Echocardiographic evaluation of the aortic valve
- Elyse Foster, MD
Elyse Foster, MD
- Professor of Clinical Medicine
- University of California, San Francisco
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".)
ECHOCARDIOGRAPHY OF THE NORMAL AORTIC VALVE
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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- ECHOCARDIOGRAPHY OF THE NORMAL AORTIC VALVE
- Two-dimensional echocardiography
- M-mode echocardiogram
- OBSTRUCTION TO LEFT VENTRICULAR OUTFLOW
- Valvular aortic stenosis
- - M-mode echocardiography
- - Two-dimensional echocardiography
- - Doppler echocardiography
- Peak velocity
- Aortic valve sclerosis
- Fixed subvalvular stenosis
- Supravalvular aortic stenosis
- ECHOCARDIOGRAPHIC DIFFERENTIATION AMONG THE CAUSES OF AORTIC STENOSIS
- Congenital bicuspid aortic valve
- Rheumatic aortic stenosis
- Degenerative aortic stenosis
- ECHOCARDIOGRAPHIC EVALUATION OF THE AORTIC VALVE FOR TRANSCATHETER AORTIC VALVE REPLACEMENT
- AORTIC REGURGITATION
- M-mode echocardiogram
- - Chronic aortic regurgitation
- - Acute aortic regurgitation
- Two-dimensional echocardiography
- Doppler echocardiography
- - Width of the vena contracta
- - Jet width
- - Reversal of aortic flow
- - Continuous wave Doppler
- - Severity of aortic regurgitation
- Echocardiography and the timing of surgery for aortic regurgitation
- ECHOCARDIOGRAPHIC DETERMINATION OF THE ETIOLOGY OF AORTIC REGURGITATION
- Aortic root disease
- - Marfan syndrome
- - Aortic dissection
- - Sinus of Valsalva aneurysm
- Bicuspid aortic valve
- Rheumatic disease
- Subaortic stenosis
- Myxomatous disease
- Aortic valve sclerosis
- Rheumatoid arthritis
- Leaflet fenestrations
- Ventricular septal defect
- SUMMARY AND RECOMMENDATIONS