Fig. 5

Decision aid to guide assessment of aortic regurgitation severity. If AR visually appears mild or less in severity, this should be clarified using a selection of the specific criteria as listed in the green box. If confirmed, there is no need to attempt further assessment. In those patients where AR appears more than mild, further detailed evaluation is required. In this scenario, the severity of AR can be confirmed if at least one quantitative / qualitative characteristic, one corroborative characteristic, and indexed left ventricular volumes are all in agreement. For example: a patient with a VC of 0.7cm, holodiastolic flow reversal in the descending thoracic aorta, and dilated indexed LV volumes, clearly has severe AR. In this situation the focus should then be on key prognostic features including the indexed LVESd, LV function, and aortic dimensions. If quantitative/qualitative characteristics, corroborative characteristics, and indexed LV volumes are not in agreement, further imaging such as TOE is recommended to clarify severity and ensure optimal management of the patient. In a significant minority of cases, quantitative assessment will not be possible, either because image quality is insufficient, or other factors such as valve calcification impedes detailed quantification. In such cases, the BSE recommend that further imaging (such as TOE) is advised within the report. This ensures appropriate classification of AR severity, optimal timing of follow-up and promotes good clinical management. (AR = aortic regurgitation; LVOT = left ventricular outflow tract; Ao = aorta; CW = continuous wave; PHT = pressure half time; LV = left ventricular; LVOTd = left ventricular outflow tract diameter; VC = vena contract; EROA = effective regurgitation office area; LVESd = left ventricular end systolic dimension; LVEF = left ventricular ejection fraction; TOE = transoesophageal echocardiography)