A trans-thoracic echocardiographic window that enables en-face view of the pulmonary valve – A proof of concept pilot study

Echocardiographic evaluation of the pulmonary valve anatomy is more difficult than for other valves. Visualization of the pulmonary valve is usually obtained from the parasternal short and long-axis views at the level of the aortic valve or from a subcostal approach. In these views only one or two leaflets can be simultaneously visualized.

The aim of this study is to evaluate a novel trans thoracic window for better visualization of all leaflets of the pulmonary valve.

Methods:

During a standard and clinically indicated trans thoracic echo study, a few additional echocardiographic views were obtained. The new window is obtained by moving the transducer 2-5 centimeters from its standard parasternal short axis position at the level of the aortic valve towards the left subclavian region. In addition, the transducer is rotated clockwise about 30⁰ with some anterior tilt. This position enables imaging the pulmonary valve en-face. The quality of the imaging was assessed and graded by the investigators.

Results

Studies were performed on 96 patients, 49 (51%) males, age range from 0 to 93 years, median 5 years, weight average 31 Kg. The pulmonary valve imaging quality according to patient`s age are displayed in the table. There was a significant difference (P<0.0001) in imaging quality between patients age ≤ 10 years (n=59) and > 10 years (n=37)

Conclusions:

This pulmonary valve view enables good quality images in newborns and children with lower quality images in older children and adults.

En-face view of a normal pulmonary valve