Echoing the Classics: Femoral Artery Doppler as the Modern-Day Traube's and Duroziez's Signs in Severe Aortic Regurgitation: A Case Series

Figures

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  Figure 1. Case 1. Two-dimensional (2D) TTE, parasternal long-axis (A) and apical long-axis (B) diastolic views without (left) and with (right) color-flow Doppler, demonstrates aortic root dilatation and severe AR; continuous-wave (C) and pulsed-wave (D) Doppler across the aortic valve demonstrates dense spectral Doppler AR display with diastolic flow reversal in the FA spectral Doppler profile (arrow). Intraoperative 2D TEE, midesophageal long-axis (143°) zoom view (E), demonstrates normal aortic valve leaflet motion, aortic effacement with an ascending aortic aneurysm, and a mobile, linear echo-density (arrow) consistent with a type A aortic dissection. Ao, Aorta; ERO, effective regurgitant orifice; LA, left atrium; LV, left ventricle; RV, right ventricle; RVol, regurgitant volume; VC, vena contracta.

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  Figure 2. Case 2. Two-dimensional (2D) TTE, systolic (A) and diastolic (B) parasternal long-axis apical 3-chamber diastolic view with and without color-flow Doppler (C), and 2D TEE, midesophageal zoomed orthogonal biplane (125° and 55°) diastolic views with color-flow Doppler, demonstrate severe eccentric AR jet. Pulsed-wave Doppler of the descending thoracic aorta from the deep esophageal view (E) demonstrates a spectral Doppler profile with anterograde systolic flow without holodiastolic flow reversal; pulsed-wave Doppler of the FA (F) demonstrates a spectral Doppler profile with holodiastolic flow reversal (arrow); continuous-wave Doppler (G) demonstrates high aortic valve velocity and transvalvular gradients. LA, Left atrium; LV, left ventricle; LVIDd, left ventricular internal diameter end diastole; LVIDs, left ventricular internal diameter end systole; LVOT, left ventricular outflow tract; RV, right ventricle.

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  Figure 3. Case 2. Cardiac computed tomography, noncontrast (A) and systolic phase (B) multiplanar reconstruction, oblique long-axis views, demonstrates severe calcification and degeneration of the bioprosthetic valve with restricted leaflet opening (arrows). Ao, Aorta; LA, left atrium; LV, left ventricle; PA, pulmonary artery.

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  Figure 4. Case 3. Two-dimensional TEE, deep gastric long-axis (0°) diastolic view with color-flow Doppler (A) and zoomed mid-esophageal long-axis (135°) diastolic view without (left) and with (right) color-flow Doppler (B), demonstrates thickened, restricted aortic valve leaflets with a coaptation gap and severe AR. Pulsed-wave Doppler demonstrates holodiastolic flow reversal (arrows) in the spectral Doppler profiles from the descending aorta (C), abdominal aorta (D), and FA (E). Ao, aorta; LA, left atrium; LV, left ventricle; RV, right ventricle.

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  Figure 5. Case 4. Two-dimensional TEE, midesophageal long-axis (A; 135°) and short-axis (B; 30°) diastolic view without (left) and with (right) color-flow Doppler, demonstrates a ruptured sinus of Valsalva aneurysm with an aorta–to–right ventricle shunt; pulsed-wave Doppler demonstrates holodiastolic flow reversal (arrows) in the spectral Doppler profiles from the descending aorta (C), abdominal aorta (D), and FA (E).

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  Figure 6. Case 5. Two-dimensional TTE, apical 5-chamber diastolic view without (left) and with (right) color-flow Doppler (Nyquist limit setting at 61 cm/sec [A] and 23 cm/sec [B]), demonstrates an aneurysmal aortic root with severe AR; continuous-wave and pulsed-wave spectral Doppler displays demonstrate a dense AR profile (C) and holodiastolic flow reversal (arrows) in the aortic arch (D) and FA (E). Ao, Aorta; ERO, effective regurgitant orifice; LA, left atrium; LV, left ventricle; RVol, regurgitant volume; VC, vena contracta.

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  Figure 7. Case 5. Two-dimensional TEE, deep transgastric long-axis (155°) diastolic view with color-flow Doppler (A) and midesophageal long-axis (130°) end-diastolic zoomed view (B), demonstrates severely dilated aortic root with aortic valve coaptation gap and severe AR. Three-dimensional TEE, photorealistic volume-rendered short-axis (60°) diastolic view of the aortic valve without (C) and with (D) color-flow Doppler, demonstrates the trileaflet aortic valve coaptation gap and central AR.

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  Figure 8. Illustration demonstrating diastolic flow reversal in the FA using pulsed-wave Doppler echocardiography, along with the corresponding eponymous signs of severe AR: Traube's sign and Duroziez's sign.