A case of isolated bicuspid pulmonary valve

Our case highlights the finding of an abnormal pulmonary valve on 2D echocardiography, confirmed to be of bicuspid morphology with 3D imaging. The use of biplane imaging both in transthoracic and transoesophageal echocardiography and routine use of three-dimensional views particularly in transoesophageal echocardiography are of incremental value in better delineating pulmonary valve anatomy. Learning points: Bicuspid pulmonary valve as an isolated clinical entity is a rare finding in clinical practice with an incidence of about 0.1%. The true prevalence of the condition may be underestimated because of difficulty in visualising the pulmonary valve en-face on standard two-dimensional echocardiography. Trans-oesophageal echocardiography may provide better visualization of the pulmonary valve when transthoracic images are affected by interference from the left lung. Routine use of 3D echocardiography with biplane and zoomed views should be advocated for a full morphological assessment of the pulmonary valve, whether imaging via the transthoracic or transoesophageal approach. Keywords: 2D echocardiography, 2D transoesophageal echocardiography, 3D transoesophageal echocardiography Background Bicuspid pulmonary valve is considered a rare congenital anomaly. Although standard 2D trans-thoracic echocardiography can readily detect pulmonary valve dysfunction, morphological assessment may be limited by the close proximity of the pulmonary valve to the lungs and the inability to view the pulmonary valve en face. Our case report suggests that the finding of an abnormal pulmonary valve on standard transthoracic echocardiography should warrant further interrogation with 3D imaging, ideally with a trans-oesophageal approach. This allows a full morphological assessment of the pulmonary valve increasing the chances of detecting a bicuspid anatomy, which may otherwise be missed.