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Echocardiographic evaluation of the aortic valve

Elyse Foster, MD
Section Editor
Warren J Manning, MD
Deputy Editor
Susan B Yeon, MD, JD, FACC


Echocardiography is the most effective means of evaluating the aortic valve in normal and diseased states. For most conditions, transthoracic (surface) echocardiography (TTE) is sufficient. Congenital, degenerative, and inflammatory lesions are readily recognized and their severity graded. In addition, it is standard practice for TTE to be the sole method of serial evaluation of aortic stenosis and aortic regurgitation.

This topic will review echocardiography of the aortic valve. The diagnosis and management of aortic stenosis and aortic regurgitation are discussed separately in individual topic reviews including the following: (See "Clinical manifestations and diagnosis of aortic stenosis in adults" and "Indications for valve replacement in aortic stenosis in adults" and "Medical management of asymptomatic aortic stenosis in adults" and "Medical management of symptomatic aortic stenosis" and "Clinical manifestations and diagnosis of chronic aortic regurgitation in adults" and "Natural history and management of chronic aortic regurgitation in adults".)


Two-dimensional echocardiography — Two-dimensional imaging of the normal aortic valve in the parasternal long axis view demonstrates two leaflets (right and noncoronary) (image 1), while the parasternal short axis demonstrates a symmetrical structure with three uniformly thin leaflets that open equally, forming a circular orifice during most of systole (figure 1). During diastole, the normal leaflets form a three pointed star with a slight thickening or prominence at the central closing point formed by the aortic leaflet nodules, known as the nodules of Arantius. The three aortic valve cusps may also be visualized in a subcostal view.

The aortic valve is composed of three cusps: the left, right, and noncoronary cusps. The left cusp guards the left sinus of Valsalva, with the left main coronary artery arising superior to and midway between the commissures of this cusp. The right cusp guards the right sinus of Valsalva, with the right coronary artery arising anteriorly and superiorly. It is the most anterior cusp and is positioned immediately just posterior to the right ventricular outflow tract. Its most rightward commissure is adjacent to the septal attachment of the tricuspid valve. The noncoronary cusp is located posteromedially, guards the noncoronary sinus of Valsalva, and is adjacent to the interatrial septum.

M-mode echocardiogram — M-mode echocardiography of the aortic valve is performed in conjunction with two-dimensional imaging by targeting the M-mode beam through the aortic leaflets as displayed in the two-dimensional cross sectional view. The M-mode image of a normal aortic valve and root includes a number of distinctive features:

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Literature review current through: Nov 2017. | This topic last updated: Mar 21, 2016.
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