspid. This gives it the characteristic fish-mouth appearance. This anomaly is generally not detected much later in life, because most persons with this cardiac defect remain asymptomatic until well into adulthood.