Defaults: 1X 2X 3X 4X      
2D Evaluation of the Aortic Valve
Part 1
Education>Expert TEE>Aortic Valve>2D Evaluation of Aortic Valve>1
 
2D Evaluation of the Aortic Valve Apparatus
Number of Cusps
 
Initial 2D evaluation of the aortic valve involves describing the type of valve that is present.  Aortic valves typically have 3 cusps (right, left, and non-coronary), however, unicuspid, bicuspid, and quadricuspid valves can occur.  Unicuspid aortic valves usually have incomplete fusion of all of the leaflets and exhibit aortic stenosis.  Quadricuspid aortic valves have 4 cusps where a single original cusp has split or failed to fuse in utero.  Quadricuspid aortic valves are associated with aortic regurgitation.
Unicuspid Aortic Valve
 
 
script
script
Bicuspid Aortic Valve Quadricuspid Aortic Valve

 

Bicuspid aortic valves can involve the fusion of the right and non-coronary cusps, right and left coronary cusps, and the non-coronary and left cusps.  Bicuspid aortic valves are a congenital disease, however, heavily calcified or sclerosed aortic valves can present functionally as an acquired bicuspid aortic valve.  Bicuspid aortic valves may be associated with ascending aortic dilation.
script
script
LCC/RCC BAV Acquired BAV
Leaflet Motion
 

The aortic valve leaflets can exhibit normal, excessive, restrictive, or a oscillating motion.  Normal leaflet motion occurs when leaflets coaptation occurs at the aortic valve annular plane during diastole and each leaflet extends to become parallel with the the LVOT/Aorta plane during systole.  Excessive leaflet motion is best recognized during diastole when a leaflet moves below the aortic valve annular plane during diastole.   Restricted leaflet motion occurs when the leaflets cannot extend to become parallel to the aorta during systole. 

Leaflets may oscillate or appear to be "flapping" during systole.  Oscillating leaflets indicate leaflets that are caught in a turbulent jet from subaortic stenosis or high velocity ejection of blood.  Excessive leaflet motion is an indication of aortic regurgitation.  Restrictive leaflet motion implies decreased cardiac output, aortic valve sclerosis or aortic valve stenosis.  Aortic valve sclerosis is calcification of the aortic valve leaflets which may cause turbulence (and a murmur) but does not decrease the aortic valve area to the threshold of stenosis. Aortic valve sclerosis has been associated with an increased morbidity and mortality in the elderly.

script
Normal Motion
 
script
script
   
Restricted Motion Excessive Motion
   
script
script
   
Oscillating Leaflets Sclerosis
Previous Page
Next Page
 
 
Instution Info  
User Info  
CME Info  
Help  
User License  
HIPAA  
Privacy Policy  
References   
Calcs   
 
CME Sponsor: University of Nebraska Medical Center - Center for Continuing Education This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education through the joint providership of University of Nebraska Medical Center, Center for Continuing Education and JLS Interactive, LLC.
The University of Nebraska Medical Center, Center for Continuing Education is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

CE Sponsor: American Society of Radiological Technologists (ASRT)This activity is approved by the American Society of Radiologic Technologists (ASRT) as sonography-related continuing education (CE). Credit(s) issued for successful completion of ASRT-approved CE activities are accepted by the American Registry of Diagnostic Medical Sonography, American Registry of Radiological Technologists, Cardiovascular Credentialing International and Canadian Association of Registered Diagnostic Ultrasound Professionals. Contact the applicable registry for additional information / restrictions on their acceptance of ASRT CE credit.
Copyright Statement
© Copyright 2000-2018 JLS Interactive, LLC.
Content from this web site may not be used or reproduced for non-personal or
commercial purposes without express written permission by JLS Interactive, LLC.