Basics

Cause of Chronic Aortic Regurgitation Cause of Chronic Aortic Regurgitation
Degenerativ Aortic dilatation
Congenital Postendocarditis
Rheumatic Aortic valve prolaps
Hemodynamics in AR Hemodynamics in AR
NOTE:
An elevation of
LVFP (diastolic
dysfunction)
usually denotes
LV deterioration
(symptoms!)
Volume overload
NOTE:
An elevation of
LVFP (diastolic
dysfunction)
usually denotes
LV deterioration
(symptoms!)
Dilated LV
NOTE:
An elevation of
LVFP (diastolic
dysfunction)
usually denotes
LV deterioration
(symptoms!)
Hyperdynamic
NOTE:
An elevation of
LVFP (diastolic
dysfunction)
usually denotes
LV deterioration
(symptoms!) Filling pressure !/!
NOTE:
An elevation of
LVFP (diastolic
dysfunction)
usually denotes
LV deterioration
(symptoms!)
Afterload !
NOTE:
An elevation of
LVFP (diastolic
dysfunction)
usually denotes
LV deterioration
(symptoms!)
Indirect findings in AR Indirect findings in AR
Dilated LV Hyperdynamic function
Eccentric LV hypertrophy Mildly enlarged LA
MR (annular dilatation)
Imaging and Quantification of AR Jet Imaging and Quantification of AR Jet
NOTE:
Look at Vena contracta
and PISA! Use
integrative approach
to quantification.
PLAX
NOTE:
Look at Vena contracta
and PISA! Use
integrative approach
to quantification.
PSAX (visualize origin of jet)
NOTE:
Look at Vena contracta
and PISA! Use
integrative approach
to quantification.
4 ch view/ 3 ch view
NOTE:
Look at Vena contracta
and PISA! Use
integrative approach
to quantification.
Suprasternal (to determine
retrograde flow)
NOTE:
Look at Vena contracta
and PISA! Use
integrative approach
to quantification.
010 // Aortic Regurgitation
1
Aortic Regurgitation — Reference Values
Mild Moderate Severe
Vena contracta < 3mm 3-6mm > 6mm
Jet width (% of LVOT) < 25 25—65 > 65
Flow convergence
(PISA)
not visible small large
PHT AR (msec) > 500—600 200—500 < 200
Pitfalls Pitfalls
NOTE:
AR signal should
have a vel. above 4,5
m/sec! Otherwise
signal quality is
inadequate!
Jet problems (complex,
eccentric, multiple)
AR CW signal
problems
NOTE:
AR signal should
have a vel. above 4,5
m/sec! Otherwise
signal quality is
inadequate!
Calcified valves
Machine settings
(PRF)
NOTE:
AR signal should
have a vel. above 4,5
m/sec! Otherwise
signal quality is
inadequate!
Hemodynamic calculation of regurgitant volume and fraction
SVMV = CSAMV x VTIMV = D
2
x 0.785
SVLVOT = CSALVOT x VTILVOT = D
2
x 0.785
010 // Aortic Regurgitation
2
Reference Values Mild Moderate Severe
Regurgitant volume (ml/beat) < 30 30—59 ≥ 60
Regurgitant fraction (%) < 30 30—49 ≥ 50
PISA Method
AR
flow
= 2! x r
2
x V
r
r = radius of flow convergence,
Vr = corresponding aliasing velocity,
Rvel = max. Vel of AR jet,
ERO = efective regurgitant orifice
Reference Values Mild Moderate Severe
ERO (cm
2
)
< 0,1 0,1—0,29 ≥ 0,3
Acute Aortic Regurgitation
Causes
NOTE:
LV Size = normal
or mildly dilated
and hyperdynamic
Endocarditis
NOTE:
LV Size = normal
or mildly dilated
and hyperdynamic
Cusp rupture
NOTE:
LV Size = normal
or mildly dilated
and hyperdynamic Aortic dissection
NOTE:
LV Size = normal
or mildly dilated
and hyperdynamic
Iatrogenic (trauma)
NOTE:
LV Size = normal
or mildly dilated
and hyperdynamic
010 // Aortic Regurgitation
3
Echofeatures of acute AR Echofeatures of acute AR
Small/mildly dilated LV Tachycardia
“Initially“ hyperdynamic
LV
Holodiastolic retrograde
flow (Ao. desc.)
Short deceleration AR Premature MV-closure
Indications for surgery
Indication in symptomatic patients with severe AR
Reduced LVF (LVEF < 50%)
Dilated LV (LVEDD > 70mm LVES > 50mm (25mm/m2))
If EF is too poor (< 30— 35%) ! Heart
transplantation
010 // Aortic Regurgitation
4