Cross-sectional echocardiographic detection of aortic valve prolapse

Abstract To determine the potential for cross-sectional echocardiography to define aortic valve prolapse, 14 controls with a mean age of 51 ± 10 years (SD) with normal cardiac catheterization were studied by cross-sectional echocardiographic left ventricular longitudinal and short axis views to define normal aortic valve morphology and motion characteristics. Similarly, 112 patients with cross-sectional echocardiographic mitral valve morphology and motion characteristics. In all 14 controls the left ventricular longitudinal view revealed the aortic valve as a faint echo reflector with symmetrical cusps whose closure point as well as the cusp tissue itself did not display any downward (or prolapsing) motion toward the left ventricular outflow tract. In the group of 112 patients with mitral valve prolapse, the aortic valve was successfully imaged for detailed analysis in 77. Sixty of these 77 (78%) had a mean age of 38 ± 18 years (SD) and revealed aortic valve morphology motion characteristics similar to controls. All of the remaining 17 patients (mean age 36 ± 21 years, 11 female) revealed a downward displacement (or prolapse) of the aortic valve during diastole. There was an increased echo reflection from the cusp tissue in 16 of 17 and in six of 17, cusp size was asymmetric, producing eccentricity of the coaptation point. All six of these had three aortic cusps seen on the short axis view. The aortic root size was normal in all controls in the 60 patients with mitral valve prolapse without aortic valve prolapse, whereas six of 17 patients with aortic valve prolapse had aortic rood enlargement. When comparing the group with (N = 17) and without (N = 60) aortic valve prolapse, the tricuspid valve was prolapsed in 16 of 17 compared to 31 of 60 (p = NS), and aortic insufficiency was present in four of 17 compared to none of 60 (p ≤ 0.01). In conclusion, cross-sectional echocardiography can identify a subset of patients with mitral valve prolapse who have aortic valve prolapse in which aortic root dilatation and aortic regurgitation may be encountered. Such patients may reflect a more diffuse myxomatous degeneration of the cardiac skeleton.