| Structural parameters | |
|---|---|
| LV size | |
| Utility/Advantages: | Enlargement sensitive for chronic significant AR, important for outcomes. Normal size virtually excludes significant chronic AR. |
| Limitations: | Enlargement seen in other conditions. May be normal in acute significant AR. |
| Aortic cusps alterations | |
| Utility/Advantages: | Simple, usually abnormal in severe AR; Flail valve denotes severe AR. |
| Limitations: | Poor accuracy, may grossly underestimate or overestimate the defect. |
| Doppler parameters | |
| Jet width or jet cross-sectional area in LVOT –Color Flow | |
| Utility/Advantages: | Simple, very sensitive, quick screen for AR. |
| Limitations: | Expands unpredictably below the orifice. Inaccurate for eccentric jets. |
| Vena contracta Width | |
| Utility/Advantages: | Simple, quantitative, good at identifying mild or severe AR. |
| Limitations: | Not useful for multiple AR jets. Small values; thus small error leads to large % error. |
| PISA method | |
| Utility/Advantages: | Quantitative. Provides both lesion severity (EROA) and volume overload (R vol). |
| Limitations: | Feasibility is limited by aortic valve calcifications. Not valid for multiple jets, less accurate in eccentric jets. Provides peak flow and maximal EROA. Underestimation is possible with aortic aneurysms. Limited experience. |
| Flow quantitation–PW | |
| Utility/Advantages: | Quantitative, valid with multiple jets and eccentric jets. Provides both lesion severity (EROA, RF) and volume overload (R Vol). |
| Limitations: | Not valid for combined MR and AR, unless pulmonic site is used. |
| Jet density–CW | |
| Utility/Advantages: | Simple. Faint or incomplete jet compatible with mild AR. |
| Limitations: | Qualitative. Overlap between moderate and severe AR. Complementary data only. |
| Jet deceleration rate (PHT) –CW | |
| Utility/Advantages: | Simple. |
| Limitations: | Qualitative; affected by changes in LV and aortic diastolic pressures. |
| Diastolic flow reversal in descending aorta –PW | |
| Utility/Advantages: | Simple. |
| Limitations: | Depends on rigidity of aorta. Brief velocity reversal is normal. |
AR, Aortic regurgitation; CW, continuous wave Doppler; EROA, effective regurgitant orifice area; LV, left ventricle; LVOT, left ventricular outflow tract; MR, mitral regurgitation; PHT, pressure half-time; PW, pulsed wave Doppler; R Vol, regurgitant volume; RF, regurgitant fraction; VC, vena contracta width.