Background
Subaortic obstruction by a membrane or systolic anterior motion of the mitral valve leaflets is usually suspected in young patients, especially if the anatomy of the aortic valve is not clearly stenotic and unexplained left ventricular hypertrophy exists in the context of high transaortic gradients.
Main body
In certain circumstances, some patients show both aortic and subaortic stenotic lesions of variable severity. Doppler echocardiography can help in grading severity in the case of single-level obstruction but not in patients with multilevel obstruction where the continuity equation is of no value. Three-dimensional (3D) echocardiography allows "en-face" visualization of each level of the aortic valve and subaortic tract; in addition, direct planimetry of the areas can be done using multiplanar reformatting.
Conclusions
Accordingly, 3D echocardiography plays a crucial role in the assessment in patients with multilevel left ventricular outflow tract obstruction as it can accurately delineate the location and size, and severity of the stenosis.
14-years old asymptomatic boy with holosystolic murmur heard over the
lower left sternal border. Zoomed apical 5 chamber view revealed a
perimembranous ventricular septal defect (VSD) which was closed by an
aneurysmal leaflet of the tricuspid valve (TV) (Figure A) .Color Doppler
across the defect showed left to right shunt (Figure B) Short axis view
at the level of the aortic valve showed that VSD was extending from 10
to 11 o’clock . (Figure C). Injection of bubbles showed negative
contrast inside the right ventricle indicating incomplete defect
closure. (Figure D) 3D Transesophageal Echocardiography (TOE) with
zoomed mode showed the entry point from the left ventricular side and
exit point from the right ventricular side.(Figure E) En-face viewing of
the TV from the right ventricular perspective showed an aneurysm-like
pouch formed by the anterior leaflet (Figure F) The left atrial and
ventricular size was normal and the shunt ratio was 1.3 so he was
treated conservatively. Ventricular septal defect is the most common
congenital anomaly.The incidence of spontaneous closure is still
undetermined .Different mechanisms for anatomical closure have been
proposed such as the adherence of the septal leaflet and/or the anterior
leaflet of the tricuspid valve to the margins of the defect forming an
aneurysm-like pouch that maybe mistaken for an aneurysm of the
membranous septum. Echocardiography is the gold standard for evaluation
of the site , size and type of VSD and its relation to the tricuspid
valve. Recently, transcatheter closure is feasible and efficacious in
properly selected patients.
A 57-year-old man presented with exertional dyspnea. An early systolic murmur was heard over the aortic areas 2D and 3D. Echocardiography revealed unicuspid, unicommissural aortic valve (UAV) with a characteristic "teardrop" lateral orifice (Figure 1A) and moderate
BACKGROUND and AIM:Recent data suggested that one third of patients meeting conventional electrocardiographic (ECG) criteria for left bundle branch block (LBBB) may be misdiagnosed and new, stricter, ECG criteria for LBBB have been proposed (Strauss's criteria). Accordingly, we used two-dimensional speckle tracking echocardiography (2DSTE), to compare left ventricular (LV) mechanics in patients with LBBB according to conventional versus Strauss's ECG criteria for LBBB.
57-years old man presented with exertional dyspnea. An early systolic
murmur was heard over the aortic areas 2D and 3D Echocardiography
revealed unicuspid , unicommissural aortic valve (UAV) with a
characteristic “teardrop” lateral orifice (Figure A) and moderate
valve stenosis (3D planimetered aortic valve area (AVA) is 1.1cm2)
(Figure B) Continuous wave Doppler across aortic valve (AV) showed high
peak and mean systolic gradients of 85 and 60mmHg respectively.(Figure
C). 2D /3D Transesophageal Echocardiography (TOE) revealed a subaortic
ridge attached to the posterior annulus (Arrow) (Figure D) Further
En-face viewing of the aortic valve from the left ventricular outflow
tract (LVOT) perspective showed a shelf-like ridge extending from the
commissure to the cusp (Arrow) (Figure E) Zoomed mode of the aortic-
LVOT junction confirmed the presence of the subaortic ridge seen
attached to the posterior aortic annulus near the commissural opening
(Figure F) The patient was referred for surgical consultation ..
Unicupid aortic valve (UAV) is a rare congenital anomaly that has.2
subtypes ; unicomissural and acommissural subtypes. Both can present
with variable degrees of the aortic stenosis (AS) and/or aortic valve
regurgitation (AR).UAV has more early, accelerated and severe valvular
degeneration in addition to smaller orifice in comparison with bicuspid
and tricuspid aortic valve. Echocardiography is the gold standard for
diagnosis and evaluation of the AV morphology and function and the
associated disorders such as ventricular septal defect , aortopathy and
subaortic obstruction.. Surgical aortic valve replacement (AVR) and
repair of the associated anomalies are the most common treatment
modality .
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