Aortic regurgitation echocardiography

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Varun Kumar, M.B.B.S.; Lakshmi Gopalakrishnan, M.B.B.S.; Mohammed A. Sbeih, M.D. [3]; Usama Talib, BSc, MD [4]

Overview

The echocardiogram is the single most useful diagnostic imaging study in the diagnosis and ongoing surveillance of the severity of aortic insufficiency. Echocardiography allows for serial assessment of left ventricular volumes which can be critical in determining the timing of aortic valve replacement. Aortic valve replacement should be performed if the LVEF is ≤ 55% or if left ventricular end-systolic dimension is > 55mm.[1]

Echocardiography

The echocardiographic findings in severe aortic regurgitation include:[2][3][4][5]

  • An AI color jet dimension > 60 percent of the left ventricular outflow tract (LVOT) diameter (may not be true if the jet is eccentric)
  • The pressure half-time of the regurgitant jet is < 250 msec
  • Early termination of the mitral inflow (due to an increase in LV pressure as a result of the AI)
  • Early diastolic flow reversal in the descending aorta
  • Regurgitant volume > 60 ml
  • Regurgitant fraction > 55 percent
Aortic Regurgitation M Mode

Characteristics of aortic insufficiency are demonstrated by:

  • Increased duration between E and A peaks.
  • Fluttering of the anterior mitral valve leaflet due to AI jet turbulence.

Echocardiography Follow-Up

Frequency of echocardiograms in asymptomatic patients with aortic regurgitation with normal stroke volume:

  • Progressive (stage B) with mild severity: every 3-5 years
  • Progressive (stage B) with moderate severity: every 1-2 years
  • Severe (stage C): every 6-12 months (more frequently in case of a dilating left ventricle)

Severe Aortic Insufficiency (Color Doppler)

Moderate Aortic Insufficiency (Color Doppler)

Aortic Insufficiency Combined with Stenosis (Color Doppler)

2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Diseases (DO NOT EDIT)[6]

Diagnosis and Follow Up

Class I
"1. TTE is indicated in patients with signs or symptoms of AR (stages A to D) for accurate diagnosis of the cause of regurgitation, regurgitant severity, and LV size and systolic function, and for determining clinical outcome and timing of valve intervention. (Level of Evidence: B) "
"2. TTE is indicated in patients with dilated aortic sinuses or ascending aorta or with a bicuspid aortic valve (stages A and B) to evaluate the presence and severity of AR. (Level of Evidence: B) "

2008 Focused Update Incorporated into the 2006 ACC/AHA Guidelines for the Management of Patients with Valvular Heart Disease (DO NOT EDIT)[7]

Echocardiography (DO NOT EDIT)[7]

Class I
"1. Echocardiography is indicated to confirm the presence and severity of acute or chronic AR. (Level of Evidence: B)"
"2. Echocardiography is indicated for diagnosis and assessment of the cause of chronic AR (including valve morphology and aortic root size and morphology) and for assessment of LV hypertrophy, dimension (or volume), and systolic function. (Level of Evidence: B)"
"3. Echocardiography is indicated in patients with an enlarged aortic root to assess regurgitation and the severity of aortic dilatation. (Level of Evidence: B)"
"4. Echocardiography is indicated for the periodic re-evaluation of LV size and function in asymptomatic patients with severe AR. (Level of Evidence: B)"
"5. Radionuclide angiography or magnetic resonance imaging is indicated for the initial and serial assessment of LV volume and function at rest in patients with AR and suboptimal echocardiograms. (Level of Evidence: B)"
"6. Echocardiography is indicated to re-evaluate mild, moderate, or severe AR in patients with new or changing symptoms. (Level of Evidence: B)"

References

  1. Bonow RO, Carabello B, de Leon AC, Edmunds LH, Fedderly BJ, Freed MD; et al. (1998). "ACC/AHA Guidelines for the Management of Patients With Valvular Heart Disease. Executive Summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients With Valvular Heart Disease)". J Heart Valve Dis. 7 (6): 672–707. PMID 9870202.
  2. Zoghbi WA, Enriquez-Sarano M, Foster E, Grayburn PA, Kraft CD, Levine RA, Nihoyannopoulos P, Otto CM, Quinones MA, Rakowski H, Stewart WJ, Waggoner A, Weissman NJ (2003). "Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography". Journal of the American Society of Echocardiography : Official Publication of the American Society of Echocardiography. 16 (7): 777–802. doi:10.1016/S0894-7317(03)00335-3. PMID 12835667. Retrieved 2011-03-02. Unknown parameter |month= ignored (help)
  3. Desjardins VA, Enriquez-Sarano M, Tajik AJ, Bailey KR, Seward JB (1996). "Intensity of murmurs correlates with severity of valvular regurgitation". Am J Med. 100 (2): 149–56. PMID 8629648.
  4. Grande RD, Katz WE (2011). "Acute aortic regurgitation secondary to disk embolization of a Björk-Shiley prosthetic aortic valve". J Am Soc Echocardiogr. 24 (3): 350.e5–6. doi:10.1016/j.echo.2010.07.001. PMID 20708374.
  5. Saranteas T, Christodoulaki K, Rinaki D, Kostopanagiotou G (2011). "Transthoracic echocardiography for the identification of acute aortic regurgitation in the intensive care unit". J Cardiothorac Vasc Anesth. 25 (1): 204–5. doi:10.1053/j.jvca.2009.11.015. PMID 20117022.
  6. "2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary". Retrieved 4 March 2014.
  7. 7.0 7.1 Bonow RO, Carabello BA, Chatterjee K; et al. (2008). "2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons". Circulation. 118 (15): e523–661. doi:10.1161/CIRCULATIONAHA.108.190748. PMID 18820172. Unknown parameter |month= ignored (help)


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