Diagnostics

Indication: assessment of aortic valve structure and function, cause and severity of regurgitation, the left ventricle and other heart valves [2]

• TTE: modality of choice for initial assessment of all patients with suspected AR

• TEE [5]

  • Moderate to severe AR, if TTE findings are equivocal

  • Preoperative planning

General findings

• Abnormal aortic valve leaflets

• Fluttering of the anterior mitral valve leaflet [2][3]

• Regurgitant AR jet on Doppler flow tracing

• Dilated aorta [9]

Findings specific to acute AR [7]

• Reduced cardiac output

• Elevated end-diastolic left ventricular pressure

• Early mitral valve closing

• Rapid equilibration of aortic and left ventricular pressure

Findings specific to chronic AR: increased LV size and volume

ECG: nonspecific; helps rule out differential diagnoses (e.g., ACS, cardiac arrhythmia)

• Acute AR: possible signs of the underlying cause (e.g., signs of myocardial ischemia in aortic dissection)

• Chronic AR

  • ECG signs of LVH

  • ST-segment depression and T-wave inversion in I, aVL, V5, and V6[2]

Chest x-ray: used to assess for pulmonary edema and rule out other causes of acute dyspnea

• Acute AR [1]

  • Normal heart silhouette

  • X-ray signs of pulmonary congestion or edema

• Chronic AR [2]

  • X-ray signs of LVH

  • Enlarged cardiac silhouette

• Chronic AR or acute AR caused by aortic dissection: possible prominent aortic root/arch