Double aortic and pulmonary valves: An artifact generated by ultrasound refraction.

Echocardiography is an essential diagnostic tool for the investigation of the cardiovascular system. However, the nature of the ultrasound beam may lead to artifacts such as doubling of cardiac structures because of refraction. Here we present two illustrative cases showing doubling of the aortic ring and double regurgitation through the pulmonary valve. Doubling by refraction is different from other artifacts generating double images, such as mirroring of the ultrasound beam (eg, by prosthetic valves). Anatomic structures between the transducer and the heart such as the pleura, pericardium, or rib cartilage may induce refraction of the ultrasound beam resulting in doubling of cardiac structures. The resulting doubling of anatomic structures must not be misdiagnosed.