From the Guidelines
Rocking of the heart seen on Parasternal Long Axis (PLAX) Transthoracic Echocardiogram (TTE) is a significant finding that may indicate paravalvular regurgitation, particularly in patients with prosthetic heart valves. This phenomenon is often associated with abnormal mechanical or biologic valves, characterized by immobile occluder, dehiscence, or rocking [ 1 ]. The presence of rocking motion can be an indicator of severe aortic prosthetic valve regurgitation, which can be further evaluated using qualitative, semi-quantitative, and quantitative parameters, such as valve structure and motion, color flow AR jet width, and diastolic flow reversal in the descending aorta [ 1 ].
Key points to consider when evaluating rocking of the heart on TTE include:
- Abnormal valve structure and motion, such as immobile occluder, dehiscence, or rocking, which can indicate paravalvular regurgitation [ 1 ]
- Color flow Doppler imaging to demonstrate normal forward flow and pathologic regurgitation [ 1 ]
- Semi-quantitative parameters, such as pressure half-time, circumferential extent of paravalvular regurgitation, and vena contracta width, to assess the severity of regurgitation [ 1 ]
- Quantitative parameters, such as effective regurgitant orifice area and regurgitant volume, to evaluate the severity of regurgitation [ 1 ]
In clinical practice, the presence of rocking motion on TTE should prompt further evaluation to determine the underlying cause and severity of the regurgitation. This may involve additional imaging modalities, such as transesophageal echocardiography (TOE) or cardiac magnetic resonance (CMR), to provide a more comprehensive assessment of the prosthetic valve and surrounding structures [ 1 ].