Short-axis imaging of the pulmonary valve through a modified parasternal view: A feasibility study in young children

Background: The aortic and pulmonary valves are both tricuspid valves. All cusps of the aortic valve can be imaged in the parasternal short-axis view but the pulmonary valve cusps are not routinely imaged during trans-thoracic echocardiography. Methods: We evaluated the feasibility of imaging all three pulmonary valve cusps in the short-axis by a modified parasternal view in 100 consecutive children below the age of 5 years. Results: A satisfactory short-axis imaging of the pulmonary valve was possible in 96 of 100 consecutive children in whom a complete echocardiogram study was performed. This detected abnormalities in the pulmonary valve in 10 children. This included bicuspid pulmonary valves, tricuspid pulmonary valves with unequal cusps, and a quadricuspid pulmonary valve. Visualization of the pulmonary valve permitted preoperative planning of pulmonary valve repair in one infant with a concomitant large ventricular septal defect. Conclusion: An adequate visualisation of the pulmonary valve leaflets by a modified parasternal view during trans-thoracic echocardiography was feasible in a vast majority of young children. The modified pulmonary short-axis view should hence be included as the part of a comprehensive pediatric echocardiographic protocol.