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Review
. 2022 Oct;50(8):1041-1050.
doi: 10.1002/jcu.23299.

Aortic regurgitation: A multimodality approach

Agnese Siani  1 , Francesco Perone  2 , Pietro Costantini  1 , Sara Rodolfi  1 , Giuseppe Muscogiuri  3   4 , Sandro Sironi  3   5 , Serena Carriero  6 , Anna Giulia Pavon  7 , Ivo van der Bilt  8 , Philippe van Rosendael  9 , Lysette Broekhuizen  9 , Arco Teske  9 , Maarten Jan Cramer  9 , Marco Guglielmo  9
Affiliations
Review

Aortic regurgitation: A multimodality approach

Agnese Siani et al. J Clin Ultrasound. 2022 Oct.

Abstract

Aortic regurgitation (AR) is a common valvular pathology. Multimodality noninvasive cardiovascular imaging is routinely used to assess the mechanism of AR, degree, and its hemodynamic impact on the cardiovascular system. Collecting this information is crucial in establishing the prognosis and in guiding patient management and follow-up. While echocardiography remains the primary test to assess AR, a comprehensive assessment of this valvulopathy can be obtained by combining the information from different techniques. This state-of-the-art review is intended to provide an update ed overview of the applications, strengths, and limits of transthoracic echocardiography, cardiac magnetic resonance, and cardiac computed tomography in patients with AR.

Keywords: aortic regurgitation; cardiac magnetic resonance; computed tomography; echocardiography; multimodality imaging.

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Conflict of interest statement

The authors declare no relationship with industry and financial associations within the past two years that pose a conflict of interest in the submitted article.

Figures

FIGURE 1
FIGURE 1
Echocardiographic assessment of aortic regurgitation: (A) TTE colorDoppler focused on left ventricle outflow tract showing a large aortic regurgitant jet, (B) TTE CW Doppler of the regurgitant jet, (C) TTE CW Doppler showing holodiastolic flow reversal in the descending aorta. (D,E) TEE assessment of a patient with severe aortic regurgitation due to a large coaptation defect secondary to aortic root dilatation. (F) 3D TEE assessment of the aortic valve 3D: three dimensional. CW, continuous wave; TTE, transthoracic echocardiography; TEE, transoesophageal echocardiography
FIGURE 2
FIGURE 2
Cardiac magnetic resonance assessment of aortic regurgitation: (A) Visualization of a “jet” (hypointense signal due to phase loss of proton spin due to turbulent flow) of aortic insufficiency with a cine‐SSFP sequence; (B) late gadolinium enhancement sequence showing an intramyocardial enhancement of the anterior and antero‐lateral wall of the left ventricle. (C) Native T1 mapping to assess the presence of interstitial fibrosis, (D) flow/time curve phase contrast derived: positive values refer to forward flow while negative values indicate backward (regurgitant) flow, (E) example of measurement of regurgitant volume (Reg. volume) and regurgitant fraction (Reg. fraction) using flow/time curve phase contrast derived. SSFP, steady state free precession
FIGURE 3
FIGURE 3
Computed tomography assessment of aortic regurgitation. (A) type A aortic dissection in a patient with AR, (B) aorta ascendens dilatation in a patient with moderate AR (C), volume rendering of the coronary arteries, (D) Bicuspid aortic valve with degeneration of the valve leaflets, (E) volume rendering of the thoracoabdominal aorta. AR, aortic RegurgitationFlow
FIGURE 4
FIGURE 4
How to choose the right imaging modality in patients with aortic regurgitation. CMR, cardiac magnetic resonance; CT, computed tomography; TEE, transesophageal echocardiography; TTE, transthoracic echocardiography
See this image and copyright information in PMC

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