Bicuspid aortic stenosis anatomy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Varun Kumar, M.B.B.S. [2]; Usama Talib, BSc, MD [3]


The Bicuspid Aortic Valve has two cusps: one larger than the other. It is considered unobstructive if the edges of the cusps are free. If the edges are fused or no free the aortic valve is considered obstructive developing a dome during systole.[1]


Bicuspid aortic valve have two distinct anatomical configurations:[2]

  1. Antero-posterior orientation of the commissures resulting in right and left cusps. This occurs in approximately 53 percent of cases. The right coronary artery originates from the right cusp and the left coronary from the left cusp. The false raphe is present in right cusp.
  2. 47 percent of patients have commissures on right and left sides of annulus resulting in anterior and posterior cusps. The ostia of both coronary arteries and the false raphe are present in anterior cusp.

There are five varieties of congenitally abnormal aortic valves based on the number and types of cusps and commisures:[3][4][5]

  1. Unicuspid:
    • Acommissural
    • Unicommissural
  2. Bicuspid
  3. Tricuspid:
    • Miniature (small aortic ring)
    • Dysplastic
    • Cuspal inequality
  4. Quadricuspid
  5. Six-cuspid

Here is a bicuspid aortic valve compared with a normal aortic valve:
Bicuspid aortic valve
Normal aortic valve


  1. Gago-Díaz M, Brion M, Gallego P, Calvo F, Robledo-Carmona J, Saura D; et al. (2016). "The genetic component of bicuspid aortic valve and aortic dilation. An exome-wide association study.". J Mol Cell Cardiol. 102: 3–9. PMID 27894865. doi:10.1016/j.yjmcc.2016.11.012. 
  2. Roberts WC (1970). "The congenitally bicuspid aortic valve. A study of 85 autopsy cases". The American Journal of Cardiology. 26 (1): 72–83. PMID 5427836.  Unknown parameter |month= ignored (help);
  3. Hamatani Y, Ishibashi-Ueda H, Nagai T, Sugano Y, Kanzaki H, Yasuda S; et al. (2016). "Pathological Investigation of Congenital Bicuspid Aortic Valve Stenosis, Compared with Atherosclerotic Tricuspid Aortic Valve Stenosis and Congenital Bicuspid Aortic Valve Regurgitation.". PLoS One. 11 (8): e0160208. PMC 4968844Freely accessible. PMID 27479126. doi:10.1371/journal.pone.0160208. 
  4. Kwon HJ, Park JH, Kim SS, Sun BJ, Jin SA, Kim JH; et al. (2016). "Severe Aortic Stenosis Associated with Unicommissural Unicuspid Aortic Valve in a Middle Aged Male.". J Cardiovasc Ultrasound. 24 (3): 247–250. PMC 5050315Freely accessible. PMID 27721957. doi:10.4250/jcu.2016.24.3.247. 
  5. Sangalli F, Formica F, Avalli L, Paolini G (2005). "Quadricuspid aortic valve as a cause of severe aortic regurgitation.". Ital Heart J. 6 (2): 157–9. PMID 15819511.