left parasternal window
parasternal long axis view
parasternal short axis view (aortic valve level)
apical 5-chamber view.
right parasternal window
apical 3-chamber (long axis) view
subcostal short axis view
(Fig. 6.11, p. 55). The subcostal short axis view is seldom used but can visualize the aortic valve in short axis when good views cannot be obtained from the standard locations. The suprasternal window (aorta view) allows Doppler assessment of flow in the descending thoracic aorta, which is useful in aortic regurgitation.
other congenital heart defects in up to half of cases. It can also result from a dynamic obstruction in the LVOT, causing obstruction predominantly in mid-late systole, as in hypertrophic obstructive cardiomyopathy (p. 241). In supravalvular aortic stenosis, which is uncommon, there is a fixed obstruction in the ascending aorta, just above the sinuses of Valsalva, due to a diffuse narrowing or a discrete membrane.
Table 19.1 Clinical features of aortic stenosis
Is it a tricuspid aortic valve, or is it bicuspid (or pseudobicuspid), unicuspid or quadricuspid? If there is cusp fusion, describe which cusps are involved.
Is there any thickening of the cusps? How severe?
Is there any calcification of the cusps? How severe (mild = isolated spots, moderate = larger spots, severe = extensive)? Is this diffuse or focal? If focal, which area of each cusp is affected? Is there calcification in the LVOT or aorta?
Is cusp mobility normal or restricted? Grade any cusp restriction as mild (restricted in basal third only), moderate (affecting basal and middle third) or severe (affecting entire cusp).
Is there any systolic doming of the cusps?
Is there an asymmetric closure line (suggesting a bicuspid valve)?
Is there any evidence of sub- or supravalvular stenosis?
imaging probe and a standalone ‘pencil’ probe. Ignore traces obtained from ectopic beats (and the beat following an ectopic).