The above parasternal short axis images show a bicuspic aortic valve. The commissure is asymmetric and is almost in an anteroposterior direction. There are only two cusps- a larger right one and a smaller left one. The top figure shows the commissure in the closed position of the valve and the bottom figure shows the orifice. It can be seen that the valve orifice is much less compared to that in a normal tricuspid aortic valve. This patient had mild aortic stenosis.

Spontaneous echo contrast/ Dynamic intra cardiac echo

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Parasternal long axis view is seen. Left atrium is enlarged. Mitral valve is rheumatic with anterior mitral leaflet (the upper one) showing hockey stick deformity. A swirling pattern is seen in the left atrium. This is called spontaneous echo contrast (SEC). It is also called dynamic intracardiac echo (DICE). This occurs in conditions of blood stasis and is due to aggregation of cellular components of blood. Here, it occurred in the left atrium due to mitral stenosis and atrial fibrillation. Spontaneous echo contrast in the left atrium is associated with increased risk of thromboembolism and cerebrovascular accident.

Diagnosis- Patent ductus arteriosus (PDA) with vegetations in the pulmonary artery at the point where the jet strikes.

left ventricular endomyocardial fibrosis echocardiogram restrictive cardiomyopathy diastolic dysfunction echo

Parasternal long axis view showing obliteration of apical part of left ventricular cavity.

left ventricular endomyocardial fibrosis echocardiogram restrictive cardiomyopathy diastolic dysfunction echo

Apical four chamber view showing obliteration of left ventricular apex by an echogenic mass suggestive of left ventricular endomyocardial fibrosis.

left ventricular endomyocardial fibrosis echocardiogram restrictive cardiomyopathy diastolic dysfunction echo

Pulse wave Doppler at mitral valve level showing restrictive pattern with E very much more than A.

left ventricular endomyocardial fibrosis echocardiogram restrictive cardiomyopathy diastolic dysfunction echo

Tissue Doppler at the lateral part of the mitral annulus showing E’ much lesser than A’ again indicating diastolic dysfunction.

severe mitral regurgitation echocardiogram

severe mitral regurgitation echocardiogram

Diagnosis- Severe mitral regurgitation.

Comments-

1. Apical four chamber view.
2. Mitral regurgitation jet extending into the pulmonary veins.
3. Pulse wave Doppler from pulmonary vein reveals mitral regurgitation jet.

mitral regurgitation echocardiogram echo echocardiography echocardiographic interesting image

Diagnosis- Moderate mitral regurgitation.

Comments-

1. Parasternal long axis view.
2. Left atrium is dilated (compare with aorta).
3. Left ventricle is dilated (the dots on the left side are in centimeters).
4. Moderate posterior directed mitral regurgitation jet seen.

The mechanism of  mitral regurgitation is clear from the next film taken in systole. This shows incomplete coaptation of the mitral leaflets in systole (absent zona coapta).

supravalvular pulmonary stenosis echocardiogram

supravalvular pulmonary stenosis echocardiogram

Diagnosis- Supravalvular pulmonary stenosis.

Parasternal short axis view at aortic valve level. Shows a membrane with an aperture in the main pulmonary artery distal to the pulmonary valve. Continuous wave Doppler shown two gradients- a lower one across the pulmonary valve and a higher one across the supravalvular membrane.

Ventricular septal defect due to acute myocardial infarction. Apical four chamber view is shown both as 2D and with color flow. The VSD is in the distal interventricular septum. Temporary pacing lead can be seen in the right ventricle in the upper figure.

Right atrial mass atrium thrombus interesting echo echocardiogram echocardiography image cardiac ultra sound

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Apical four chamber echo image showing a large mass in the right atrium attached to the interatrial septum. It turned out to be a thrombus on pathological examination after surgery.