A raphe between two fused cusps is visible in 50–88% in bicuspid aortic valve (BAV) by transthoracic echocardiogram (TTE) and the presence of raphe, particularly if calcified, is associated with early BAV degeneration and future development of aortic stenosis (AS). We describe two patients with right-left fusion BAV without visible raphe at diagnosis in the 1990s. A 33-year-old man with baseline TTE performed in 1994 (Panel A-left, Supplementary dataSupplementary data online, Video S1) had a ‘normally functioning’ BAV without raphe. Interval TTE in 2001 revealed a visible raphe and TTE 15 years from baseline (2009) revealed a calcified raphe in both systole and diastole (Panel A-right, arrows, Supplementary dataSupplementary data online, Video S2) with mild AS (mean systolic pressure gradient 17 mmHg).

中文翻译：

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二尖瓣主动脉瓣：一种不断发展的结构。

经胸腔超声心动图（TTE）在二尖瓣主动脉瓣（BAV）中可见两个融合的尖瓣之间的缝隙，其中50–88％可见，并且缝隙的存在（尤其是钙化的情况）与早期BAV变性和主动脉瓣狭窄的未来发展有关）。我们在1990年代的诊断中描述了两名患有左右融合BAV且无可见缝隙的患者。一名1994年进行基线TTE训练的33岁男性（面板A左，补充数据，在线补充数据，视频S1）的BAV正常，无裂口。2001年的间隔TTE显示可见缝隙，距基线（2009年）15年的TTE显示收缩压和舒张钙化缝隙（面板A右，箭头，补充数据在线补充数据，视频S2），伴有轻度AS（平均收缩压梯度） 17毫米汞柱）。