A New Approach to Assessment of Aortic Regurgitation; Planimetric Measurement of Diastolic Aortic Valve Malcoaptation Area by Transesophageal Echocardiography

Doppler echocardiographic calculation of regurgitant orifice area (ROA) is a different approach in the assessment of the severity of aortic regurgitation (AR), but these Doppler methods are based on indirect calculation of ROA, However, there is no available echocardiographic study in which diastolic coaptation defect of the regurgitant aortic valve measured by planimetry. The aim of this study is to evaluate AR severity by planimetric measurement of diastolic coaptation defect in patients who underwent transesophageal echocardiography (TEE). Diastolic coaptation defect was defined as diastolic aortic valve malcoaptation area (DA VMA). Study population comprised 90 patients (M 38, F 52, mean age 42±26) with AR which were gradedas mild (n=45), moderate (n=3 ı ) and severe (n=ı4) by hemodynamic assessment (HA). Mean values of DA VMA for each groups of AR grade were determined by TEE and cut-of limits which differentiate each corresponding AR grade from other grades were investigated. Mean DA VMA of mild, moderate and severe AR groups were O . ı5±0 . 05 , 0.29±0.08 and 0.68±0.21 cmı, respectively (mil d vs moderate P0.2-0.4 cm2) and severe (>0.4 cm2) coaptation defect. For mild AR, sensitivity, specificity, positive and negative predictive value (PD+, PD-) and diagnostic accuracy (DA) of DAVMA (<0.2 cm2) were 85, 97, 97, 87, and 91 %, respectively. Also, sensitivity, specificity, PO (+), PD (-),DA of DAVMA (>0.2-0.4 cm2) were 84, 92, 8 ı , 93, and 90 % for mil d AR; and of DA VMA (>0.4) were 98, 93, 93, 98 and 97 %for severe AR. DAVMA is found to be well correlated (r=0.75) with AR grades as determined by HA. We conclude that transesophageal planimetric measurement of DA VMA is reliable and feasible method based on functional anatomic assessment of the valve to evaluate severity of aortic regurgitation.