Armstrong, W.F. and Feigenbaum, H. (2001) Echocardiography, Heart Disease, Text Book of Cardiovascular Medicine. 6th Edition, Chapter 7, Figure 7-48 (Bottom), Saunders, Philadelphia, 182.

has been cited by the following article:

• TITLE: Rheumatic Aortic Valve Disease with Mitral Stenosis—A Case Report

  AUTHORS: Ramachandran Muthiah

  KEYWORDS: Rheumatic Bicuspid Aortic Valve, Aortic Regurgitation, Mitral Stenosis, Eccentricity Index, Smoke, Water Fall Sign, Bow and Arrow Sign

  JOURNAL NAME: Case Reports in Clinical Medicine, Vol.5 No.8, August 31, 2016

  ABSTRACT: Congenitally malformed aortic valves are more susceptible to valve injury due to rheumatic fever, mechanical stress of altered flow patterns, atherosclerotic risk factors and degenerative changes. Rheumatic involvement usually occurs in childhood and it is progressive leading to diffuse thickening and fibrosis at leaflet edges and thus differentiated from other patterns of valve damage. Background of this case report revealed the bicuspid nature of the aortic valve due to rheumatic commissural fusion and analysis of echocardiographic parameters in combined lesions of both aortic and mitral valves with severe LV (left ventricular) dysfunction. Left ventricular (LV) and left atrial (LA) dilations predisposing to the formation of smoke (SEC-spontaneous echo contrast) in LV and LA as a consequence of mitral and aortic valve disease are illustrated by 2D echocardiographic imaging in this 41-year-old male.