Aortic regurgitation in the elderly: Difference between revisions
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| [[File:Siren.gif|30px|link=Aortic regurgitation resident survival guide]]|| <br> || <br> | |||
| [[Aortic regurgitation resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']] | |||
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{{Aortic insufficiency}} | |||
{{CMG}}; '''Associate Editor-in-Chief:''' {{CZ}}; [[Varun Kumar]], M.B.B.S.; [[Lakshmi Gopalakrishnan]], M.B.B.S. | |||
{{ | ==Incidence== | ||
The incidence of aortic regurgitation in the elderly is low in comparison to the incidence of [[aortic stenosis]] and [[mitral regurgitation]].<ref name="pmid10190406">{{cite journal |author=Singh JP, Evans JC, Levy D, Larson MG, Freed LA, Fuller DL, Lehman B, Benjamin EJ |title=Prevalence and clinical determinants of mitral, tricuspid, and aortic regurgitation (the Framingham Heart Study) |journal=[[The American Journal of Cardiology]] |volume=83 |issue=6 |pages=897–902 |year=1999 |month=March |pmid=10190406 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0002-9149(98)01064-9 |accessdate=2011-03-28}}</ref> The majority of elderly patients have combined [[aortic stenosis]] and [[aortic insufficiency]] and the incidence of pure [[aortic insufficiency]] is rare.<ref name="pmid9307446">{{cite journal |author=Akins CW, Daggett WM, Vlahakes GJ, Hilgenberg AD, Torchiana DF, Madsen JC, Buckley MJ |title=Cardiac operations in patients 80 years old and older |journal=[[The Annals of Thoracic Surgery]] |volume=64 |issue=3 |pages=606–14; discussion 614–5 |year=1997 |month=September |pmid=9307446 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0003497597006152 |accessdate=2011-04-07}}</ref> | |||
==Etiology== | |||
*Acute aortic regurgitation in the elderly is due to either [[aortic dissection]] or [[infective endocarditis]].<ref name="pmid15470217">{{cite journal| author=Enriquez-Sarano M, Tajik AJ| title=Clinical practice. Aortic regurgitation. | journal=N Engl J Med | year= 2004 | volume= 351 | issue= 15 | pages= 1539-46 | pmid=15470217 | doi=10.1056/NEJMcp030912 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15470217 }} </ref><ref name="pmid24603191">{{cite journal| author=Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA et al.| title=2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. | journal=J Am Coll Cardiol | year= 2014 | volume= 63 | issue= 22 | pages= e57-185 | pmid=24603191 | doi=10.1016/j.jacc.2014.02.536 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24603191 }} </ref> | |||
*Chronic aortic regurgitation is due to [[hypertension]], calcification-related [[aortic stenosis]], or [[bicuspid aortic valve]] causing [[ascending aorta]] dilatation with resultant aortic insufficiency.<ref name="Nishimura-2002">{{Cite journal | last1 = Nishimura | first1 = RA. | title = Cardiology patient pages. Aortic valve disease. | journal = Circulation | volume = 106 | issue = 7 | pages = 770-2 | month = Aug | year = 2002 | doi = | PMID = 12176943 }}</ref><ref name="Nishimura-2002">{{Cite journal | last1 = Nishimura | first1 = RA. | title = Cardiology patient pages. Aortic valve disease. | journal = Circulation | volume = 106 | issue = 7 | pages = 770-2 | month = Aug | year = 2002 | doi = | PMID = 12176943 }}</ref><ref name="Kim-1996">{{Cite journal | last1 = Kim | first1 = M. | last2 = Roman | first2 = MJ. | last3 = Cavallini | first3 = MC. | last4 = Schwartz | first4 = JE. | last5 = Pickering | first5 = TG. | last6 = Devereux | first6 = RB. | title = Effect of hypertension on aortic root size and prevalence of aortic regurgitation. | journal = Hypertension | volume = 28 | issue = 1 | pages = 47-52 | month = Jul | year = 1996 | doi = | PMID = 8675263 }}</ref> | |||
{{ | ==Treatment== | ||
*The goal of surgery in the elderly is to improve the quality of life; hence, the presence of symptoms is an important guide to determining whether or not [[Aortic valve replacement|aortic valve replacement/repair]] should be performed. | |||
*It is recommended that patients with asymptomatic chronic aortic regurgitation with evidence of marked [[left ventricular]] dilatation or [[left ventricular dysfunction]] to undergo surgery.<ref name="pmid18820172">{{cite journal |author=Bonow RO, Carabello BA, Chatterjee K, de Leon AC, Faxon DP, Freed MD, Gaasch WH, Lytle BW, Nishimura RA, O'Gara PT, O'Rourke RA, Otto CM, Shah PM, Shanewise JS |title=2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons |journal=[[Circulation]] |volume=118 |issue=15 |pages=e523–661 |year=2008 |month=October |pmid=18820172 |doi=10.1161/CIRCULATIONAHA.108.190748 |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=18820172 |accessdate=2011-03-28}}</ref> | |||
== | ==Prognosis== | ||
Younger and middle-aged patients with [[aortic regurgitation]] have better outcomes than elderly patients especially those over 75 years of age. Many of these patients have co-existing [[coronary heart disease]]s and develop [[left ventricular dysfunction]] and symptoms of [[heart failure]] earlier with poor postoperative survival rates.<ref name="pmid6872164">{{cite journal| author=Bonow RO, Rosing DR, McIntosh CL, Jones M, Maron BJ, Lan KK et al.| title=The natural history of asymptomatic patients with aortic regurgitation and normal left ventricular function. | journal=Circulation | year= 1983 | volume= 68 | issue= 3 | pages= 509-17 | pmid=6872164 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6872164 }} </ref> | |||
==References== | ==References== | ||
{{Reflist|2}} | |||
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[[CME Category::Cardiology]] | |||
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Latest revision as of 21:28, 4 January 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-in-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Varun Kumar, M.B.B.S.; Lakshmi Gopalakrishnan, M.B.B.S.
Incidence
The incidence of aortic regurgitation in the elderly is low in comparison to the incidence of aortic stenosis and mitral regurgitation.[1] The majority of elderly patients have combined aortic stenosis and aortic insufficiency and the incidence of pure aortic insufficiency is rare.[2]
Etiology
- Acute aortic regurgitation in the elderly is due to either aortic dissection or infective endocarditis.[3][4]
- Chronic aortic regurgitation is due to hypertension, calcification-related aortic stenosis, or bicuspid aortic valve causing ascending aorta dilatation with resultant aortic insufficiency.[5][5][6]
Treatment
- The goal of surgery in the elderly is to improve the quality of life; hence, the presence of symptoms is an important guide to determining whether or not aortic valve replacement/repair should be performed.
- It is recommended that patients with asymptomatic chronic aortic regurgitation with evidence of marked left ventricular dilatation or left ventricular dysfunction to undergo surgery.[7]
Prognosis
Younger and middle-aged patients with aortic regurgitation have better outcomes than elderly patients especially those over 75 years of age. Many of these patients have co-existing coronary heart diseases and develop left ventricular dysfunction and symptoms of heart failure earlier with poor postoperative survival rates.[8]
References
- ↑ Singh JP, Evans JC, Levy D, Larson MG, Freed LA, Fuller DL, Lehman B, Benjamin EJ (1999). "Prevalence and clinical determinants of mitral, tricuspid, and aortic regurgitation (the Framingham Heart Study)". The American Journal of Cardiology. 83 (6): 897–902. PMID 10190406. Retrieved 2011-03-28. Unknown parameter
|month=ignored (help) - ↑ Akins CW, Daggett WM, Vlahakes GJ, Hilgenberg AD, Torchiana DF, Madsen JC, Buckley MJ (1997). "Cardiac operations in patients 80 years old and older". The Annals of Thoracic Surgery. 64 (3): 606–14, discussion 614–5. PMID 9307446. Retrieved 2011-04-07. Unknown parameter
|month=ignored (help) - ↑ Enriquez-Sarano M, Tajik AJ (2004). "Clinical practice. Aortic regurgitation". N Engl J Med. 351 (15): 1539–46. doi:10.1056/NEJMcp030912. PMID 15470217.
- ↑ Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA; et al. (2014). "2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines". J Am Coll Cardiol. 63 (22): e57–185. doi:10.1016/j.jacc.2014.02.536. PMID 24603191.
- ↑ 5.0 5.1 Nishimura, RA. (2002). "Cardiology patient pages. Aortic valve disease". Circulation. 106 (7): 770–2. PMID 12176943. Unknown parameter
|month=ignored (help) - ↑ Kim, M.; Roman, MJ.; Cavallini, MC.; Schwartz, JE.; Pickering, TG.; Devereux, RB. (1996). "Effect of hypertension on aortic root size and prevalence of aortic regurgitation". Hypertension. 28 (1): 47–52. PMID 8675263. Unknown parameter
|month=ignored (help) - ↑ Bonow RO, Carabello BA, Chatterjee K, de Leon AC, Faxon DP, Freed MD, Gaasch WH, Lytle BW, Nishimura RA, O'Gara PT, O'Rourke RA, Otto CM, Shah PM, Shanewise JS (2008). "2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons". Circulation. 118 (15): e523–661. doi:10.1161/CIRCULATIONAHA.108.190748. PMID 18820172. Retrieved 2011-03-28. Unknown parameter
|month=ignored (help) - ↑ Bonow RO, Rosing DR, McIntosh CL, Jones M, Maron BJ, Lan KK; et al. (1983). "The natural history of asymptomatic patients with aortic regurgitation and normal left ventricular function". Circulation. 68 (3): 509–17. PMID 6872164.