By Pierre Janin
Great case! I’m a junior trainee getting my head around TTE, so am looking forward to more cases!
I’m still struggling with examining the AV/aortic root, including looking at aortic root size etc. Could you comment on what was wrong with the AV on the initial PLA 2D view?
Hi,The aortic valve is normaly a thin, mobile structure, especialy in a young patient. The leaflet are normaly well visualized and move fairly symetricaly in the PLA view. In this case, on the PLA views the AV seems bulky (esp. the anterior leaflet) with an excessive amount of echos (the white cluster on the anterior part of the valve) and reduced mobility (the anerior leaflet is not moving well). Also there is a lot of heterogenous speckles in the colour doppler mode, that suggest possible turbulences (high velocities) and therefore further supporting some valvular abnormality. When looking very carefully, some mobile material is actually seen, attached to the valve (much more obvious in the views presented in the answer video).Many elderly patients will have calcified AV, with or without significant stenosis. Similar hyperechogenic leaflet will be seen in these patients too, but usually with more posterior attenuation, and without any mobile part attached to the valve. In any case, an hyperechogenic and poorly mobile valve in a young patient should raise suspicion.I hope that this helps,Thank you for your comments!P. Janin.
Great teaching case Pierre.
I particularly like the clarification regarding the acoustic attenuation difference between a calcified valve (also usually an older patient) and a ‘something other’ cause, such as a vegetation.
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