Aortic valve anomalies

Zoom in 2D on the aortic valve. It is thickened and does not open fully. Parasternal short axis view.

Colour box with flow acceleration at the aortic valve opening. The valve does not open fully. 

M-mode in the parasternal long axis at the tip of the mitral valve for assessment of shortening fraction, and signs of LV hypertrophy.

M-mode in the parasternal short axis at the tip of the mitral valve for assessment of shortening fraction, and signs of LV hypertrophy.

Another clip in the parasternal long axis view

One may appreciate the degree of ascending aorta dilation in the suprasternal view

Flow acceleration in the ascending aorta. This is a good angle, in the suprasternal view, to appreciate the peak gradient of the aortic stenosis, because of angle of insonation. 

It is important to rule out any associated hypoplastic aortic arch, coarctation and even distal coarctation. Here the flow is seen in the descending aorta. 

There is some concern when evaluation the PW-Doppler in the Descending Aorta. There is some subjective low velocities in systole, possibly indicating some compromise to the systemic blood flow in the descending aorta. 

Ductus is bidirectional. With some right to left shunting in systole. 

Bidirectional PDA by CW-Doppler. 

It is important to sweep and tilt in order to follow the trajectory of the flow coming out of the LVOT. 

Zoom in the parasternal short axis over the aortic valve area. 

By B-mode, one may appreciate some minimal LV hypertrophy, which is usually quite present in the context of long-standing aortic stenosis. 

Sweep with colour in the parasternal short axis. There is only minimal (if any) LV hypertrophy. 

Apical 4 Chamber with RV focused view. Aortic stenosis may be associated with significant LV systolic and diastolic dysfunction, which may lead to post-capillary pulmonary hypertension and RV dysfunction. As such, it is important to evaluate the biventricular function. 

Apical 4 chamber view, LV Focus. One may see that there is adequate systolic contraction. 

Acceleration at the level of the aortic valve in the 5 chamber view. 

Gradient obtained through the LVOT, estimated at a peak of 81 mmHg. 

TDI at the level of the septum.

TAPSE

The valve is seen now with a larger opening at the peak of systole. 

One may appreciate the leaftlets of the aortic valve by M-Mode.

Colour flow indicating acceleration at aortic valve.

Flow the the ascending aorta with acceleration starting at the level of the valve. This may be appreciated during the sweep and tilting. 

The peak gradient is of 49 mmHg post-dilatation. There is also some degree of aortic insufficiency during diastole. 

Measurement of the aorta (ascending, transverse and isthmus)

Right to left PDA gradient in systole

Parasternal short axis view with a sweep outlining: the aortic valve, the LV and the RV (for subjective appreciation of function) and presence of some septal flattening. 

M-mode at the level of the parasternal long axis. 

Apical 5 chamber view outlining the aortic regurgitation. There is turbulence at the LVOT. 

Another clip of the Apical 5 chamber view outlining the aortic regurgitation. There is turbulence at the LVOT. 

PW-Doppler in the descending aorta, outlining some retrograde flow possibly secondary to the aortic insufficiency. 

Tracing at the LVOT outlining the aortic insufficiency, as well as the LVOT peak gradient of flow during peak of systole (40.83 mmHg). 

PW-Doppler in the descending aorta. This was sampled in the pre-ductal area, outlining that some of the holodiastolic retrograde flow is secondary to the aortic insufficiency (rather than from ductal steal)

PDA diameter

Parasternal short axis view outlining the stenotic aortic valve

There is acceleration of flow (from the coarctation) at the area of the ductus arteriosus, which is restrictive.

Coarctation with small arch at the isthmus. 

Flow acceleration at the level of the isthmus, outlining an area of coarctation.

View of the aortic valve obtained from the subcostal region. 

Partially opening Aortic-valve by M-Mode

Severely reduced LV function with fractional shortening of 15%

Peak systolic gradient through the Aortic valve from the suprasternal notch estimated at 65 mmHg

Peak systolic gradient through the Aortic valve from the apical view estimated at 64 mmHg

dp/dt of LV of 768 mmHg/s (detal T 41.67 msec) - Calculator here. This indicates LV dysfunction (Normal > 1200 mmHg/s)

Mean Aortic Gradient of 33 mmhg during systole (stenosis).

Depressed mild to moderate LV function with EF of 42%.

RV-RA velocity gradient indicating a TR of 37 mmHg (incomplete curve), which is slightly increased and possibly secondary to LV diastolic dysfunction and post-capillary obstruction. 

Global longituinal strain outlining depressed deformation.