On 2D echo, how is the motion of a congenitally stenotic aortic valve typically described?

The motion of a congenitally stenotic aortic valve is typically described as “doming.” This term refers to the characteristic movement of the valve leaflets, which often maintain a dome-like appearance during systole due to their inability to fully open because of the stenosis.

In congenitally stenotic aortic valves, the leaflets may be malformed or fused, leading to limited opening that creates a distinct visual pattern on 2D echocardiography. The doming effect is a result of the pressure gradient across the valve during ventricular contraction, causing the leaflets to bulge upward into the outflow tract.

This specific description helps in differentiating it from other possible valve motions. For example, fluttering might suggest a more chaotic or abnormal motion, typically associated with different valve pathologies. Flat motion could imply poor leaflet function without the characteristic dome, while rapid opening and closing would suggest a more normal function rather than stenosis, as a stenotic valve does not open fully or close rapidly. Understanding these terms and their implications is essential for accurate echocardiographic assessment.