Aortic Regurgitation - Cardiology Notes
Assessment of Severity
- Color flow of AI
- Severe if >60% of LVOT area
- Measure Pressure Half Time
- <250 severe
- >400 mild
- Measure Flow in descending Aorta
- Measure size of Aorta including annulus, ascending aorta, and arch
- Measure size of Vena contracta
- >6mm is severe
- Measure Pisa
- ERO > 0.4 is severe
- Measure for Diastolic Flow Reversal in aorta
- Look for Increased LV Size
| Indicator | Mild | Moderate | Severe |
|---|---|---|---|
| Angiographic Grade | 1+ | 2+ | 3+ |
| Vena Contracta Width (mm) | <0.3 | 0.3 to 0.60 | >.6 |
| Regurgitant Orifice Area | <0.2 | 0.2 to 0.39 | >.4 |
Indications for Surgery
- LVED dimensions > 7.5 cm and LVES dimensions >5.5 cm (The 55 rule)
- EF < 50%
- FC III or IV
- FC II angina
Quantification of Aortic Insufficiency by Aortography
The pigtail catheter is placed a few centimeters above the aortic root. Grading the amount of regurgitation is based on the amount of opacification of the ventricle 2 complete cardiac cycles after injection compared to that of the aortic root.
1+ Brief and incomplete ventricualar opacification. Clears rapidly.
2+ Moderate opacification of the ventricle that clears in less that 2 cycles.
Never greater than aortic root opacification.
2+ AI Marfan Syndrome
3+ Opacification of the ventricle equal to aortic root opacification within 2 cycles.
Delayed clearing of ventricle over several cycles.
3+ AI
4+ Opacification of the ventricle almost immediately that is greater than
that of the aortic root with delayed clearing of the ventricle.
4+ AI
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