Aortic insufficiency echocardiography


 * Associate Editor-In-Chief:, Varun Kumar, M.B.B.S., Lakshmi Gopalakrishnan, M.B.B.S., Mohammed A. Sbeih, M.D. [mailto:msbeih@perfuse.org]

Overview
The echocardiogram is the single most useful diagnostic imaging study in the diagnosis and ongoing surveillance of the severity of aortic insufficiency. Echocardiography allows for serial assessment of left ventricular volumes which can be critical in determining the timing of aortic valve replacement. Aortic valve replacement should be performed if the LVEF is ≤ 55% or if left ventricular end-systolic dimension is >55 mm.

Echocardiographic Findings in Severe Aortic Insufficiency
The echocardiographic findings in severe aortic regurgitation include:
 * An AI color jet dimension > 60 percent of the left ventricular outflow tract (LVOT) diameter (may not be true if the jet is eccentric)
 * The pressure half-time of the regurgitant jet is < 250 msec
 * Early termination of the mitral inflow (due to an increase in LV pressure as a result of the AI)
 * Early diastolic flow reversal in the descending aorta.
 * Regurgitant volume > 60 ml
 * Regurgitant fraction > 55 percent



Characteristics of aortic insufficiency are demonstrated by:
 * Increased duration between E and A peaks
 * Fluttering of the anterior mitral valve leaflet due to AI jet turbulence

Severe Aortic Insufficiency Video 2
==ACC/AHA Guidelines- Echocardiography in Aortic Insufficiency (DO NOT EDIT) == {{cquote|

Class I
1. Echocardiography is indicated to confirm the presence and severity of acute or chronic AR. (Level of Evidence: B)

2. Echocardiography is indicated for diagnosis and assessment of the cause of chronic AR (including valve morphology and aortic root size and morphology) and for assessment of LV hypertrophy, dimension (or volume), and systolic function. (Level of Evidence: B)

3. Echocardiography is indicated in patients with an enlarged aortic root to assess regurgitation and the severity of aortic dilatation. (Level of Evidence: B)

4. Echocardiography is indicated for the periodic re-evaluation of LV size and function in asymptomatic patients with severe AR. (Level of Evidence: B)

5. Radionuclide angiography or magnetic resonance imaging is indicated for the initial and serial assessment of LV volume and function at rest in patients with AR and suboptimal echocardiograms. (Level of Evidence: B)

6. Echocardiography is indicated to re-evaluate mild, moderate, or severe AR in patients with new or changing symptoms. (Level of Evidence: B)

Class IIa
1. Exercise stress testing for chronic AR is reasonable for assessment of functional capacity and symptomatic response in patients with a history of equivocal symptoms. (Level of Evidence: B)

2. Exercise stress testing for patients with chronic AR is reasonable for the evaluation of symptoms and functional capacity before participation in athletic activities. (Level of Evidence: C)

3. Magnetic resonance imaging is reasonable for the estimation of AR severity in patients with unsatisfactory echocardiograms. (Level of Evidence: B)

Class IIb
1. Exercise stress testing in patients with radionuclide angiography may be considered for assessment of LV function in asymptomatic or symptomatic patients with chronic AR. (Level of Evidence: B)}}