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Congenital vs. Degenerative/Rheumatic aortic stenosis

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Symptom/Finding
Congenital or Degenerative?
2 cusps with a football shaped opening seen on PSAX   Congenital AS (bicuspid)  
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A raphe or underdeveloped cusp may be present.   Congenital AS (bicuspid)  
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Cusps will appear thickened and may exhibit doming   Congenital AS (bicuspid)  
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Post stenotic dilatation of the aortic root and ascending aorta   Both  
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Thickening and calcification of the cusps   Degenerative/rheumatic  
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Decreased excursion of the cusps   Degenerative/rheumatic  
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MAC   Degenerative/rheumatic  
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LVH – long-standing AS   Both  
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LAE due to volume and pressure overload   Degenerative/rheumatic  
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Late stage: LV dilatation, decreased systolic function, LV failure   Degenerative/rheumatic  
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