Aortic Regurgitation

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]