Specimen A This is a pathology specimen from a 45-year-old patient with a stenotic congenital bicuspid aortic valve. The valve is still pliable with fibrosis and minor calcium deposits. Note the marked left ventricular hypertrophy, characterized by thickened ventricular walls and a small left ventricular cavity.

Specimen B This is an enlarged view of a pathology specimen from a patient with a stenotic congenital bicuspid aortic valve. The slit-like orifice is characteristic. Note the raphe in the middle of the conjoined cusps. While the two leaflets are of equal size in this specimen, the conjoined cusp is often larger.

Specimen C This is an enlarged view of a pathology specimen from a patient with a heavily calcified and thickened congenital bicuspid aortic valve. With age, fibrosis and calcification typically occur. In older patients, these changes may be engrafted on a normal trileaflet valve.