AR supportive signs: jet/LVOT width & aortic flow reversal

Jet/LVOT, holodiastolic reversal · PLAX colour (jet width vs LVOT width just below the valve); PW in the proximal descending aorta (SSN) and abdominal aorta

Normal range & thresholds

• Jet width/LVOT ≥65% severe (central jets) ^[4].
• Holodiastolic reversal in the proximal descending aorta with end-diastolic velocity >20 cm/s supports severe AR; reversal in the abdominal aorta is more specific ^[4].

Pathophysiology

A large regurgitant orifice produces a wide jet at its origin and a diastolic runoff large enough to pull blood backward from the distal aorta throughout diastole.

Raised by

• Severe AR; also AV fistula, PDA, and a very compliant aorta can cause reversal

Lowered by

• Eccentric jets under-represented in width; low compliance

Technique & pitfalls

• Measure jet width within 1 cm of the valve; PW sample in the upper descending aorta with low filter.

Pseudo-change & artefact

• Eccentric jets; brief early-diastolic reversal is normal.

Treatment thresholds

• Supportive severity criteria; surgery driven by symptoms and LV triggers ^[6,7].

Next step

• PISA/volumetrics (card 67), CMR RF.

Drugs

BP control reduces regurgitant volume modestly.

Reversibility

Abolished by valve surgery.