aortic regurgitation assessment by ECHO.

assessment of AR

1. ECHOCARDIOGRAPHIC ASSESSMENT OF AORTIC REGURGITATION Dr. NITHESH KUMAR ASSOCIATE CONSULTANT CARDIOLOGY KAUVERY HOSPITAL, VADAPALANI

2. Aortic valve anatomy 3 cusp, 3 commissures, 3-4 cm sq in area

3. RCC NCC

4. Common Causes of AR Congenital Bicuspid aortic valve. Rheumatic disease. Calcific degeneration. Infective endocarditis Idiopathic aortic dilatation. Myxomatous degeneration. Dissection of the ascending aorta.

5. Options ?? TTE TEE 3D echocardiography

6. Leaflets Prolapse Number Vegetation Calcification

7. Vegetation

8. Calcification

9. Any dissection? In PLAX, PSAX, Suprasternal view

10. Left ventricular dimension and function In chronic AR LVESD <50-55 mm LVEDD <70-75 mm

11. Doppler Assessment of AR (Qualitative) Color doppler jet width Color jet width VS LVOT width in PLAX view Mild AR <25% Severe AR ≥65 % Length of AR jet should not be used to assess AR severity

12. Vena contracta width Mild AR < 0.3 cm Severe AR> 0.6 cm

13. Pressure half time (PHT) CW doppler in Apical five chamber view Mild AR >500 ms Severe AR < 200 ms Steeper is severe

14. Diastolic flow reversal in aorta PW doppler in suprasternal (descending thoracic aorta) or subcostal (abdominal aorta) view ECG gated echo needed Holodiastolic flow reversal is abnormal. Brief flow reversal may be present normally.

15. Doppler Assessemnt of AR (Quantitative) Not frequently done Often be determined by combination of qualitative methods and 2D assessment Options: PISA (Proximal Isovelocity Surface Area) Regurgitant volume Regurgitant fraction Effective regurgitant orifice area (EROA)

16. Indirect sign of AR Increased EPSS. Fluttering of mitral leaflet. Reverse doming of the anterior mitral leaflet Dilated Left ventricle.

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