Bicuspid Aortic Valve - Erler Zimmer 3D anatomy Series MP2033

This dissection model highlighting a bicuspid Aortic Valve is part of the exclusive Monash 3D anatomy series, a comprehensive series of human dissections reproduced with ultra-high resolution color 3D printing.

Clinical History.

A 64-year-old woman presented with a history of chest pain for 5 months, associated with dyspnea and wheezing for 4 months. On physical examination, she was dyspnea, with expiratory breathlessness, left-sided crepitations, and signs of right pleural effusion. Heart rate and blood pressure were normal. There was a precordial systolic murmur and a wheezing beat at the apex in the left 5th intercostal space 10 cm from the midline. There was no peripheral edema. The patient died 4 days after admission.

Pathology

The heart was opened to visualize the left ventricle and associated valves. The aortic valve has 2 cusps instead of the usual 3. The valves are otherwise normal except for slight irregular thickening. The aortic origins of the left and right coronary arteries are amply evident, as is the left circumflex coronary artery, seen cut transversely in the atrioventricular groove on the right lower edge of the specimen. Dense pericardial fibrosis and adhesions are present on the posterior side of the specimen, indicative of constrictive pericarditis. The cause of this is not evident from the history. At autopsy, there was ascites, a small shrunken cirrhotic liver, bilateral pleural effusions (R>L), and right lung collapse. The cause of death was cirrhosis of the liver and failure, possibly consequential to the constrictive pericarditis described above. The bicuspid aortic valve was an incidental finding.

Additional Information.

Bicuspid aortic valve is a more common congenital anomaly than widely appreciated as it can remain asymptomatic until late in life. The condition predisposes to the development of calcific aortic stenosis, usually between the 5th and 7th decades of life. They can occur alone or as part of a congenital syndrome, such as tetralogy of Fallot. The latter is a combination of four congenital anomalies, including a ventricular septal defect, pulmonary valve stenosis, misplaced aorta, and right ventricular hypertrophy.
Bicuspid aortic valves have unequal cusp sizes usually due to the fusion of two or three normal cusps. This can lead to increased valve dysfunction. Patients with bicuspid aortic valves are at high risk for aortic dilatation and dissection.
Bicuspid aortic valves are more likely to calcify in old age than tricuspid aortic valves, and this is due to the abnormal motion and turbulence caused by the unequal size of the leaflets.
With increasing age, patients may develop aortic stenosis or aortic regurgitation. When these become severe, symptoms associated with dyspnea and reduced exercise tolerance may develop. This may be the first sign of a bicuspid aortic valve. The diagnosis of bicuspid aortic valves is confirmed by transthoracic echocardiogram.

What advantages does the Monash University anatomical dissection collection offer over plastic models or plastinated human specimens?

• Each body replica has been carefully created from selected patient X-ray data or human cadaver specimens selected by a highly trained team of anatomists at the Monash University Center for Human Anatomy Education to illustrate a range of clinically important areas of anatomy with a quality and fidelity that cannot be achieved with conventional anatomical models-this is real anatomy, not stylized anatomy.
• Each body replica has been rigorously checked by a team of highly trained anatomists at the Center for Human Anatomy Education, Monash University, to ensure the anatomical accuracy of the final product.
• The body replicas are not real human tissue and therefore not subject to any barriers of transportation, import, or use in educational facilities that do not hold an anatomy license. The Monash 3D Anatomy dissection series avoids these and other ethical issues that are raised when dealing with plastinated human remains.