Which statement best describes the 2D echocardiographic hallmark of rheumatic aortic stenosis?

Which statement best describes the 2D echocardiographic hallmark of rheumatic aortic stenosis?

• A. Leaflet thickening with calcification
• B. Prolapse with regurgitation
• C. Normal cusps
• D. Echogenic cusps with systolic doming

Answer: (D)

Rheumatic aortic stenosis shows thickened, echogenic aortic valve cusps with restricted motion due to inflammatory changes and commissural fusion. On 2D echo, this manifests as cusps that domes during systole—the systolic doming—because the fused, stiff cusps cannot open fully. This combination of echogenic, fibrotic cusps and systolic doming is the hallmark of rheumatic involvement. In contrast, simple leaflet thickening with calcification can occur in other forms of valve disease, prolapse with regurgitation points to a different pathology, and normal cusps would not reflect rheumatic disease.

Rheumatic aortic stenosis shows thickened, echogenic aortic valve cusps with restricted motion due to inflammatory changes and commissural fusion. On 2D echo, this manifests as cusps that domes during systole—the systolic doming—because the fused, stiff cusps cannot open fully. This combination of echogenic, fibrotic cusps and systolic doming is the hallmark of rheumatic involvement. In contrast, simple leaflet thickening with calcification can occur in other forms of valve disease, prolapse with regurgitation points to a different pathology, and normal cusps would not reflect rheumatic disease.