Schematic of the transthoracic echocardiographic evaluation of fused BAV symmetry in the parasternal short axis. Applicable to similar tomographic views obtained from cardiac computed tomography and cardiac magnetic resonance, the figure demonstrates different commissural angles of the non-fused cusps (applicable to the 3 fused BAV phenotypes, although only right–left cusp fusion is shown) that define symmetry. (Left panel) Symmetrical (angle 160–180°) right–left cusp fusion BAV with raphe, where the 2 functional cusps are almost the same size/shape (the non-fused cusp is a little larger) and the commissural angle of the non-fused cusp is about 170°. (Middle panel) Asymmetrical (angle 140–159°) right–left fusion BAV with a raphe, and the commissural angle of the non-fused cusp is about 150°. (Right panel) Very asymmetrical (angle 120–139°) right–left fusion BAV shows retraction of the conjoined cusp at the raphe area and the commissural angle of the non-fused cusp is about 130°. Note that retraction is more prominent as the angle decreases and that this may cause aortic regurgitation. Modified from Michelena et al. [10] with permission from Elsevier. BAV: bicuspid aortic valve.