Two-dimensional transthoracic echocardiogram (2D TTE) and M-mode echocardiographic images along with a phonocardiogram of the normal aortic root from the parasternal short axis position

Panel A shows the short axis view from a two-dimensional echocardiogram recorded at the base of the heart at the level of the aortic valve; the line (M) bisecting the aortic valve represents the plane of the M-mode beam used to generate the M-mode echocardiogram in panel B. The aortic valve opens nearly to the aortic (Ao) walls (panel B) and while opened it has a box-like configuration. The line marks the peak of the R wave on the ECG. There is a brisk anterior systolic motion of the entire Ao root and even faster earlier diastolic relaxation (posterior motion); the posterior movement of the aortic root occurs predominantly in early diastole with very little movement in late diastole. This pattern occurs in young healthy hearts that rely predominantly on early relaxation for filling rather than atrial contraction. The M-mode echocardiogram with simultaneous phonocardiogram is seen in panel C. The vibrations on the posterior moving noncoronary aortic leaflet (down arrows) are similar in timing and frequency with the low intensity, early systolic "innocent" murmur recorded on the phonocardiogram (up arrows). These vibrations are common in normal valves with normal or elevated cardiac output.