To analyze the echocardioimagedata features of solo-systolic aortic regurgitation (SSAR) after continuous flow (CF) left ventricular assist device (LVAD) implantation to approach its mechanisms and clinical significance.

We retrospectively identified four patients with SSAR after CF-LVAD implantation at TEDA International Cardiovascular Hospital from March 2019 to June 2022. Pre-operative transthoracic echocardiography (TTE), intra- and post-operative transesophageal echocardiography (TEE), and follow-up TTE were performed in all patients. The aortic root dimensions, aortic valvular opening, aortic regurgitation duration, and vena contracta (VC) width were measured and analyzed.

Post-implantation TTE revealed ventricular septal paradoxical motion due to the unloading of the left ventricle, whereas the septum slightly bowed towards the left ventricle during diastole. The systolic velocity of mitral annulus motion became significantly reduced or negative. The aortic valve consistently closed or intermittently opened. The diameter of the aortic annulus and aortic sinus slightly increased. The morphology of the aortic annulus changed throughout the cycles, with the AV annulus abnormally distorted and dilated during systole. SSAR occurred in four cases (16.7 %), graded as minimal or mild. Subsequent follow-up results showed that SSAR was transient or unchanged in three cases and was worsening in one case.

SSSAR post-LVAD implantation is a peculiar and previously neglected hemodynamic sign, which relates to left ventricular unloading and reversed transaortic pressure gradient resulting from LVAD support. SSAR may serve as s surrogate for early reversible aortic valve lesions owing to the special pathophysiology of CF-LVAD.