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Figure 2 Incomplete leaflet closure is characterized by a persistent diastolic orifice that is best visualized in the short-axis view of the aortic leaflets, usually obtained at approximately 45° by multiplane TEE. It is important to find the short-axis plane in which the diastolic orifice appears smallest so as to avoid overestimation of the size of the persistent diastolic orifice. The top panel shows the short-axis view of the aortic valve leaflets in systole; the bottom panel shows the persistent valve orifice in diastole. It should be noted that a persistent diastolic orifice can be visualized in the long-axis view when it is optimally aligned. However, off-axis views in the longitudinal plane can falsely create the appearance of incomplete leaflet closure. We therefore recommend the more reliable short-axis view.
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