X

B Apical long axis

Diastole

The appearance of the valve in systole is characteristic of this etiology, and has been referred to as a fish-mouth appearance, rather than the triangular appearance of normal valves (Fig. 5; please see companion DVD for corresponding video).

two-dimensional assessment

Important morphological information can be gained from initial two-dimensional (2D) views of the aortic valve. Leaflet restriction in the setting of adequate cardiac output is the hallmark of aortic stenosis, which can be readily discerned in the parasternal long-axis view. Failure of aortic leaflets to open fully with ventricular ejection often signifies some degree of aortic stenosis (Fig. 6; please see companion DVD for corresponding video). Eccentric valve opening visualized in the parasternal long views is a further clue to the presence of a bicuspid aortic valve. Stenotic aortic valves are generally thickened or calcified. This is easily seen on either 2D or M-mode assessment of the valve (Fig. 7).

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