Abnormalities seen in the great arteries view
Aortic Valve Stenosis
Aortic valve stenosis is a narrowing at the level of the valve. The aortic valve is thickened and does not 'disappear' in systole. The color Doppler demonstrates turbulent flow PW Doppler across the valve shows increased velocity (≥100 cm/sec) in the second trimester. The severity of aortic stenosis varies from mild to severe. This is an evolving lesion which can progress during pregnancy to more severe stenosis or to complete atresia of the aortic valve.
Prevalence
Isolated aortic stenosis is found in about 1 in 10,000 live births.
Other abnormalities
Aortic stenosis is rarely associated with extracardiac and genetic conditions.
Prognosis
If left ventricular function is preserved, balloon valvuloplasty may be performed, either in the neonatal period or later in infancy or even young adulthood with good long-term outcome. In critical aortic stenosis with impaired left ventricular function the treatment is similar to that of hypoplastic left heart syndrome (Fontan circulation) with guarded long-term outcome and curtailed life expectancy.
Videos
Case 1: The four-chamber view of the heart is normal. The great arteries are normally connected and they appear equal in size. However, the aortic valve is thickened (white arrowhead) and does not completely disappear in systole. Colour Doppler shows aliased flow within the ascending aorta and in PW Doppler the velocity is >120 cm/s.
Case 2: This is a case of critical aortic stenosis/atresia. In the four-chamber view of the heart the left ventricle is dilated, hyperechogenic and poorly contracting. The aortic valve is thickened and not opening (red arrowhead). On colour Doppler there is reverse flow in the aortic arch (white arrowhead) and no flow across the mitral valve.
Aortic valve stenosis: case 1
Aortic valve stenosis: case 2