Aortic regurgitation is a type of heart valve disease in which the valve does not close properly as a result some of the blood is back flow from the Aorta into the left ventricle during diastole .Regurgitation is seen in echo Guidance by using Parasternal long axis view AND Parasternal short axis view ,apical 5 chamber view and apical 3 chamber view it is the best seen in color flow imaging .The severity of this is calculated and evaluated by VC,PISA,EROA,PHT,CW DOPPLER, REGURGITANT VOLUME ,REGURGITANT FRACTION this echo approach use to all Healthcare workers and the health care students it is easily understandable .I hope that u will support me and stimulate me to do more presentation related on this category Love u all for the supports Thank u guys
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
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
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
16.
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
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
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
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
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