Aortic valve second auscultation area

The second auscultation area of ​​the aortic valve is a very important diagnostic site clinically. If there is a murmur in this area, it may be caused by arterial stenosis. The diagnosis of aortic regurgitation also needs to be confirmed in conjunction with examination of this area. Aortic valve replacement and ventriculoplasty are also mainly performed in this area. Now let’s take a closer look at the second auscultation area of ​​the aortic valve.

The first auscultation area of ​​the aortic valve is at the second intercostal space on the right edge of the sternum, which is actually the auscultation area of ​​the aortic valve in a normal heart. The second auscultation area is between the 3rd and 4th intercostal spaces on the left edge. The early diastolic murmur of aortic regurgitation and the diastolic murmur of aortic regurgitation due to rheumatic combined valvular disease are often heard loudest in the second auscultation area of ​​the aortic valve.

The aortic valve is a semilunar valve located between the left ventricle and the aorta. It prevents blood from entering the aorta from flowing back into the left ventricle and is morphologically similar to the pulmonary valve. Because of its central location, the aortic valve has close relationships with various heart chambers and valves. A thorough knowledge of these relationships is fundamental to the understanding of aortic valve pathology and many congenital heart malformations.

The aortic valve is composed of 3 semilunar valves. Like the pulmonary valve, the aortic valve leaflets are attached to

The arc passes over the ventricle-arterial junction. Thus, each valve leaflet is attached to the aorta within the left ventricle. Behind each valve leaflet, the aortic wall bulges outward to form the aortic sinuses. When the leaflets are closed, they align with each other along the commissure toward the center, and a thickened nodule, the Arantius nodule, is formed at the midpoint of the commissure (free edge). The peripheral commissure line adjacent to the commissure is thinner and may have small perforations.

When the ventricles contract, blood rushes upward, pushing the aortic valve leaflets away from the center of the aortic cavity; when the ventricles relax, the valve leaflets passively descend into the center of the aortic cavity. When the valve morphology is normal, the three leaflets coapt along the commissure edge and support the blood column in the aorta to prevent it from flowing back into the ventricle. Two of the three aortic sinuses give rise to the coronary arteries and are therefore named the left, right, and noncoronary sinuses. By studying the attachment edges of each leaflet, we can clearly understand the relationship between the aortic valve and the surrounding structures. Starting from the back, the junction between the noncoronary and left coronary valves is located as the area of ​​aortic-mitral continuation. The subaortic fibrous drape is located below the commissure. To the right of this junction, the noncoronary valve attaches to the superior aspect of the posterior left ventricular outflow tract diverticulum. Here the valve is related to the right atrial wall. As the attachment of the noncoronary valve ascends from the nadir to the junction between the noncoronary valve and the right coronary valve, the attachment margin lies directly above the portion of the atrial septum that contains the atrioventricular node.

The junction between the noncoronary and right coronary valves is located directly above the perforators of the atrioventricular bundle and the membranous ventricular septum. The attachment of the right coronary valve then descends across the central fibrous body and ascends to the junction between the right and left coronary valves. Just below this junction, the uppermost portion of the subvalvular aortic outflow tract is formed by the aortic wall. An incision through this site accesses the space between the surface of the aorta and the pulmonary trunk.

The corresponding left and right coronary valves descend from this junction and attach to the left ventricular outflow tract myocardium. Only a small portion of this region of the normal heart is a true outflow tract septum, so the pulmonary and aortic valves are supported by their own cuffs of myocardium. Although the left and right ventricular outflow tracts face each other, the subaortic incision is made below the right ventricular infundibulum. As the lateral part of the left coronary valve descends from the commissure to the bottom of the left coronary sinus, it becomes the only part of the aortic valve that is independent of other heart chambers.