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Fig. 3. —78-year-old woman with severely stenotic aortic valve
complicated by aortic regurgitation. Doppler sonography waveforms from
arteries (right common carotid artery is shown as example) show bisferious
pulse, with prominent mid systolic retraction (arrow) distinct from
dicrotic notch (arrowhead). Dicrotic notch is normal finding and is
because of closure of aortic valve, temporary cessation of forward flow,
followed by resumption of forward flow driven by elastic rebound of aortic
wall. Mechanism of pulsus bisferiens in aortic insufficiency is not well
understood. One view is that first peak represents initial high-volume
ejection of blood, which is followed by abrupt mid systolic flow deceleration
caused by regurgitant valve, and second peak represents tidal wave reflected
from distended aorta as it relaxes or from periphery of body. Others argue
that rapid ejection of large volume of blood (increased preload of left
ventricle) creates transient suction (Venturi) effect in aorta, which in turn
produces mid systolic retraction in carotid artery waveform.
