Aortic Regurgitation

Degenerative/ valve disease flow of blood from the aorta into the LV during diastole. The LV may initially compensate by dilating to accommodate the extra volume but over time this can lead to LV dysfunction.

On physical exam, AR presents as a blowing, decrescendo diastolic murmur, best heard at the left sternal border. There may be also signs of wide pulse pressure, such as bounding pulses or head bobbing (De Musset's sign).

There are many possible causes of AR, including:
- Degenerative/rheumatic valve disease
- Aortic root dilation (e.g. in connective tissue disorders like Marfan syndrome)
- Aortic dissection (sudden onset)
- Infective endocarditis
- Iatrogenic causes (e.g. after valvular procedures)

Note: The video shown has no regurgitation
Check out UBC's video of severe AR: https://www.ubcimpocus.com/new-gallery/2019/4/24/severe-ar-a4c

Steps for Image Acquisition:

Obtain an A5C: Start with an A4C, ensuring the septum is straight and centred. Transition into an A5C and visualize the LVOT and aortic valve.
Turn On Colour Doppler: Adjust the colour doppler box to encompass the entire LVOT and aortic valve.
Freeze and measure: In diastole, freeze the image when the regurgitant jet is most prominent. Use calipers to measure:
- Jet width, LVOT diameter (within 1cm of aortic valve)

Interpretation:

Mild: Jet width < 25% of LVOT diameter
Moderate: Jet width 25–65% of LVOT diameter
Severe: Jet width > 65% of LVOT diameter