Aortic Regurgitation

What is AI

retrograde blood flow through AoV during LV diastole

4 types of AI

Aortic Root dilation, aortic root distortion, abnormal cusps, poor commissural support

What is root dilation

increased blood pressure (systemic arterial hypertension), atherosclerosis (plaque buildup), connective tissue disorders, congenital BAV, aneurysm of valsalva (doubling in size), aortic dissection (separate flow channel)

What is root distortion

scarring of root and possibly cusps

What can cause root distortion

aoritis-inflammation from rheumatoid arthritis

autoimmune diseases-such as systemic lupus erythematosus

Abnormal cusps

congenital abnormality (shape/# of cusps), calcific degeneration of valve annulus in elderly, rheumatic valve, aortic valve prolapse, infective endocarditis

Poor Commissural support

VSD, aortic dissection, aortic trauma

Acute Severe AR

endocarditis, trauma/type A aortic dissection

Mitral inflow volume combined with AR volume does what

significantly elevates LVEDP (end diastolic pressure) with normal LV size, thickness and systolic Fx.

What does Acute Severe AR result in

diastolic MR and early closure of MV as LV pressure exceeds LA

Chronic Severe AR

gradual dilation of LV to spherical shape accomadating larger volume. Small increase in LVEDP and maintains normal LV systolic fx, mild LV thickening

Frank Starling Principle

larger preload from dilation allows larger stroke volume to accomodate regurgitation

What does chronic severe AR eventually lead to?

too much preload and LV dysfunction with decrease in SV with eccentric LVH (increased LV mass)

Patient symptoms Severe AR

chest pain, dyspnea and edema

AR jet height to LVOT Height Ratio

PLAX View, height of AR jet in LVOT .5-1cm proximal to AoV

AR Jet Area to LVOT Area Ratio

area of AR color jet in LVOT within 1 cm of AoV in PSAX. “eyeball” method

Vena Contracta Width

PLAX views zoom on AoV with smallest sector possible. Height of narrowest portion of AR jet on LV side.

Density of AR waveform with

CW doppler at timing of Vmax from apical 5Ch or 3Ch.

For Diastolic flow reversal in aorta use

PW doppler. (severe AR will be holodiastolic w higher velocity)

A smaller ½ Time means

it’s more severe with CW doppler

Pressure Half Time

Time in millisec for velocity to fall to half the initial velocity. CW doppler in apical views. Measure slope from early AR diastolic peak velocity to end diastolic velocity

AR severity by Stroke Volume

(preferred) RVol= SV regurgitant valve-SV competent valve. Can’t have MR for this method to work.

Stroke Volume

amount of blood per beat. Normal is 70-100 cc

Regurgitant fraction

% all forward flow regurgitating. RF%=(regurg vol/LVOT SV) x 100 %

AR severity by PISA Method

AR VTI and PkVreg not accurate for EROA or regurg vol w significant MR