echocardiogram of aortic valve

1. ECHO MEET
AORTIC VALVE & ROOT ANATOMY

2. INTRODUCTION
 located at the junction of LV outflow tract and ascending Aorta.
 annulus, cusp and commissure
 3 cusp –
 anterior wall(right coronary cusp)
 posterior wall(left and posterior cusp)
 Cusp - fold of endocardium with central fibrous core.
 Each cusp
 thick basal border
 deeply concave on its aortic aspects and horizontal free margins.

3.  Behind each cusp aortic wall bulges to form aortic sinus of valsava.
 Coronary arteries arise form the sinus
 Commisures - tall peacked space between the attachment of
adjacent cusp and attain the level of aortic sinotubular junction


4. •
Aortic Root - Anatomy

5. 
Histology:
fibrous continuity with the anterior
leaflet of the mitral valve and the
membranous septum;
connective tissue (fibrous strands)
unites the aortic root to the
interventricular septum.

6. They are attached to the aortic root in a semilunar fashion
Valve Leaflets
triangular space underneath the leaflet (trigone) is
part of the left ventricle.
highest point of the trigone where the leaflets meet
=commissure
commissures are localised immediately below the
Sinotubular Junction.
2 trigones underneath the commissures of the
noncoronary leaflet are fibrous structures
other underneath the commissure between the right
and the left leaflets is mostly a muscular structure.

7. Sinuses of Valsalva
leaflet proximally
sinotubular junction distally
3 elliptical inlets
• Guaranteeing coronary artery
perfusion during systole
• Creating eddies to close the
aortic leaflets during diastole

8. terminal edge of the aortic root
imaginary line that connects together the 3 commissures.
Young
adults
AA>STJ
Adults
AA =
STJ
Elderly
AA<STJ
BASE = Aortic Annulus (AA)
Sinotubular Junction

9. Anatomic and Echocardiographic Relationship
Between the Components of the Normal Aortic Root
Systole
Diastole
120 degree - LAX
ST junctionAnnulus
Tubular aortaSinuses

10. TRANSTHORASIC
ECHOCARDIOGRAPHY

11. PARASTERNAL LONGAXIS (PLAX )

12.  linear thin lines, parallel and close to the walls of the aortic root .
 right cusp lies anteriorly
 either non-coronary or left coronary leaflets =posteriorly
 cusp coaptation occurs at a level corresponding to the middle of
the sinuses of Valsalva, i.e. halfway between the ventriculo-aortic
junction and the sinotubular junction.
 measurements of the left ventricular outflow tract/aortic annulus
 aortic root diameters at various levels

13.  antero-posterior diameter of the aortic annulus hinge points
of the aortic valve cusps (inner edge - inner edge) during
mid-systole when the annulus reaches its largest size.
 aortic root diameter at the level of Valsalva sinuses
=largest, followed by the sinotubular junction and the aortic
annulus.

18. PARASTERNAL SHORT AXIS

19.  en face as seen from the left ventricle
 three cusps open symmetrically and form a circular or triangular
orifice during systole
 during diastole=Y” sign with equal space between the 3 commissures.
 number of cusps
 integrity of cusps and commissures
 normal origin of coronary arteries
 bicuspid and a tricuspid aortic valve =during systole, since a raphe
between 2 fused cusps of a bicuspid valve is indistinguishable from a
normal commissure of a tricuspid valve when the valve is closed
during diastole.

27. M MODE

31. APICAL VIEW

33. DOPPLER STUDY

35. SUB COSTAL VEIW

37. TRANS OESOPHAGEAL VEIW

38.  detailed assessment is required (surgical or procedural
planning, suspected infective endocarditis etc),
 long- and short-axis transoesophageal views
 more precise measurements of aortic annulus

40. 3D ECHOCARDIOGRAPHY

41.  3D =short-axis views
 en face not only from the left ventricle, but also from the aortic
root or any desired unconventional orientation.
 valve morphology and cusp number, since the commissures are
oriented upwards .

42.  en face visualization of left ventricular outflow tract/aortic
annulus

45. THANK YOU