Intraoperative Transesophageal Echocardiographic Assessment of Aortic Valve Repair in a Child – What to Look for?

Figure 1. Pre-CPB TEE examination showing the assessment of aortic annulus and aortic valve leaflets. (a). Three-dimensional imaging of the aortic valve in short axis view shows prolapsing left coronary cusp (LCC), elongated right coronary cusp (RCC) and a small and restrictive noncoronary cusp (NCC). (b). Measurement of aortic annulus in the mid-esophageal aortic valve long axis view shows a dilated annulus of 31.3 mm. (c). Mid-esophageal aortic valve long axis view showing prolapse of left coronary cusp (LCC) and severe eccentric aortic regurgitation (AR). Abbreviations: 3D, three dimensional; AV, aortic valve; LAX, long axis; ME, midesophageal; SAX, short axis; TEE, transesophageal echocardiography

Figure 2. Post-CPB TEE examination showing the assessment of aortic annulus and residual aortic regurgitation. (a) Measurement of aortic annulus after AV repair in ME AV long axis view; (b) ME AV long axis view (colour compare) shows less than mild residual aortic regurgitation after the aortic valve repair (red arrow). Abbreviations: AA, aortic annulus; AV, aortic valve; CPB, cardiopulmonary bypass; LAX, long axis; ME, mid esophageal; TEE, transesophageal echocardiography

Figure 3. Post-CPB TEE examination showing the assessment of aortic root dimensions and transvalvular pressure gradients. (a). Measurement of coaptation height (distance of cusp apposition, measured in the diastolic phase) in the ME AV long-axis view; (b). Measurement of the effective height (distance measured from the aortic annulus to the coaptation tip in diastole) in the ME AV LAX view; (c). Post-CPB TEE continuous wave Doppler measurement of the mean gradient across the AV in deep TG long axis view shows a mean gradient of 9 mmHg across the AV. Abbreviations: AV, aortic valve; CPB, cardiopulmonary bypass; LAX, long axis; ME, midesophageal; TEE, transesophageal echocardiography; TG, transgastric

Figure 4. Illustrative diagram showing the mechanism of aortic regurgitation and echocardiographic measurement of aortic root dimensions after aortic valve repair. (a). illustrative sketch showing classification of different mechanisms of aortic regurgitation; (b). Illustrative diagrammatic representation of aortic root showing the measurement of effective height; (c). Illustrative diagram of aortic root showing the measurement of coaptation height