Peripheral angiographic view of severe aortic regurgitation

A 72-year-old hypertensive male patient was admitted to the emergency ward with chest discomfort and exertional dyspnea. Because his chest pain was suggestive of ischemia and his troponin was elevated more than 11 times the upper limit of normal, a coronary angiography was planned. During sheath placement, a femoral bruit was noticed. An angiographic view was obtained at the end of catheterization, which revealed forward and reverse flow of opaque along the right femoral artery (Video 1). Because there had been a diastolic murmur at the left sternal border upon physical evaluation, the first diagnosis we suspected was aortic regurgitation (AR). Transthorasic echocardiography performed after angiography also confirmed severe AR. AR is one of the most commonly encountered heart valve diseases. As for any disease, physical examination is essential for the diagnosis of AR. In addition to auscultation of the heart murmurs, there are classic peripheral signs of AR that show as a result of the widened pulse pressure, such as Duroziez’s sign (murmur) and Traube’s sign (pistol-shot sound), both of which are auscultated over the femoral artery. Echocardiography is a crucial technique used to confirm the diagnosis of AR as well as to assess its severity, prognosis, and valve morphology. Holodiastolic flow reversal in the descending aorta and the abdominal aorta is a qualitative hallmark of severe AR.