Mastering Aortic Regurgitation: A Practical Echo Guide
Break down the essential parameters for accurate AR assessment — from pressure half-time to diastolic flow reversal
Origins of Aortic Regurgitation
A normal aortic valve is comprised of three semilunar cusps that attach to the aortic wall. Aortic regurgitation (AR), also known as aortic insufficiency, is a form of valvular heart disease that allows for the retrograde flow of blood back into the left ventricle. In aortic regurgitation, blood flows backward from the aorta into the left ventricle during diastole. Over time, this volume overload can lead to left ventricular dilation, increased wall stress, and eventually a reduced ejection fraction. Clinical management depends on both the severity and the acuity of the regurgitation.
Echocardiography is essential for evaluating the aortic valve and accurately grading aortic regurgitation using 2D imaging, color Doppler, and spectral Doppler. By upgrading, you’ll unlock a detailed breakdown of the key measurements used in AR assessment, including:
Classification of Aortic Insufficiency
Left ventricular volume assessment
Pressure half-time breakdown
Color Doppler jet ratios
Identifying diastolic flow reversal with Spectral Doppler
Mastering these parameters will enhance your ability to diagnose and manage aortic regurgitation with confidence and precision.
Acute vs Chronic
Acute aortic regurgitation is a cardiovascular emergency characterized by sudden left ventricular pressure overload, most commonly caused by infective endocarditis, acute aortic dissection, blunt chest trauma, or iatrogenic injury such as complications from a transcatheter aortic valve replacement (TAVR). In contrast, chronic AR develops gradually, leading to left ventricular volume overload due to progressive structural abnormalities of the valve or aortic root. Causes of chronic AR include congenital bicuspid valve, rheumatic heart disease, degenerative cusp changes, aortic root dilation from hypertension or connective tissue disorders, and less commonly, prior endocarditis or inflammatory conditions.