Flail aortic valve leaflets: M-mode and two-dimensional echocardiographic manifestations

Four patients with documented flail aortic valve leaflets were studied using M-mode and two-dimensional echocardiography (2-D echo). Two had aortic valve endocarditis, one had endocarditis involving a congenital heart defect, and one had a myxomatous aortic valve. Mitral valve flutter and early mitral valve closure led to the diagnosis of severe aortic insufficiency in three patients. Diastolic aortic valve flutter, considered to be specific for a flail aortic leaflet, was present in three patients. In the fourth patient left ventricular outflow tract (LVOT) echoes were present, but did not distinguish between a flail aortic leaflet and an aortic vegetation. Two-D echo confirmed LVOT echoes in all patients. Discrimination between a flail leaflet and a vegetation(s) without leaflet disruption was accomplished by noting the hinge point of the LVOT diastolic echoes, which was the aortic wall in patients with a flail leaflet.The combination of these M-mode and 2-D echocardiographic findings permitted the diagnosis of a flail aortic leaflet to be made accurately and noninvasively. In two patients surgery was performed without prior cardiac catheterization.