Reviewed and revised 13/6/12
- aortic regurgitation is diastolic reflux of blood from aorta to LV due to malposition of the aortic cusps.
RISK FACTORS
- age
- enlarged aortic root diameter: Marfans, Enhlers-Danlos, oesteogenesis imperfecta, connective tissue disorders
- bicuspid AV
- atherosclerosis
- infective endocarditis
- rheumatic heart disease
- connective tissue or inflammatory diseases
- antiphospholipid syndrome
- trauma
- ankylosing spondilitis
SYMPTOMS
- SOBOE
- angina
- LVF
EXAMINATION
- decrescendo diastolic murmur
- systolic ejection murmur (high ejection volume)
- absent second heart sound
- bounding carotid pulse
- head bobbing
- uvula pulsation
- pistol shot sounds over femoral artery
- compression of finger nails with a glass slide: capillary pulsations
ECHO
Goals
- look at anatomy of aortic valve leaflets and root
- assess severity of AR
- quantify LV size and function
Anatomy
- leaflets: bicuspid, tricuspid, vegetations, degeneration.
- annulus: size
- root: size of sinus of Valsalva, dissection
Severity
- jet width/LVOT width (< 25% = mild, >65% = severe)
MANAGEMENT
Indications for aortic valve replacement
- acute AR
- any symptoms (NYHA II or greater)
- declining EF
- declining EF with exercise
Non-surgical issues
- best to operate before LV end-diastolic diameter increases to >55 mm or 25 mm/m2 or before LVEF falls to <55%
- avoid beta-blockers (prolongs diastole)
- intra-aortic ballon pump is contra-indicated
- decrease afterload in chronic AR (improves LV function)
References
Lifeinthefastlane.com
- ICU Mind Maps by Paul Young
Journal articles and textbooks
- Bekeredjian R, Grayburn PA. Valvular heart disease: aortic regurgitation. Circulation. 2005 Jul 5;112(1):125-34. Review. Erratum in: Circulation. 2005 Aug 30;112(9):e124. PubMed PMID: 15998697 [Free Fulltext]
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