The normal aortic valve, as shown in the drawing, has three leaflets (flaps, cusps) that move flexibly, opening and closing to control the flow of blood into the aorta from the left ventricle of the heart as it beats. When the cusps come together as the valve closes, the shape is that of a trisected circle.
In contrast, a BAV has only two leaflets, also shown in the diagram on the left. It is sometimes described as resembling the mouth of a fish as it opens and closes. Depending on the degree of malformation and associated malfunction, blood flowing through the valve may make an abnormal sound, called a murmur. While some bicuspid aortic valves are silent, the detection of a murmur may be the first indication of abnormality of the aortic valve. Over time a bicuspid valve may lose its ability to open widely, close properly or both.
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