Analyze This Image: Clinical Findings Correlation

Ronald H Wharton, MD

Disclosures

July 25, 2016

Explanation:

The M-mode through the aortic valve (Figure 2) demonstrates that the closure of the leaflets during diastole is far from the center of the aorta. This is a common M-mode finding of a bicuspid aortic valve, one of the clinical correlates of which is a systolic ejection click.

The M-mode through the mitral valve (Figure 1) demonstrates diastolic fluttering of the anterior mitral leaflet. This is a qualitative sign of aortic regurgitation, as the regurgitant jet hits the anterior mitral leaflet. This is the echocardiographic correlate of the "Austin Flint" murmur. Notice that the LV systolic function is normal, yet the anterior mitral leaflet never makes it close to the septum during diastole (the E-point septal separation is abnormal because the excursion of the anterior mitral leaflet is impaired).

The parasternal short-axis image with color (Figure 4) demonstrates severe aortic regurgitation.

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Figure 4

What's the other important finding? Look again closely at the parasternal long-axis window (Figure 3).

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Figure 3

Do you notice how small the descending thoracic aorta is? This is because there is a coarctation of the aorta, which can be found in some patients who have a bicuspid aortic valve (and can lead to claudication). Note the pulsed-wave (PW) Doppler of the abdominal aorta (Figure 5), showing the characteristic flow that persists throughout diastole.

Figure 5

Also shown are suprasternal images (2D and color, Figures 6 and 7) of the descending thoracic aorta, as its caliber drastically tapers.

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Figure 6

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Figure 7

The only choice that could not be accounted for would be heart failure given that the left atrial size is normal; in the absence of an acute process, elevated left-sided filling pressures would be very unlikely.

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