PMC5067464_01
Two-dimensional trans-thoracic echocardiography (2D-TTE) with color Doppler and color M mode. Parasternal long axis (PLAX) views in systole (A and B) showing two forward turbulent jets from left ventricular outflow tract (LVOT), one through the bicuspid aortic valve (BAV) into aorta and another through the rent into the sinus of Valsalva aneurysm (SOVA). Slightly dilated coronary sinus was also seen. PLAX views in diastole (C and D) showing two regurgitant jets into LV, one as trivial aortic regurgitation and another from aneurysm to LV through the rent (arrow in A and C). Color M mode through aorta and aneurysm (E) showing two different turbulent jets through them. 2D-TTE in parasternal short axis view (F) showing the BAV with SOVA and its communication with the aortic root (arrowhead in A, C and F showing the opening of SOVA into aorta). AO, aorta; AN, sinus of Valsalva aneurysm (SOVA); LA, left atrium; LV, left ventricle; RA, right atrium.
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Three-dimensional (3D)-TTE with color Doppler showed the thick, stenotic BAV and the ruptured SOVA and two systolic turbulent jets through LVOT (Fig. 2A-D, Supplementary Movies 5 and 6). 3D-TTE clearly demonstrated the proximity of SOVA opening to the aortic cusps, as this was partially closed by the aortic cusp during ventricular systole (Fig. 2A, Supplementary Movie 7).