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Systole PSAX

Fig. 5. Bicuspid aortic valves may have a visible raphe—the fusion ridge of two aortic leaflets. The aortic orifice often exhibits an ovoid or "fish mouth" appearance during systole. PSAX, parasternal short axis view. (Please see companion DVD for corresponding video.)

Fig. 5. Bicuspid aortic valves may have a visible raphe—the fusion ridge of two aortic leaflets. The aortic orifice often exhibits an ovoid or "fish mouth" appearance during systole. PSAX, parasternal short axis view. (Please see companion DVD for corresponding video.)

Lvot Diameter Plax
Cardiac Ultrasound Laboratory. Massachusetts General Hospita Fig. 6. (A) Left ventricle dimensions (parasternal long-axis [PLAX] measurements). (B) Dimensions of the aorta (PLAX measurements).
Mmode Bicuspid Aortic Valve
Fig. 7. M-mode showing premature diastolic closure of the mitral valve—a reflection of the hemodynamic impact of aortic regurgitation on the left ventricle. Other M-mode signs include anterior mitral valve leaflet fluttering (and less commonly, septal diastolic fluttering).
Aortic Regurgitation Jet Width
Fig. 8. Ratio of the aortic jet width (diameter) to left ventricular outflow tract (LVOT) diameter. The diameter of the color jet is measured immediately beneath the aortic valve is a semi-quantitative index of aortic regurgitation severity.

width is not related to the degree of regurgitation. The ratio of jet diameter to left ventricular outflow tract diameter can be calculated (Fig. 9). This ratio can provide a semi-quantitative estimate of the degree of regurgitation: less than 10%, trace; 10-24%, mild; 25-65%, moderate; and greater than 65%, severe.

Measurement of the vena contracta—the regurgitant jet as it traverses the aortic orifice or the effective regurgitant area—can also be used to estimate aortic regurgitant severity. Using a Nyquist limit of 50-60 cm/s, a vena contracta width of less than 0.3 cm correlates with mild aortic regurgitation. A vena contracta width of 0.3-0.6 cm is

Vena Contracta Width (mm)

Color Flow Velocity Scale

Right ventricle^

Color Flow Velocity Scale

Right ventricle^

Vena Contracta

Aortic regurgitant jet

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