Aortic Regurgitation

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Aortic Regurgitation
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Echocardiographic Approach

• Valve Anatomy and Etiology
• Severity of Aortic Regurgitation
• Left Ventricular Response
• Associated abnormalities

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Etiology

• Leaflet abnormalities
• Congenital bicuspid valve
• Calcific valve disease
• Rheumatic valve disease

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Etiology

• Leaflet abnormalities
• Myxomatous valve disease
• Endocarditis
• Nonbacteria thrombotic endocarditis

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Etiology

• Aortic Root abnormalities
• Hypertensive aortic root abnormalities.
• Cystic medial necrosis
• Marfans Syndrome
• Aortic dissection

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2D/M-Mode Findings

• High frequency fluttering of the AMVL
• Reverse doming of the AMVL
• Jet lesion on septum or AMVL

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2D/M-mode Findings
Aortic Regurgitation
Distance
Time
Systole
Diastole
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Reverse Doming
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Jet Lesion on Septum
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Jet Lesion on AMVL
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2D/M-Mode Findings

• Aortic valve and root anatomic abnormalities.
• Left ventricular dilatation and sphericity.
• Increased EPPS

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Sphericity
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2D/M-mode Findings
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Chronic Versus Acute
Chronic Acute
Etiology Bicuspid valve Hypertension Endocarditis Aortic dissection
LV size Dilated Normal
LVEDP Normal Elevated
Pulse Pressure Wide Narrow
CW Doppler slope Flat Steep
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Evaluation

• Doppler Flow Mapping
• Continuous-wave Doppler
• Descending aortic diastolic flow reversal
• Volume flow at two sites

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Color Flow Mapping

• Mild
• Moderate
• Severe

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Color Flow Mapping
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Color Flow Mapping
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Color Flow Mapping
Scale Severity
1 Mild
2 Moderate
3 Moderately Severe
4 Severe
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Evaluation
Jet Length Apical 5-chamber Apical 3- chamber
Jet Width PSAX
Jet Height PSAX
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Jet Length
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Jet Height

• Measure the maximal AP diameter of the
  regurgitant jet at the junction of the LVOT and
  the aortic annulus using the PLAX.

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Jet Height
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Jet Height
Grade Severity JH
1 Mild lt 4 mm
2 Moderate 4 to 7 mm
3 Moderately Severe 8 to 10 mm
4 Severe gt 10 mm
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JH/LVOH

• Measure the max AP diameter of the regurgitant
  jet at the junction of the LVOT and the aortic
  annulus using the PLAX.
• Measure the Maximal height of the LVOT at the
  same location (LVOH).
• Divide the jet height (JH) by the LVOT height
  (LVOH)

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JH/LVOH
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JH/LVOH
Grade Severity JH/LVOH
1 Mild lt 25
2 Moderate 25 to 46
3 Moderately Severe 47 to 64
4 Severe gt 64
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JSAA/LVOTA

• Planimetry of the RJ in PSAX JSAA
• Planimetry of the LVOT in PSAX LVOTA
• Calculate the JSAA/LVOTA ratio

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JSAA/LVOTA
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JSAA/LVOTA
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JSAA/LVOTA
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JSAA/LVOTA
Grade Severity JSAA/LVOTA
1 Mild lt 4
2 Moderate 4 to 24
3 Moderately Severe 25 to 59
4 Severe gt 60
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CW Doppler

• Onset at AV closure (IVRT)
• Rapid increase in velocity to a max of 3 to 5
  m/s.
• Gradual decline in velocity during diastole.
• Abrupt deceleration during IVCT

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CW Doppler

• Assess the signal intensity, relative to the
  antegrade velocity.
• Moderate to severe signal intensity recorded
  throughout diastole.
• Mild recordable signal at the beginning or at
  the end.

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Acute vs Chronic
Pressure
Velocity
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Chronic Regurgitation
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Chronic Regurgitation
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Acute Regurgitation
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Acute Regurgitation
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PHT
Deceleration time
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PHT

• PHT (ms) DT (ms) x 0.29
•  

Regurgitation Severity PHT
Mild gt 500 ms
Moderate 350 500 ms
Moderately Severe 200 - 350 ms
Severe lt 200 ms
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Flow Reversal

• Holodiastolic Flow Reversal in the Descending
  aorta
• Severe Regurgitation holodiastolic flow
  reversal in the proximal abdominal aorta
• Sensitivity 100
• Specificity 97
• FP - PDA

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Flow Reversal
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Flow Reversal
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Flow Reversal
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Flow Reversal
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Flow Reversal
Liver
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Volume Flow at Two Intracardiac Sites

• SV CSA x VTI
• Calculate Transaortic SV (Total SV).
• Calculate the Transmitral SV (Forward SV).
• Regurgitant volume Total SV Forward SV.

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Transaortic (Total) SV
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Transortic (Total) SV
VTI
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Transaortic (Total) SV
Diameter
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Transmitral (Forward) SV
VTI
cm/s
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Transmitral (Forward) SV
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Transmitral (Forward) SV