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Aortic root disease and valve disease associated with ankylosing spondylitis

^a Division of Cardiology, Veterans Affairs Medical Center, and University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA

View larger version (151K): [in a new window]   Figure 1 (A) For illustration, this longitudinal transesophageal echocardiography view in a 46-year-old healthy volunteer demonstrates normal aortic root walls (small arrows), noncoronary cusps (ncc) and right coronary cusps (rcc), aorto-mitral junction (arrow) and normal mobility of the anterior mitral leaflet (aml). LA = left atrium; LV = left ventricle. (B) This transesophageal echocardiography view in a 44-year-old patient demonstrates moderate thickening of the aortic root predominantly of the posterior wall (small arrows) extending to the basal anterior mitral leaflet, forming a subaortic bump (arrows) and markedly decreasing its mobility (elbow sign). Mild mitral regurgitation was demonstrated. (C) This transesophageal echocardiography view of a 47-year-old patient demonstrates marked thickening of the aortic root predominantly of the posterior wall and a prominent subaortic bump (arrow) decreasing the mobility of the anterior mitral leaflet. Small, homogeneously echoreflectant nodularities at the tip of the noncoronary cusp (ncc) and right coronary cusp (rcc) (arrowheads) are also noted. Associated mild aortic and mitral regurgitation was demonstrated.

View larger version (115K): [in a new window]   Figure 2 (A) This preoperative short axis transesophageal echocardiography view of the aortic valve in a 34-year-old patient demonstrates thickening of the aortic root walls (small arrows) and irregular thickening of the three aortic cusp tips (arrowheads). Severe aortic regurgitation with a central jet was demonstrated. (B) This panel demonstrates retracted, rolled noncoronary cusp (ncc) and right coronary cusp (rcc) and irregularly thickened margins of the three aortic cusps (arrowheads). A central regurgitant orifice was confirmed. lcc = left coronary cusp.