A, Transthoracic echocardiography demonstrates significant dilatation of the aortic root in the left parasternal long-axis diastolic zoomed view (double-headed arrow; see Movie I in the Data Supplement. B, Systolic doming of the conjoined cusp (anterior cusp; arrow; see Movie I in the Data Supplement. C, High left parasternal view of the ascending aorta (Ao) showing progressive tapering of the aortic size from proximal to middle sections (double-headed arrows). D, Left parasternal short-axis diastolic view with zoom showing right (R)–left (L) fusion bicuspid aortic valve with dominant noncoronary cusp (N)/sinus (see Movie II in the Data Supplement. E, Intraoperative photograph with the root already excised shows the conjoined cusp (C) with prominent raphe (arrow). F, The excised bicuspid valve with a thickened conjoined cusp (C) and large, translucent noncoronary cusp (N). LA indicates left atrium; and RVOT, right ventricular outflow tract.