Answers:

1. Differential diagnosis:

a. Aortic stenosis, hypertrophic cardiomyopathy and hypertensive cardiac disease.

2. Figure 1 shows:

a. The valve cusps are markedly thickened and distorted with nodular calcification.

3. Figure 2 shows:

a. Cusps not leaflets, therefore it is an atrioventricular valve, and the finding of left ventricular hypertrophy would indicate it was the aortic rather than pulmonic valve.  The diagnosis is Aortic stenosis

b. Congenitally bicuspid aortic valve (normal aortic valve has three valve cusps vs. two seen in this case):

1. in these abnormal valves, earlier degenerative changes occur with an earlier presentation clinically compared with degenerative calcific aortic stenosis.

2. Rheumatic valve disease would show fusion of the cusps, which congenitally bicuspid or age related degenerative aortic stenosis does not usually show.

WebPath Case Review:

• Aortic valve, bicuspid, gross

• Aortic valve, senile calcific aortic stenosis, gross

See a similar case at http://www.telepathology.com/cases/forum/case3.htm

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