Fig. 17

Bicurpid aortic valve with moderate aortic insufficiency and focal thickening, likely related to endocarditis. a Diastolic image in short axis of the aortic valve demonstrates incomplete coaptation of the valve leaflets with a regurgitant orifice (*). Just anterior to this regurgitant orifice, there is a focal thickening of the valve, representing a vegetation. b Systolic image in short axis demonstrates a “fish-mouth” opening of the aortic valve with a visible raphe (arrowhead) within the anterior leaflet. This raphe is actually a “pseudoraphe” as it does not open as a normal raphe, but can mimic the appearance of a trileaflet aortic valve on diastolic imaging. The regurgitant orifice in diastole appears to be related to the free edge of this pseudoraphae. c Three-chamber view in diastole demonstrates incomplete coaptation of the aortic valve (black arrowhead), with focal thickening (a vegetation) associated with the free edge of the anterior leaflet