PMC10060794_01
Two-dimensional transthoracic echocardiography: (A) A large sac-like aneurysm (white asterisk) located on the left front of the aortic root and communicating with it. (B) The number of aortic cusps could not be confirmed, as they were highly calcified and scattered with vegetation. (C) Aortic valve scattered with vegetations (red arrow) and local leaflets prolapsed (yellow arrow). (D) Aortic valve scattered with vegetation (red arrow) and local leaflet perforated (green arrow). (E) Parasternal long-axis view, color Doppler revealed two main aortic regurgitant jets, indicative of perforation (green arrow) and prolapsus (yellow arrow). (F) Apical five-chamber view, color Doppler revealed two main aortic regurgitant jets, indicative of perforation (green arrow) and prolapsus (yellow arrow). LA, left atrium; LV, left ventricle; RV, right ventricle; AA ascending aorta.
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F1
The results illustrated a large aneurysm with the sac-like structure in the left frontal aortic root and communicated with it (Figure 1A). However, the number of aortic cusps could not be confirmed in the short-axis view, as it was highly calcified and scattered with vegetations, leading to mild stenosis (peak systolic velocity: 2.9 m/s) (Figure 1B). In addition, we identified a local prolapse and perforation of the aortic valve with a moderate regurgitation by multibeam (Figures 1C-F).
Head-to-head comparisons among traditional three-dimensional transthoracic echocardiography (A), TrueVue (B), and TrueVue Glass (C-F) in the evaluation of the aortic root pseudoaneurysm (white asterisk, its neck: white arrow). Different views of pseudoaneurysm in the TrueVue Glass mode: en face (C), dorsal (D), bottom (E), and internal (F) perspective. TrueVue Glass increased the degree of tissue transparency, providing a translucent view, and allowing one to visualize the full view of pseudoaneurysm, as well as its neck. LA, left atrium; LV, left ventricle; RV, right ventricle; AA ascending aorta.
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F2
TrueVue imaging mode. The virtual light source was introduced and placed inside the aneurysm, which transmitted light from the inside out, improving the border definition (Figure 2B). Next, we initiated the Glass mode to obtain a transparent rendering effect for further evaluation (Figures 2C-F).
(A) TrueVue vividly revealed a bicuspid aortic valve. (B) TrueVue clearly showed an echolucent area at the ten o'clock position of the left anterior leaflet, suggesting an area of perforation of 0.24 cm2 (white arrow). (C) TrueVue merged with three-dimensional color Doppler clearly demonstrated the origin of two different aortic regurgitant jets. One originated from the perforation (white arrow), and the other originated from the prolapsus (blue arrow). AV, aortic valve.
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F3
TrueVue imaging mode vividly revealed a bicuspid aortic valve with two leaflets in the left anterior and the right posterior directions, and a straight-line aortic valve closure shape (Figure 3A). The left anterior leaflet prolapsed with a perforation of 0.24 cm2 (Figures 3B,C).