Left heart: aortic and mitral valves
Aortic valve (valva aortae) is best evaluated in mid-diastole when it is closed. On short-axis reconstructions, three cusps (cusps) are clearly differentiated: left coronary, right coronary, and non-coronary, as well as the commissures and sinuses of Valsalva. Approximately 1–2% of people have a congenital anomaly—a bicuspid valve. In systole, due to fusion of the left and right coronary cusps, it forms a characteristic slit-like orifice, which eventually leads to stenosis or regurgitation.
Mitral valve (valva mitralis) has a saddle-shaped fibrous ring and two leaflets (leaflets): a semi-circular anterior and a rectangular posterior. Chordae tendineae (chordae tendineae) extend from the free edge of the leaflets and attach to two papillary muscles (anterolateral and posteromedial). Normally, upon closure, the leaflets slightly overlap each other, preventing backflow of blood. Optimal visualization is achieved on multiplanar short-axis reconstructions in mid-diastole, as well as in two-, three-, and four-chamber views.
Right heart: pulmonary valve and tricuspid valve
Pulmonary valve (valva trunci pulmonalis) consists of a fibrous ring, three cusps, and three commissures. It is best viewed in the sagittal plane, where the right ventricular outflow tract is clearly visible, or on slices directly in the plane of the valve.
Tricuspid valve (valva tricuspidalis) also consists of three cusps: anterior, superior, and inferior. Due to the fact that these cusps are extremely thin, they are moderately difficult to visualize—significantly worse than the mitral valve. Transverse or four-chamber views are used for their assessment.
Echocardiography (EchoCG) in valve assessment
EchoCG is the method of choice for the primary assessment of hemodynamics and valve function due to its high frame rate (10–33 ms per frame) and absence of radiation exposure. Ultrasound waves with a frequency of 2.0–7.5 MHz are used for the study.
- Anatomy assessment: performed in standard two-dimensional (2D) mode. Synchronization of cine loops with ECG allows tracking of leaflet motion in real time.
- Doppler ultrasound: indispensable for the valve apparatus. Color mapping shows flow direction, and blood flow velocity measurement helps non-invasively calculate pressure gradients.
The key disadvantage of the method is its dependence on acoustic windows. Ultrasound does not pass through air (lungs) or bones and is attenuated by fat. Therefore, in patients with obesity or chronic obstructive pulmonary disease (COPD), visualization quality is reduced. The study is usually performed through standard approaches: left parasternal (in the left lateral position), apical, subcostal, and suprasternal.
Briefly: answers to topical questions
What are the names of the tricuspid valve cusps according to the international anatomical nomenclature?
Sources provide different naming options for the three cusps of the tricuspid valve.
- Anterior cusp (anterior / cuspis anterior) is mentioned in both description variants.
- Superior cusp (superior) is distinguished in one of the sources.
- Inferior cusp (inferior) is distinguished in one of the sources.
- Septal cusp (cuspis septalis) is located closer to the septum.
- Posterior cusp (cuspis posterior) is characterized by a smaller size.
What is the normal opening area of the mitral and aortic valves?
Normal opening area in the sources is provided only for the mitral valve.
- Mitral valve (Mitral Valve) — the opening area in diastole is 4.0–5.0 cm².
- Aortic valve (Aortic Valve) — normal area is not specified, however, a value less than 1.0 cm² is a criterion for severe stenosis.
Which sinuses of Valsalva are distinguished in the aortic root?
In the aortic root, which originates from the upper part of the left ventricle, three sinuses are distinguished.
- Right coronary sinus — the right coronary artery originates from it.
- Left coronary sinus — the left coronary artery originates from it.
- Non-coronary sinus — usually located posterolaterally on the right.
Class and exam questions
During which phase of the cardiac cycle does the CT scanner deliver the maximum radiation dose?
The full dose is delivered in diastole (the resting phase) to visualize the valves and coronary arteries as clearly as possible. In systole, the dose is reduced thanks to ECG modulation algorithms.
Why do the mitral valve leaflets not prolapse into the atrium during systole?
They are held by chordae tendineae—strong fibrous cords that connect the free edges of the leaflets to the papillary muscles of the left ventricle.
Which diagnostic imaging method is preferred when pulmonary embolism (PE) is suspected?
The method of first choice is CT pulmonary angiography. This same method (in the form of aortic CT angiography) is a priority in acute aortic syndromes.
What else to study on this topic
- Cardiac CT ECG dose modulation technique
- CT anatomy and volume rendering of the pulmonary veins
- Doppler ultrasound: assessment of pressure gradients across valves
- Imaging of the normal pericardium and cardiac veins
- Window setting parameters when searching for extracardiac pathology on CT
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