Table 4.11 Summary: Echocardiographic features of aortic regurgitation

Aims of echocardiographic examination

Confirm diagnosis

Use 2DE to evaluate valvular structure

Use M-mode to detect vibration of aortic valve and septal mitral leaflet

Use pulsed-wave Doppler to detect and map area of jet

Assess significance

Use 2DE to gain subjective impression of volume overload

Use M-mode to measure left ventricular diameter at end-diastole and end-systole

Technique

Right parasternal long-axis view for overall assessment of cardiac function

Right parasternal long- and short-axis views for identification of lesions

Right parasternal short-axis view for positioning of cursor for measurement of LVD

Tilted left parasternal long-axis view for CW Doppler measurement of jet velocity

Tilted left parasternal long-axis view for pulsed-wave Doppler mapping

Common findings

Nodular thickening of the aortic valve (2DEI

High4requency vibration of the aortic valve (M-mode)

High-frequency vibration of the septal mitral leaflet (M-mode)

Increased end-diastolic LV dimensions (M-mode)

Increased fractional shortening % (M-mode)

Detection of regurgitant blood flow (Doppler)

Filling throughout diastole (2DE or M-mode)

Other significant findings

High-frequency vibration of the IVS

Flail leaflet

Valve prolapse

Mitral valve abnormalities

Left atrial volume overload

Large vegetations

Pulmonary artery dilation

Ventricular septal defect

Pressure gradient estimated from velocity of jet using CW Doppler

Good prognostic indicators

LVDd< 15cm

No vegetative lesions of endocarditis

Limited area of jet of AR

Velocity of jet measured using CW Doppler drops little during diastole

Poor prognostic indicators

Volume overload

Significant MR

Pathological arrhythmias

Rupture of the valve or sinus of Valsalva

Early closure of the mitral valve

Rapid decline in velocity of jet on CW Doppler

Vegetations indicating presence of endocarditis

Pulmonary artery dilation

VSD present