Aortic Regurgitation

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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


Classification of Severity
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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