Holodiastolic reversal flow in the common carotid: another indicator of the severity of aortic regurgitation

Aortic regurgitation (AR) causes an increased diastolic reverse flow at various levels of aorta and its branching vessels. A prospective study was designed to evaluate the feasibility and accuracy of duplex sonography of the common carotid artery (CCA) in patients with various degrees of AR quantified by cardiac angiography. Twenty-four patients, with pure angiographic AR, of mean age 63.5 + 2.5-year old were included. Holodiastolic reverse flow (HRF) was recorded in all seven patients with severe angiographic AR (five with grade III and two with grade IV) and in none of the seventeen patients (eight with grade I and nine with grade II) with mild angiographic AR (p < 0.001). Furthermore, HRF was recorded both in the CCA and in the aorta, where it represents another criterion of severe AR, of six patients with severe angiographic AR and was absent in the eleven patients with grade I or II AR (p < 0.001). Demonstration of HRF in the CCA may be a very helpful criterion in distinguishing patients with severe AR.