FLOW REVERSAL IN THE DESCENDING AORTA - A GUIDE TO INTRAOPERATIVE ASSESSMENT OF AORTIC REGURGITATION WITH TRANSESOPHAGEAL ECHOCARDIOGRAPHY

This study assessed the value of biplane transesophageal echocardiogra phic assessment of diastolic flow reversal in the descending aorta as an alternative to Doppler color flow imaging in determining severity o f aortic regurgitation. In 45 patients undergoing cardiac operations, the severity of aortic regurgitation was assessed by semiquantitative grading of the width of the Doppler color flow regurgitant jet relativ e to the left ventricular outflow tract, and the presence of diastolic how reversal was assessed with pulsed-wave Doppler measurements at th ree sites in the descending aorta. In four patients, the diastolic flo w reversal method was the only available form of assessment because of inadequate visualization of the left ventricular outflow tract beneat h a mitral valve prosthesis. Diastolic Bow reversal in the descending aorta was not observed in patients without aortic regurgitation and wa s always present in patients,vith severe aortic regurgitation. Aortic valve replacement successfully eliminated descending aortic flow rever sal in all 19 patients in whom it was present before valve replacement . Identification of diastolic Bow reversal at multiple sites in the de scending aorta with biplane transesophageal echocardiography helps to confirm the presence of severe aortic regurgitation and can serve as a n alternative method of assessment when visualization of the left vent ricular outflow tract is impaired.