Complex and multilevel left ventricular outflow tract obstruction: What can 3D echocardiography add?

Figures

• 

  Fig. 1. 2D TTE imaging sequence for the aortic–subaortic complex

• 

  Fig. 2. 2D TOE imaging sequence for the aortic–subaortic complex

• 

  Fig. 3. X-plane-derived aortic valve area

• 

  Fig. 4. X-plane-derived aortic valve area (panel A) and subaortic area at the level of the subaortic membrane (panel B)

• 

  Fig. 5. 3D zoomed mode, "en-face" view of the aortic valve (panel A) and subaortic membrane from the ascending aorta perspective (panel B) and subaortic membrane from LV apex (panel C)

• 

  Fig. 6. Multiplanar reformatting (MPR) of the 3D volume of the aortic valve. (panel A) Direct planimetry of the narrowest AV orifice was obtained (Panel B)

• 

  Fig. 7. Multiplanar reformatting (MPR) of the 3D volume of a subaortic membrane. (panel A) Maximum diameters and planimetered area of the LVOT at the subaortic membrane (Panel B, C)

• 

  Fig. 8. A case of rheumatic aortic valve disease. 2D TOE (aortic long- and short-axis views) shows reduced excursion of the cusps with characteristic doming. X-plane mode of the aortic valve at the level of its tips to get the true anatomical orifice. Multiplanar reformatting (MPR) of the 3D volume of the aortic valve and LVOT; accurate planimetered AVA and the anteroposterior and mediolateral diameters of the aortic annulus

• 

  Fig. 9. A case of rheumatic mitral and aortic valve diseases. In the upper panel, severe mitral valve stenosis was found; mean diastolic gradient = 15 mmHg .3D zoomed volume shows the characteristic "en-face" view of the thickened leaflets and commissural fusion. MVA was traced using MPR as 0.9 cm2. In the middle panel, a 2D parasternal long-axis view of the aortic valve shows systolic doming of the cusps. The apical 5-chamber view shows aortic valve regurgitation. In the lower panel, 3D-zoomed volume of the aortic valve shows thickened cusps and fused commissure between right and non-coronary cusps. X-plane mode and MPR-derived AVA are 0.9 cm2

• 

  Fig. 10. A right upper and middle panels, parasternal long-axis view, and M-mode show left ventricular hypertrophy and systolic anterior motion of the mitral valve. 2D TOE (left upper and right lower and middle panels) shows a subaortic membrane and aortic valve regurgitation. In the left lower panel, high peak and mean transaortic gradients

• 

  Fig. 11. Right upper panel, X-plane mode of the aortic valve, the anatomical orifice of the aortic valve is seen in the perpendicular image. Left upper panel, X-plane mode of the subaortic membrane (moving the reference line slightly to the right), the functional opening of the LVOT at the level of the subaortic membrane is clearly seen. Right lower panel, 3D-zoomed volume of the aortic valve from the ascending aorta perspective shows the trileaflet valve with thickened cusps. Left lower panel, 3D-zoomed volume (after cropping of the aortic valve plane) shows a circumferential muscular membrane with a circular opening

• 

  Fig. 12. Upper panels, multiplanar reformatting (MPR)-derived diameters and area of the LVOT at the level of the subaortic membrane. (10 X 12 mm and 1.1 cm2, respectively) Lower panels, multiplanar reformatting (MPR)-derived aortic valve area (mid-systolic and at the tips) is 3.1 cm2