Sellers grading in cath
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Sellers grading aortic regurgitation cardiac catheterization aortography
Here is a complete breakdown of Sellers grading used during cardiac catheterization:
Sellers Grading of Aortic Regurgitation (AR)
Sellers grading (Sellers et al., 1964) is a semi-quantitative angiographic method to assess the severity of aortic regurgitation during cardiac catheterization. Contrast dye is injected into the aortic root (aortography), and the degree of diastolic backflow of contrast into the left ventricle (LV) is graded on a 1+ to 4+ scale.
The Grading Scale
| Grade | Severity | Description |
|---|---|---|
| 1+ | Mild | A small amount of contrast enters the LV during diastole and clears with each systole (LV never becomes fully opacified) |
| 2+ | Moderate | Contrast enters the LV with each diastole, but the LV is less dense than the aorta (incomplete filling) |
| 3+ | Moderately Severe | The LV is equal in density to the ascending aorta |
| 4+ | Severe | Complete, dense opacification of the LV on the first beat; the LV is more densely opacified than the ascending aorta |
Key Points to Remember
- Procedure: Contrast is injected into the aortic root; retrograde flow into the LV is assessed visually.
- Catheter position matters: If the catheter is placed too close to the aortic valve, AR will be overestimated.
- Injection volume/rate: A high-volume, high-rate injection can also artificially inflate the grade.
- Hemodynamics: Afterload conditions at the time of assessment affect the apparent severity.
- Limitation: Sellers grading has weak inter-observer reproducibility (kappa 0.47-0.72), which is why quantitative methods (e.g., regurgitant fraction by cardiac MRI) are preferred when precision is needed.
- TAVI context: Sellers grading has been adapted for post-TAVI aortic regurgitation assessment (Frick et al.), making it relevant in structural heart disease interventions.
Memory Aid
Think of it as how much the LV "fills up" with contrast:
- 1+: Washes out (clears each beat)
- 2+: Stays but faint (less than aorta)
- 3+: Matches the aorta
- 4+: Beats the aorta (denser than aorta from beat 1)
This grading directly parallels the clinical severity of AR and guides decisions on valve intervention.
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