[Pulsed Doppler echography in the quantification of aortic insufficiency in adults]

Since several methods based on doppler-echocardiography have been suggested to quantify aortic valve regurgitation, we compared two of these methods--left ventricular diastolic jet mapping and evaluation of blood flow in the descending aorta--with the results of left heart catheterization in 82 patients with aortic regurgitation. The invasive quantification rested on the degree of left ventricular opacification after contrast injection into the supra-sigmoid aorta, the results being classified into 3 grades. Left ventricular mapping was carried out using pulsed doppler ultrasound by the apical route; results were expressed as 3 grades of increasing severity. Blood flow in the aorta was recorded using pulsed doppler velocimetry by the suprasternal route at the level of the aortic isthmus where we measured the diastolic to systolic velocity integrals ratio (D/S). Apical mapping could be performed in 81 of the 82 patients, whereas suprasternal planimetry could be performed in only 56 patients (68 p. 100). Mapping provided good correlations with catheterization in 65 patients (80 p. 100); discordances were observed mainly in patients with aortic leakage due to prosthetic valve dysfunction (4/8 prosthetic valves) or with major left ventricular dilatation (found in 7 out of 9 cases of underestimation of leakage by the doppler system). The D/S ratio values obtained by the suprasternal route ranged from 16 to 28 p. 100 for mild angiographic leakage, from 34 to 66 p. 100 for moderate leakage, and from 52 to 155 p. 100 for severe leakage. "Borderline" values of 30 and 60 p. 100 respectively enabled the various degrees of aortic regurgitation to be separated. Despite their limitations, the non-invasive methods used in combination are effective in quantifying aortic regurgitation in most cases; mapping offers the advantage of simplicity: the suprasternal study is more accurate but cannot be performed in all patients.