COMPARED LOCATIONS OF THE REGURGITANT AORTIC JETS AT THEIR ORIGIN ANDIN THE LEFT-VENTRICLE - A DOPPLER APPROACH TO THE UNDERLYING TYPE OF AORTIC ORIFICES IN ADULT PATIENTS

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 or ifice (AO-O) in connection with the normal, in case of tricuspid, or a bnormal commissural closure line, in case of bicuspid orifices, might entail different directions of regurgitant jets in the left ventricula r 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 s tudied in order to determine their locations-anterior, central or post erior-and if these locations were similar or not at both sites. Data w ere reviewed and correlated with the number of cusps on 53 patients op erated for aortic regurgitation. There were 83% tri- and 16.9% bicuspi d valves. In 43 patients with tricuspid AO-O, similar locations were f ound between JO, having a central onset, with or without an anterior o r posterior spreading, and jets in the LVOT: central 38%, anterior 9%, posterior 53%. In 10 patients, there was discrepancy between an eccen tric onset of JO and the direction of jets in the LVOT, spreading towa rds the opposite location. Nine of these patients had bicuspid AO-O. T here was 1 false-positive bicuspid AO-O (sensitivity and specificity r anging from 90 to 100%). Thus, coupling both the imaging of the regurg itant jet at the AO-O and the LVOT is a reliable method to rapidly ass ess the underlying type of AO-O, whatever the age and the calcificatio ns.