This is a systolic still-frame of a 2-dimensional parasternal long axis view that clearly shows doming of the aortic valve leaflets, typical of a congenital bicuspid aortic valve.
The left atrium, mitral valve, left ventricle and aortic root are well seen, as are the hypertrophied posterior left ventricular wall and interventricular septum.
In the real-time study that follows, note the doming of the two aortic valve leaflets and that left ventricular function is normal.
Bicuspid short axis
This is a systolic still-frame of a 2-dimensional parasternal short axis view that clearly shows a bicuspid aortic valve that is circular in appearance. The left atrium and aortic root are also well seen.
In the real-time study that follows, note the increase in thickness of the two aortic leaflets, their eccentric motion in systole and their linear position in diastole.
Doppler
This is a still frame of a continuous wave doppler study that demonstrates significant aortic stenosis. The delayed mid-to-late systolic peak is typical, and the markedly increased velocity of the systolic jet is directly related to the severity of the stenosis. The aortic valve area obtained in this study correlates well with that obtained at cardiac catheterization.
In the real-time study that follows, note the patient's heart rate has increased. Note also the characteristic sound that is generated by this procedure in a patient with aortic stenosis.
Elderly AS
Significant aortic stenosis in the elderly patient most often occurs when a normal 3-cusped or trileaflet valve undergoes degeneration associated with fibrosis and calcification. To help understand these changes, an example of a normal study will first be presented.
Normal - long axis
This is a systolic still-frame of a 2-dimensional parasternal long axis view from a patient with a normal trileaflet aortic valve. Only two of the leaflets can be seen in this view and they are clearly open.
The left atrium, left ventricle and aortic root are well seen.
In the real-time study that follows, note the normal motion and position of the aortic leaflets in both systole and diastole.
Calcified - long axis
This is a systolic still-frame of a 2-dimensional parasternal long axis view from an older patient with severe aortic stenosis. It clearly shows a heavily calcified aortic valve.
In this view, the individual leaflets cannot be identified. The left atrium, left ventricle, and aortic root are well seen. In the real-time study that follows, note the virtual absence of motion of the aortic valve leaflets in systole and diastole.
Normal - short axis
This is a systolic still-frame of a 2-dimensional parasternal short axis view from a patient with a normal trileaflet aortic valve.
The triangular appearance of the valve is clearly seen, as are the left atrium and the aortic root.
In the real-time study that follows, note the normal motion and position of the three aortic leaflets in systole and the "y"-like configuration in diastole.
Calcified - short axis
This is a systolic still-frame of a 2-dimensional parasternal short axis view from an older patient with severe aortic stenosis.
It clearly shows the heavily calcified trileaflet aortic valve, and the left atrium and aortic root are well seen.
In the real-time study that follows, note the severely restricted motion of the aortic valve leaflets in systole and their fusion in diastole.
Severity classification
The severity of aortic stenosis can be classified as mild, moderate, or severe using the jet velocity, mean gradient, valve area, and valve area index.