Aortic Insufficiency

When is AI considered pathologic?

ANY amount - even trace

2D Features of AI

LV overload/enlargement

Thickened & stenotic leaflets

AI Jet Diameter/LVOT Diameter Ratio

Zoomed PLAX view

Measure LVOT diameter and compare it to the AI jet width diameter

Mild AI Jet Width

< 25% of LVOT

Severe AI Jet Width

≥ 65% of LVOT

AI Jet Area/LVOT Jet Area Ratio

Compares PLAX LVOT area to PSAX AI jet area

Mild AI VCW

< 0.3 cm

Severe AI VCW

> 0.7 cm

Mild AI Doppler Waveform

Dimmer signal

Flatter slope

Severe AI Doppler Waveform

Brighter signal

Steeper slope

Tace Flow Reversal in Descending Aorta

Normal in early diastole

Mild Flow Reversal In Descending Aorta

Seen with mild AI

Holodiastolic Flow Reversal in Descending Aorta

Seen with at least moderate AI

Normal Flow in Abdominal Aorta

Triphasic - normal to have some early flow reversal

Holodiastolic Flow in Abdominal Aorta

Seen with severe AI

Pressure Half Time (PHT)

Time it takes for peak LV pressure to drop to half the original pressure value

A shorter PHT value is seen more with...

Severe AI

Mild PHT

> 500 msec

Severe PHT

< 200 msec

PISA for AI

Zoomed in apical 3 chamber or PLAX view

Measure convergence

Measure AR VTI & peak velocity

Regurgitant Fraction for AI

Only use if PISA can't determine severity

Compares stroke volumes of the aortic and mitral valves

Pressure Changes with AI

Increased LV pressure

Decreased AO pressure