Continuous aortic regurgitation in severely dysfunctional native hearts after heterotopic cardiac transplantation

Doppler techniques were used to investigate the frequency and characteristics of aortic regurgitation (AR) in the severely deteriorated native heart after heterotopic cardiac transplantation. Ten patients were studied in whom the native left ventricular fractional shortening was less than 6%. AR was detected by Doppler in 6 patients. The AR was continuous throughout the cardiac cycle in 3 patients, continuous when present (but not occurring with every beat) in 2 patients and present throughout diastole and continued into midsystole in the remaining patient. AR was associated with abnormalities of aortic valve opening (either its complete or intermittent absence) and with poor forward flow and even reversed flow through the native heart. It is postulated that AR in this group mainly occurs as a result of abnormal locking of the aortic valve due to severely impaired left ventricular ejection. Abnormal left ventricular diastolic function and enlargement may also be contributory.