Severe aortic regurgitation – Echo

Severe aortic regurgitation – Echo

Severe aortic regurgitation: Echocardiogram in parasternal long axis (PLAX) view shows dilated left ventricle (LV), left atrium (LA), aorta (Ao) and a small portion of the right ventricle (RV), which is usually the outflow region. Mitral valve leaflets seen in open position between the left ventricle and left atrium are thickened. The large aortic regurgitation (AR) jet can be seen as a mosaic (multi color) jet in the left ventricular outflow tract anterior to the anterior mitral leaflet. A portion of the thickened aortic valve can be seen between the aorta and left ventricle (not labelled). The AR jet is almost filling the left ventricular outflow tract and extends well into the left ventricle, beyond the anterior mitral leaflet, indicating a free aortic regurgitation. Dilated left ventricle, aorta and left atrium also suggest that the AR is severe.

Apical five chamber view shows the dilated left ventricle, thickened anterior mitral leaflet (AML) and posterior mitral leaflet (PML). In this view also the AR jet is large, extending deep into the LV, indicating severe AR. Thickening of both aortic and mitral leaflets indicate the possible etiology as rheumatic. Mitral and aortic valves are the most often involved valves in rheumatic heart disease, the former being more common between the two. When there is associated mitral stenosis, the colour Doppler jet of mitral flow merges with that of aortic regurgitation in the left ventricle as both occur in diastole. But the velocity of aortic regurgitation jet is much higher than that of mitral stenosis as the pressure difference between aorta and left ventricle in diastole is much higher than that between left atrium and left ventricle.

Natural history study of rheumatic aortic regurgitation involving 174 young patients with median follow up of 10 years is available in Circulation [1]. It gives criteria predictive of death, congestive heart failure and angina in young patients.

Reference

1. Spagnuolo M, Kloth H, Taranta A, Doyle E, Pasternack B. Natural History of Rheumatic Aortic Regurgitation. Criteria Predictive of Death, Congestive Heart Failure, and Angina in Young Patients. Circulation. 1971 Sep;44(3):368-80.