Aortic regurgitation – eccentric jet

Aortic regurgitation – eccentric jet

Eccentric jet of aortic regurgitation cursing along the posterior margin of the left ventricular outflow tract (anterior mitral leaflet). Estimation of severity of eccentric jets may be erroneous as often the severity tends to be underestimated in case of eccentric jets. AR: aortic regurgitation; LA: left atrium; LV: left ventricle; RV: right ventricle. The frame to the right is a systolic frame and the left one is a diastolic frame. The systolic frame shows the mitral valve in the closed position while the diastolic frame shows it in the open position. The anterior mitral leaflet shows a reverse doming as the aortic regurgitation jet strikes it. Systolic frame also shows a trivial mitral regurgitation into the left atrium, just behind the mitral valve as a bluish mosaic jet.

Measurement of vena contracta or the width of the proximal regurgitant jet for grading aortic regurgitation becomes unreliable when the jet is eccentric. In central jets, a jet width less than 0.3 cm is highly specific for mild AR and a width more than 0.6 cm is highly specific for severe AR [1].

Eccentric aortic regurgitation has been described in patients with right coronary cusp prolapse complicating a ventricular septal defect [2]. In a study of 129 patients, 27 had moderate aortic regurgitation. Of these 14 had eccentric aortic regurgitation jet. One of the patients who had mild aortic regurgitation (AR) initially had eccentric jet when it progressed to moderate AR. 5 of the 9 patients with mild eccentric AR jets progressed to moderate eccentric AR jets. At the same time, only 7 of 105 who had mild central AR progressed to moderate AR. The authors concluded that eccentric AR is highly likely to progress and is malignant [2].

Eccentric aortic regurgitation has been reported in ascending aortic aneurysm [3]. As the usual assessment of severity was erroneous, proximal isovelocity surface area (PISA) method had to be used for quantification of aortic regurgitation.

References

1. Tomita H, Yamada O, Kurosaki K, Yagihara T, Echigo S. Eccentric aortic regurgitation in patients with right coronary cusp prolapse complicating a ventricular septal defect. Circ J. 2003 Aug;67(8):672-5.
2. Maurer G. Aortic regurgitation. Heart. 2006 Jul;92(7):994-1000.
3. Chatzikyriakou S, Tsiapras D, Sbarouni E, Voudris V. Eccentric aortic valve regurgitation and ascending aorta aneurysm. European Society of Cardiology. EACVI Valvular Imaging Box. Valvular Imaging Clinical cases.