Question regarding the right-sided heart valves ...

[cardio]

Hello,

I'm wondering if you can help solve a debate the is waging amongst some of the staff in the Diagnostic Medical Sonography program at NAIT. While teaching an introduction to Adult Echocardiography course, there has been some "discussion" about the leaflets that are commonly visualized in selected views of 2D echocardiography. I'm hoping that you will address the 2 questions below, and settle the discussions once & for all. Here are the questions:

On the PS-SAX view, at the level of the aortic valve, the leaflet of the pulmonary valve that is most commonly seen is the ____________________ ? I have reviewed 4 different references, and interestingly enough, the structure is identified only as "pulmonary cusp". I'd like to know which pulmonary cusp - right, left or anterior.

On the Right Ventricular Inflow view, the 2 tricuspid leaflets that are seen are the anterior leaflet & the _______________ left? In this instance, a review of several different references has produced contradictory answers. Some references indicate that the 2nd leaflet is the posterior TV leaflet, while others indicate that it is the septal TV leaflet.

Any help or additional thoughts that you can share on these 2 matters would be greatly appreciated.

Sincerely,
Bev Edwards RDMS, RDCS, RN (Assc)

[cardio]

The two tricuspid valve leaflets seen on the inflow view are the anterior and the posterior TV leaflets

The names of the three PV leaflets are the anterior, left posterior and right posterior. The anterior is also known as the infundibular or ventral leaflet. I believe the two leaflets that are seen of the pulmonic valve leaflets (in the parasternal short axis aortic valve level view) are the anterior and the left posterior PV leaflets.

James W. Tam, MD, FRCP(C), FACC
Director of Adult Echocardiography
Chief of Cardiology
Associate Professor of Medicine
University of Manitoba

[cardio]

These are 2 very interesting questions.

1. I agree with James that in the PSAX view the 2 PV cusps are likely
the anterior and L, unless there is significant clockwise rotation of
the heart. The uncertainty arises because there is no internal reference
markers to guide us and the PV is usually cut quite obliquely.

2. In the case of TV there is internal landmark. If the probe
angulatiion is such that the RV inferior wall is seen( no LV in the
image), the 2 leaflets are anterior and posterior. If the angulation is
shallow and LV is still present in the far field, then the leaflets are
anterior and septal. The anterior TV leaflet is the large one and is
invariably seen in most views.

Kwan-Leung Chan, MD FRCPC FACC
University of Ottawa Heart Institute