Tricuspid aortic valve with partial commissural fusion - Preliminary report of an apparently common cause of aortic ejection sounds with potential for serious sequelae, illustrated by two cases

We report the cases of 2 patients whose tricuspid aortic valves were found to have partial commissural fusion. Both patients experienced complications that were probably related to this abnormality: bacterial endocarditis in I instance and a lacunar stroke in the other. In order to illustrate the si milarity of physical findings, we also describe the case of a 3rd patient, who had a typical bicuspid aortic valve. Tricuspid aortic valve with partia l commissural fusion has been described in autopsy series and has been pred icted to cause an ejection sound, but we could find no previously published description of this lesion in living patients. We wish to alert others to the possible presence of aortic commissural fusi on, to its potential for serious and likely preventable sequelae, and to th e ability of carefully performed transthoracic high-resolution digital echo cardiography to demonstrate this condition when its characteristics are fou nd on physical examination.