Aortic regurgitation is a heart valve disease characterized by improper closure of the aortic valve, leading to blood flow back into the left ventricle during diastole. Diagnosis involves echocardiographic evaluation, which reveals thickened valve leaflets and ventricular dilation, among other findings; severity is assessed through various measures, including vena contracta and Doppler studies. The document outlines diagnostic criteria, imaging techniques, and the classification of regurgitant severity into mild, moderate, and severe categories.

1. AORTIC
REGURGITATION
TEAM BY
ASHWATHI
BABINA MERLIN
ASWINI
DEPT OF CARDIOLOGY
3RD YEAR

2. INTRODUCTION
It is a type of heart valve disease in which
the aortic valve doesn’t close properly
during diastole .As a result ,some of the
blood pumped back from aorta to the left
ventricle . In short back flow of blood
during diastole

4. CAUSES
 Bicuspid aortic valve
Rheumatic
Calcification
Systemic inflammatory disease
Marfan syndrome
Endocarditis
Etc ….

5. SIGNS & SYMPTOMS
 Heart murmur
 Arrhythmia
 Palpitations
 Angina
 Shortness of breath
 Swollen of ankles and feet

6. ECHOCARDIOGRAPHIC
EVALUATION
ECHO WINDOWS USED :
• Parasternal long axis view
• Parasternal short axis view (Aortic valve
level)
• Apical five chamber view
• Apical three chamber view

7. 2D ECHO FINDINGS
 Prolapsing of valve leaflets
 Incomplete leaflet coaptation during
diastole
 Valve leaflets become thickened
 Aortic annular dilation
 Aortic root dilation
 Left ventricle progresssively dilates
 Eccentric hypertrophy

8. PLAX OF AR

9. 5 CHAMBER

10. INDIRECT SIGNS
 Increased EPSS :
maximal anterior motion of MV
in early diastole and the posterior motion
of IVS is >7mm or >1cm
 High frequency fluterring of AML
 Reversed diastolic curvature of the AML
 Jet lesion on septum or mitral valve

11. M MODE OF MV IN AR

12. REVERSE DOMING OF AML

13. DILATED LV due to volume
overload

14. LV RESPONSE TO AR
It occurs due to chronic volume overload
from AR
 Left ventricle inner cavity dilation and
becomes spherical
 LV end diastolic dimension 70-75 mm
 LV end systolic dimension 50-55mm
 LV ejection fraction becomes < 50%

15. EVALUATION OF AORTIC
REGURGITANT SEVERITY
COLOR FLOW IMAGING :
Parasternal views both in long and short
axis view and allow :
 Origin of the regurgitant jet
 Width of the jet
 Cross sectional area of the jet

17. Color imaging cont …..
 Mild AR
Fills small area of the outflow tract,
central jet fills <25%
 Moderate to Severe AR :
Fills larger percentage of outflow
tract diameter
Eccentric jet traverse the outflow tract
obliquely .

18. VENA CONTRACTA
Vena contracta is the narrowest diameter
of the flowstream which reflects the
diameter of regurgitant orifice
 Color flow image in PLAX
 Narrowest segment of the jet
 Measure perpendicular to the jet

19. VC

20. SEVERITY OF AR (Vena contracta)
SEVERITY VENA
CONTRACTA
MILD AR < 0.3 cm
MODERATE AR 0.3-0.7 cm
SEVERE AR >0.7 cm

21. CONTINUOUS WAVE DOPPLER
Continuous wave doppler signal of AR is
assessed by placing doppler line in apical
five chamber view across the aortic valve
It is used to compared the density of the
the envelope of the antegrade aortic flow
and the regurgitant jet

22. Continuous wave doppler cont …
 Mild AR
Velocity of the jet is remains high and
the envelope appears flat slope
 Severe AR
The doppler envelope shows steeper
slope

23. CW at Aortic Valve in AP5CH

24. PRESSURE HALF TIME
Doppler velocity- The diastolic deceleration
slope provides a semiquantitative measure
of AR severity
 A Flat slope consist with mild AR
( Pressure Half Time >500ms)
 A steeper slope indicates severe AR
( Pressure Half Time <200ms)
 For moderate AR PHT 500-200ms

25. PHT

26. PULSE WAVE DOPPLER
 In severe AR , holodiastolic flow
reversal in abdominal aorta is seen
 In addition to this more proximal
holodiastolic flow reversal is observed in
descending aorta during severe AR
It is also known as aortic flow reversal

27. AORTIC FLOW REVERSAL

28. CONTINUITY EQUATION
LVOT
SVLVOT = CSALVOT X VTILVOT
A1 X V1 = A2 X V2

29. CONTINUITY EQUATION
CONT….
MITRAL VALVE
SVMV = CSA MV X VTIMV

30. REGURGITANT VOLUME
 It is calculated by using transaortic volume
flow and transluminal volume flow
SV LVOT = CSA LVOT X VTI LVOT
SV MV = CSA MV X VTI LVOT
◦ Mild AR - < 30 ml
◦ Moderate AR - 30 to 44 ml
◦ Moderate to Severe – 45 to 59 ml
◦ Severe - > 60 ml
RV = SVLVOT – SVMV

31. REGURGITANT FRACTION
It is defined as the percentage of regurgitant
volume
 Mild - < 30%
 Moderate – 30 – 49%
 Severe - > 50%
RF = (Rvolume / SVLVOT) x
100

32. PISA
Proximal Isovelocity Surface Area :
blood moving back towards
closed aortic valve at the given aliasing
velocity
PISA = Regurgitant flow rate / Valiasing

33. EROA
Effective regurgitant orifice area
Mild - < 0.10 sq.cm
Moderate – 0.10 – 0.29 sq.cm
Severe - >0.3 sq.cm
EROA = Regurgitant
volume / VTIAR (continuos
wave doppler)

34. SUMMARY
MILD MODERATE SEVERE
QUALITATIVE
ASSESSMENT
Aortic valve
leaflet
Normal or
Abnormal
Abnormal Abnormal
Color jet Fills small area
of LVOT
Intermediate
central jet
Larger area of
LVOT
,eccenteric jet
LV Normal Mildly dilated Severely dilated
CW Doppler Flat slope --- Steep slope
Aortic root Normal Mildly dilated Dilated
QUANTITATIVE
ASSESSMENT
Vena Contracta < 0.3 cm 0.3-0.7cm >0.7 cm
PHT >500ms 500-200ms <200ms
AR Volume <30ml 30-59ml >60ml
AR Fraction <30% 30-49% >50%
EROA <0.1 sq.cm 0.1-0.29 sq.cm >0.3 sq.cm

35. THANK YOU FOR THE
ATTENTION ….