A 40 year old male complained of decrease in exercise tolerance during the last year. He could walk normally, but significant dyspnea occurred when he climbs up the stairs to the 4th floor. The patient had no previous history of any cardiovascular and lung disease. He was on sinus rhythm, 75 beats per minute. Systolic and diastolic murmur was auscultated. After cardiologist’s consultation, the patient was referred to our echo laboratory. Two dimensional (2D) and three dimensional (3D) transthoracic echocardiography (TTE) were performed.
Video 1-1 shows TTE zoomed parasternal long axis view with color
Doppler.
Video 1-2 shows TTE parasternal short-axis view at the level of
aortic valve.
Video 1-3 shows TTE 3-chamber apical view
Video 1-4 shows TTE 4-chamber apical view
Figure 1-5 shows aortic valve systolic flow. Peak systolic velocity -
4.8 m/s, mean gradient – 60 mm Hg.
TTE revealed enlarged left heart chambers: left ventricular (LV) end diastolic volume was 200 ml, left atrial end systolic volume index was 50 ml/m2. Left ventricle ejection fraction (LV EF) was 62%. Aortic valve had 3 leaflets, 3 commissures. The valve leaflets were hyperechogenic, thickened, had limited mobility, commissures were fused(Video 1-2). Peak systolic velocity was 4.8 m/s, mean gradient was 60 mm Hg, valve area opening was 0.9 cm2 (Figure 1-5). Pressure half time (PHT) of aortic regurgitation was 360 ms, aortic regurgitation vena contracta (VC) was 0,6 cm, end-diastolic flow velocity in the descending aorta was 15 cm/s. Mitral valve leaflets were thickened with hockey stick deformity of the anterior leaflet (Video 1-3). Commissural fusion was observed in parasternal short axis view. Mitral valve diastolic flow peak velocity was 2.4 m/s, mean gradient was 14 mm Hg. 3D planimetric mitral valve opening area was 1.2-1.3 cm2
