Echocardiographic Evaluation of the Hemodynamic Effects of Chronic Aortic Insufficiency with Observations on Left Ventricular Performance

Abstract

Twelve patients with aortic insufficiency (AI) were investigated by echocardiographic methods using reflected ultrasound. No patients with associated mitral valvular disease were included. Estimates of each patient's aortic valvular total flow (Q At ) as computed from left ventricular cavity minor-axis dimension changes at end-diastole (D d ) and end-systole (D s ) were compared with their respective mitral valvular flows (Q M ) as estimated from the opening velocity of the anterior mitral leaflet. The arithmetic difference of the two valvular flows permitted calculation of the aortic regurgitant flow (Q Ar ) as Q At -Q M =Q Ar . In this series of patients Q At varied from 5.2 to 12.9 liters/min, Q M from 3.3 to 7.3 liters/min, Q Ar from 1.1 to 6.5 liters/min, ejection fraction (EF) from 0.37 to 0.60 and regurgitant fraction (Q Ar /Q At ) from 0.15 to 0.58. A statistically significant difference of Q At and Q M was not evident in a series of 20 patients without AI. Left ventricular performance in the patients with AI was estimated by echocardiographic methods by measuring the amplitude of systolic excursion of the left ventricular midwall (PWE), the mean velocity of posterior wall motion (mean PWV), and computation of the mean velocity of circumferential fiber shortening (V CF ) for the left ventricular myocardium. The data presented appear to provide a simple noninvasive method for serial observations of the hemodynamic consequences of AI and the eventual alteration of myocardial performance in such patients.