Bidirectional instantaneous aortic root blood flow was measured in 18 patients with aortic insufficiency (AI) using a catheter-tip velocity transducer. The magnitude of AI was quantitated by determining total forward systolic flow from the area of the flow velocity curve above the zero baseline and regurgitant diastolic flow from the curve area below the baseline. Effective forward flow (stroke volume) was calculated as the difference between total forward systolic flow and regurgitant diastolic flow. Regurgitant fraction was determined as the ratio of regurgitant flow to total forward flow. These data were compared with conventional angiographic estimates (1+ to 4+) of the degree of insufficiency. Velocity transducer determination of regurgitant fraction was 26% in the patient with 1+ AI, 37% (31-48%) in 2+ AI, 49% (35-61%) in 3+ AI and 72% in 4+ AI (regurgitant fraction vs angiographic grade, r = 0.84). Regurgitant flow per diastole was 9 ml in the patient with 1+ AI, 39 ml (20-49 ml) in 2+ AI, 57 ml (31-102 ml) in 3+ AI and 183 ml (143 and 223 ml) in 4+ AI (regurgitant diastolic flow vs angiographic grade, r = 0.73). Good correlation (r = 0.90) was found between values of regurgitant flow obtained from the left ventriculogram and those obtained using the velocity transducer. Although the overall association was good, wide, variability in regurgitant fraction and regurgitant flow was found in the 15 patients with 2+ to 3+ AI. These results suggest that the electromagnetic velocity catheter offers a simple technique for quantitating AI.
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