Severe Aortic Regurgitation 

 

Image Library >> Valvular Disease>> Severe Aortic Regurgitation                                                  Author: Atif Qasim, M.D.

Parasternal Long Axis

2D view

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At first glance we see the ventricle is moderately dilated. Careful inspection of the aortic valve shows a small mass prolapsing into the LVOT during diastole.
 

 

Parasternal Long Axis

Aortic Valve Zoom, 2D

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This close-up view shows indeed either there is a vegetation or severe degeneration of the aortic valve.
 

Parasternal Short Axis

Aortic Valve Level, 2D view

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In this short axis view we can see the aortic valve is trileaflet and is somewhat calcified and thickened.
 

Parasternal Short Axis

Aortic Valve with Color

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Color Doppler shows that most of the regurgitation occurs between the right and left coronary cusps

Apical 5 Chamber

2D with Color

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This apical 5 chamber view shows how far back the aortic regurgitation jet descends into the left ventricle during diastole.

Apical 5 Chamber

AI Jet, CW

 

The pressure half time is <200ms and deceleration slope of the AI jet is steep shown here with CW Doppler, suggestive of severe AI and a high regurgitant volume. The steeper the slope (shorter the pressure half time), the worse the AI as aortic diastolic pressure and LV end diastolic pressure equilibrate more quickly with an incompetent valve.
 

Apical 5 Chamber

Aortic Valve CW

 

As a result of the increased regurgitant volume from AI, flow across the aortic valve in systole is increased. This causes a flow murmur in systole across the aortic valve; do not mistake this for aortic stenosis. We have seen the valve opens well and as shown on the next slide the LVOT VTI is also high.

Apical 5 Chamber

LVOT PW

 

The LVOT VIT here is also elevated. We see a peak velocity almost approach 2m/s here. Note that the AI flow is aliased.
 

Aortic Arch View

PW Doppler

One hallmark of significant AI is that there is flow reversal in the descending aorta. PW Doppler here shows that in diastole we see flow upward and that it is holodiastolic, suggestive of severe AI.