Abstract
[first paragraph of article]Severe aortic regurgitation (AR) and/or severe abnormalities of the aortic root and the tubular ascending aorta (TAA) are indications for surgical treatment. The correct diagnosis, the choice of optimal treatment, as well as optimal timing of surgery, mainly depend on findings obtained by echocardiography - which is usually the initial diagnostic modality applied in clinical practice. Therefore, an appropriate morphological and functional quantification of the aortic valve (AV) and the aortic root complex is required. Aside from the need of standardization to provide a precise objective evaluation, the use of modern echocardiographic technologies - especially 3D-echocardiography -are less often implemented in clinical routine. The present manuscript focuses on the advantages of transthoracic and transesophageal 3D-echocardiography (TTE, TEE) for an improved assessment of the AV and the aortic root complex to provide accurate and comprehensive measurements for making the correct diagnosis and defining further therapeutic strategies.
Highlights
Severe aortic regurgitation (AR) and/or severe abnormalities of the aortic root and the tubular ascending aorta (TAA) are indications for surgical treatment1–9
The assessment of cusp morphology and function can be best performed by CL, eH and gH, which is possible for all cusps using 3D-echocardiography
Sufficient training and experience is required before it can be applied in clinical routine
Summary
Severe aortic regurgitation (AR) and/or severe abnormalities of the aortic root and the tubular ascending aorta (TAA) are indications for surgical treatment. Applying conventional 2D-echocardiography AR is qualitatively diagnosed by suspicious morphological findings of the cusps, by diastolic regurgitant jet formation into the left ventricle (LV) using color-coded Doppler echocardiography, by retrograde signals of transvalvular velocities using continuouswave (CW) Doppler echocardiography, or by diastolic reversal flow of the arterial velocities determined in the proximal descending aorta or in the left subclavian artery using pulsed-wave (PW) Doppler echocardiography. The size and the shape of the regurgitant jet area are generally not recommended for quantification of AR severity, mainly due to considerable effects of methodological issues, ultrasound system settings, and individual hemodynamic situations on the color flow signal. According to the current guidelines several semi-quantitative parameters are recommended for quantification of AR severity.
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