ACUTE AORTIC REGURGITATION IN CRITICALLY ILL PATIENTS - IMPORTANCE OFECHO-DOPPLER STUDIES

The aim of this study was to determine the relative value of clinical, echocardiographic, Doppler, and catheterization examinations in recog nizing the presence and estimating the severity of acute aortic regurg itation in critically ill patients. Retrospective analyses of clinical , echocardiographic, Doppler, and cardiac catheterization data were pe rformed. Twenty-four acutely ill patients with echo-Doppler evidence o f acute severe aortic regurgitation who either underwent aortic valve replacement (n = 21) or died and had autopsies (n = 3) were studied. C linically, acute severe regurgitation was diagnosed in the presence of an early diastolic murmur accompanied by tachypnea, tachycardia, and bilateral basilar rales. By echo-Doppler, acute severe aortic regurgit ation was diagnosed in the presence of early closure of the mitral val ve on the M-mode echocardiogram and an aortic regurgitation velocity h alf-time < 280 ms by continuous-wave Doppler ultrasound. The sensitivi ty of the clinical findings and noninvasive studies was assessed again st invasive estimates of regurgitation severity by aortography in 12 p atients and ventricular sump flow at the time of aortic valve replacem ent in 21 patients. By clinical examination, aortic regurgitation was detected in 18 (75%) patients, but was considered severe in only 12 (5 0%). M-mode echocardiography detected the presence of aortic regurgita tion in 12 patients, but premature closure of the mitral valve was see n in only 6 (25%). Doppler studies detected the presence of aortic reg urgitation in all 24 patients, and Doppler half-time < 280 ms accurate ly predicted aortic regurgitation severity in all but 2 patients. The latter patients had a markedly elevated left ventricular end-diastolic pressure and a moderately severe rather than a severe aortic regurgit ation by aortography. Aortography added little to the information alre ady obtained by Doppler studies. Two patients died while waiting for a ortography. Coronary angiography detected associated coronary artery d isease in 3 of the 12 patients. Clinically, it is difficult to evaluat e the severity of acute aortic regurgitation in the critically ill. Th e continuous-wave Doppler half-time method permits noninvasive, rapid detection and accurate estimation of aortic regurgitation severity. Ca rdiac catheterization is recommended only when the noninvasive evaluat ion is inconclusive or evaluation of the coronary anatomy is indicated .