Compared Locations of the Regurgitant Aortic Jets at Their Origin and in the Left Ventricle: A Doppler Approach to the Underlying Type of Aortic Orifices in Adult Patients

Abstract

Echocardiography is often at failure to assess a tri- or bicuspid type of orifice in aortic regurgitation on patients over 50 years old. We hypothetized that the sites of the Doppler flow areas at the aortic orifice (AO-O) in connection with the normal, in case of tricuspid, or abnormal commissural closure line, in case of bicuspid orifices, might entail different directions of regurgitant jets in the left ventricular outflow tract (LVOT) leading to this assessment. Doppler onsets and locations of jet origin (JO) at the AO-O in the long and short aortic views and of regurgitant jets in the LVOT in the long-axis view were studied in order to determine their locations - anterior, central or posterior - and if these locations were similar or not at both sites. Data were reviewed and correlated with the number of cusps on 53 patients operated for aortic regurgitation. There were 83% tri- and 16.9% bicuspid valves. In 43 patients with tricuspid AO-O, similar locations were found between JO, having a central onset, with or without an anterior or posterior spreading, and jets in the LVOT: central 38%, anterior 9%, posterior 53%. In 10 patients, there was discrepancy between an eccentric onset of JO and the direction of jets in the LVOT, spreading towards the opposite location. Nine of these patients had bicuspid AO-O. There was 1 false-positive bicuspid AO-O (sensitivity and specificity ranging from 90 to 100%). Thus, coupling both the imaging of the regurgitant jet at the AO-O and the LVOT is a reliable method to rapidly assess the underlying type of AO-O, whatever the age and the calcifications.