if you've got aortic regurgitation you need to think why is this aortic valve leaking you need to think is it the valve or is it the aorta because an aortic valve May leak because there's an abnormality of the valve itself be degenerative or B cuspid or Rheumatic or have endocarditis but it may also leak because the aortic root is dilated so it stretches the valve apart and the cusps can't meet and so they leak we'll talk about dilated atis in another lesson but the aortic regot to is assessed in exactly the same ways in both situations so we're going to look at some quick ways to assess atic regurgitation as you scan you may want to get a more detailed or complex study done by an expert if it's important for the patient's management so let's look at this parasal long AIS view here you can see this bright color which is a jet of aortic regurgitation so I'm going to look at this in quite a lot of detail I'm going to look at the neck so the narrowest bit of the Jet right up at the valve here then I'm going to look at the jet as it moves into the outflow tract I'm particularly going to focus about a half to a centimeter away from the valve and I'm going to think how much of the outflow tra is this jet filling so my outflow trap goes from about here to here and I think this bright jet here is probably filling about half of that and then I'm going to use continuous wave Doppler in an apical 5 chamber view running my cursor through the AR jet itself and I'm going to get a signal like this and I'm going to look quite carefully at this cuz there a a lot of information in this so this is our forward flow through the valve you can see this is occurring in syy and I'm looking at this now to see how bright it is and then I'm going to look at the flowing Diest which is my regurgitant Jet and I'm going to compare the echo intensity so how bright is this compared to this if the AR was absolutely torrential they would be very similar this isn't this isn't as bright and echogenic and filled in so I think this is probably going to be moderate aortic regurgitation now if this AR jet was really sort of wispy and difficult to see and and the the whole waveform wasn't filled in properly I'd be thinking that's probably mild and that would because there just not as many red blood cells in that jet so I'm not getting such an intense signal back so now I've done that I'm going to think about the pressure half time which is this measurement here I'm measuring this from the peak of the a regurgitant jet to its minimum and then the machine's going to give me this number here the AR pressure half time so I've done a couple of signals here and got 244 and I got 225 and I'm going to remember this number cuz it's going to help me in my assessment this is a really useful view for looking for aortic regurgitation this is the super sternal view we're looking at the aortic Arch and the descending aor so let's look over here at this color flow now as you remember we're scanning from up here so any flow towards our probe will be red so think about that so flow down the descending a Ultra is normal is this very bright yellowy High Velocity turbulent flow but my AR is this very sort of soft red signal coming up towards my probe that's flow going backwards up the descending a so that's not normal and I'm going to look at this really carefully now so I'm going to look red red red and what I'm doing and it takes quite a bit of uh practice really to get your eye in on this is I'm seeing how long in diasty this flow is occurring I think it's probably most of di but it's quite difficult to see this so there are other ways to interrogate this timing of this AR Jet and this is one of them and this is where M mode is pretty useful really so we run our M mode cursor exactly through the part of the descending aot we were just looking at and we get this so we've got QRS showing us that this is cyly so this is our turbulent forward flow down the descending aort and then this is our regurgitant Jet and what I'm doing is looking to see how long this jet goes on does it go all the way to the end of diast well it pretty much does it stops about here doesn't it so it's not quite Hollow diastolic you can use pulse wave dopplers similarly here and just sample here and again see if you get any flow and diol and how long the flow lasts for so now I'm going to pull together all these pieces of information to help me make my assessment of how much aortic regurgitation there is I know that my pressure halftime measurement was coming out at 220 240 something like that so that was coming in the moderate range when I looked in the parisal long axis I thought the jet filled about half of the outflow traed when I looked at my continuous wave Doppler through the aortic valve looking at the atic regur jet I thought the regur jet was sort of in the moderate range it was sort of intermediate the intensity wasn't the same as forward flow so again that's putting things into the moderate range when I looked at flow in the descending aorta I thought the regurgitant jet was almost Hollow diastolic but not quite I didn't actually measure the width in the parisal long axis view which I could have done right at the valve cuz I didn't think the images were good enough to measure that properly but all in all I'm going to report this as a moderate jet of aortic regurgitation you do need to bear in mind that if the aortic regurgitation is severe the left ventricle should be hypodynamic and if your ejection fraction isn't suggesting that you need to be careful that you may have a decompensating situation and then another thing that's really really important to remember is the difference between acute severe aortic regurgitation and severe chronic regurgitation you can get acute atic regurgitation in endius or in a dissection and that is a serious volume load into an uncompensated left ventricle and it can be very serious a similar amount of chronic aortic regurgitation can be very well tolerated so whilst you assess the aortic regurgitation similarly and make your severity assessments exactly the same your reaction to your measurements and your findings should be different as the acute situation is potentially much much more dangerous so I hope you like this video absolutely make sure to check out the course this video was taken from and to register for a free trial account which will give you access to selected chapters of the course if you want to learn how met Mastery can help you become a great clinician make sure to watch the about me Mastery video so thanks for watching and I hope to see you again soon