From the Guidelines
Course flutter of aortic valve leaflets seen in the parasternal long axis (PLAX) view on transthoracic echocardiography (TTE) is most commonly caused by aortic regurgitation, as evidenced by the European Association of Cardiovascular Imaging recommendations 1. This finding occurs when blood flows backward from the aorta into the left ventricle during diastole, causing the aortic valve leaflets to vibrate or flutter. The severity of the flutter often correlates with the degree of regurgitation. Aortic regurgitation can result from various conditions including:
- Aortic root dilation
- Bicuspid aortic valve
- Endocarditis
- Rheumatic heart disease
- Hypertension
- Connective tissue disorders like Marfan syndrome
- Degenerative valve disease The coarse nature of the flutter, as opposed to fine flutter, typically suggests more significant regurgitation. When you observe this finding, it's essential to assess the severity of regurgitation using multiple parameters, including regurgitant jet width, pressure half-time, and regurgitant volume, as recommended by the American College of Cardiology/American Heart Association task force on practice guidelines 1. Additionally, evaluation of left ventricular size and function is crucial, as chronic aortic regurgitation can lead to left ventricular dilation and eventual systolic dysfunction if left untreated. It's also important to note that the tricuspid valve can be affected by similar conditions, leading to tricuspid regurgitation, which can be functional in nature and related to tricuspid annular dilation and leaflet tethering 1. However, the primary concern with coarse flutter of the aortic valve leaflets is the underlying aortic regurgitation and its potential impact on left ventricular function.