This article investigates a case involving a 74 year old woman with bicuspid aortic valve associated with stenosis. A bicuspid aortic valve is a congenital malformation of the aortic valve. In the past, a bicuspid aortic valve was identified during surgery or necropsy, but now transthoracic and transesophageal echocardiography play a pivotal role in diagnosing this type of valve malformation. On occasion, a transthoracic echocardiogram cannot show the bicuspid nature of the aortic valve, and a transesophageal echocardiography must be performed.