Aortic regurgitation causes: Difference between revisions

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{{Aortic insufficiency}}
{{Aortic insufficiency}}
{{CMG}}; '''Associate Editor-In-Chief:''' {{CZ}}; [[Varun Kumar]], M.B.B.S.; [[Lakshmi Gopalakrishnan]], M.B.B.S.
{{CMG}}; '''Associate Editor-In-Chief:''' {{CZ}}; [[Varun Kumar]], M.B.B.S.; [[Lakshmi Gopalakrishnan]], M.B.B.S.; {{VR}}


==Overview==
==Overview==
Aortic insufficiency can be an [[acute]] illness or a [[chronic]] illness and the causes differ depending upon the acuity of the disease. In general, aortic insufficiency is due to abnormalities of the [[aortic valve]] itself or the [[aortic root]]. Aortic regurgitation secondary to dilation of the [[ascending aorta]] has overtaken the valvular aortic disease as the most common cause of aortic regurgitation.
Aortic insufficiency can be an [[acute]] illness or a [[chronic]] illness and the causes differ depending upon the acuity of the disease. In general, aortic insufficiency is due to abnormalities of the [[aortic valve]] itself or the [[aortic root]]. Aortic regurgitation secondary to dilation of the [[ascending aorta]] has overtaken the valvular aortic disease as the most common cause of aortic regurgitation.


==Causes==
==Causes==
===Causes of Aortic Insufficiency as of Site of Diseases===
====Aortic Valve Diseases====
*Congenital
**[[Bicuspid aortic valve]]
**[[Aortic valve#Disease of the aortic valve|Unicuspid aortic valve]]
*Connective tissue disorders
**[[Ehlers-Danlos syndrome]]
**[[Marfan syndrome]]
**[[Rheumatoid arthritis]]
**[[Systemic lupus erythematosus]]
*Drugs
**[[Dopamine agonists]]<ref name="pmid17202453">{{cite journal |author=Schade R, Andersohn F, Suissa S, Haverkamp W, Garbe E |title=Dopamine agonists and the risk of cardiac-valve regurgitation |journal=[[The New England Journal of Medicine]] |volume=356 |issue=1 |pages=29–38 |year=2007 |month=January |pmid=17202453 |doi=10.1056/NEJMoa062222 |url=http://dx.doi.org/10.1056/NEJMoa062222 |accessdate=2011-03-28}}</ref><ref name="pmid11104741">{{cite journal |author=Rothman RB, Baumann MH, Savage JE, Rauser L, McBride A, Hufeisen SJ, Roth BL |title=Evidence for possible involvement of 5-HT(2B) receptors in the cardiac valvulopathy associated with fenfluramine and other serotonergic medications |journal=[[Circulation]] |volume=102 |issue=23 |pages=2836–41 |year=2000 |month=December |pmid=11104741 |doi= |url=http://circ.ahajourals.org/cgi/pmidlookup?view=long&pmid=11104741 |accessdate=2011-03-28}}</ref><ref name="pmid16092580">{{cite journal |author=Waller EA, Kaplan J, Heckman MG |title=Valvular heart disease in patients taking pergolide |journal=[[Mayo Clinic Proceedings. Mayo Clinic]] |volume=80 |issue=8 |pages=1016–20 |year=2005 |month=August |pmid=16092580 |doi= |url=http://www.mayoclinicproceedings.com/cgi/pmidlookup?view=long&pmid=16092580 |accessdate=2011-03-28}}</ref>
**[[Fenfluramine]]
**[[Phentermine]]
*Endocrinal
**[[Acromegaly]]
*Inflammatory
**[[Infective endocarditis]]
**[[Rheumatic fever]]
====Aortic Root Diseases====
*[[Aortic dissection]]
*Collagen vascualr disease
**[[Giant cell arteritis]]
*Connective tissue disorders
**[[Annuloaortic ectasia]]
**[[Ehlers-Danlos syndrome]]
**[[Marfan syndrome]]
**[[Osteogenesis imperfecta]]
**[[Pseudoxanthoma elasticum]]
*[[Hypertension]]
*Inflammatory
**[[Ankylosing spondylitis]]
**[[Inflammatory bowel disease]]
**[[Psoriatic arthritis]]
**[[Reiter's syndrome]]
**[[Syphilitic aortitis]]
*[[Traumatic aortic rupture]] following blunt chest trauma or deceleration injury.
===Causes of Aortic Insufficiency as of Type of Onset===
====Causes of Acute Aortic Insufficiency====
* After [[aortic valvuloplasty]]<ref name="pmid2016464">{{cite journal |author=Isner JM |title=Acute catastrophic complications of balloon aortic valvuloplasty. The Mansfield Scientific Aortic Valvuloplasty Registry Investigators |journal=[[Journal of the American College of Cardiology]] |volume=17 |issue=6 |pages=1436–44 |year=1991 |month=May |pmid=2016464 |doi= |url= |accessdate=2011-03-28}}</ref>
* [[Aortic dissection]]: A type A dissection may disrupt the integrity of the valve leaflets causing malcoaptation of the aortic leaflets.
* [[Bacterial endocarditis]]: The [[infection]] can erode the valve, can cause a leaflet to become flail, or a vegetation can prevent coaptation of the leaflets.
* Blunt [[chest trauma]]: Trauma can disrupt the supporting apparatus of the [[aortic valve]].
* [[Myxomatous]] [[aortic valve]]: The valvular structure can degenerate.
* [[Prosthetic valve]] dysfunction
* [[Rheumatic fever]]
====Causes of Chronic Aortic Insufficiency====
* [[Ankylosing spondylitis]]: Ankylosing spondylitis can be associated with inflammation of the [[aorta]] ([[aortitis]]).<ref>Palazzi C, D' Angelo S, Lubrano E, Olivieri I. Aortic involvement in ankylosing spondylitis. Clin Exp Rheumatol. May-Jun 2008;26(3 Suppl 49):S131-4.</ref> The inflammatory process can also involve the septum and cause [[conduction disease]].
* [[Aortic dissection]]: A type A dissection may disrupt the integrity of the valve leaflets causing malcoaptation of the aortic leaflets.
* [[Arteriosclerosis]]
* [[Bechterew's Disease|Bechterew's disease]]
* [[Behcet disease]]: Rarely, in 5% of Behcet's cases there is an [[aortitis]] that involves the [[ascending aorta]] and in some cases the [[coronary arteries]].
* [[Bicuspid aortic valve]]: This is the most common congenital abnormality of the [[heart]]. It is the most common cause of isolated aortic insufficiency requiring surgical repair. Bicuspid aortic valve is also associated with [[inflammation]] of the [[aorta]] (an aortopathy) which may lead to dilation of the [[aorta]] and/or [[aortic dissection]] that can worsen the aortic insufficiency.<ref>Friedman T, Mani A, Elefteriades JA. Bicuspid aortic valve: clinical approach and scientific review of a common clinical entity. Expert Rev Cardiovasc Ther. Feb 2008;6(2):235-48.</ref>
* [[Cystic medial necrosis]] of the aorta
* [[Ehlers-Danlos syndrome]]
* [[Giant cell arteritis]]: [[GCA]] may also be associated with an [[aortitis]] as well as [[coronary artery disease]].<ref>Eberhardt RT, Dhadly M. Giant cell arteritis: diagnosis, management, and cardiovascular implications. Cardiol Rev. Mar-Apr 2007;15(2):55-61.</ref>
* [[Hypertension]]
* [[Marfan Syndrome]]
* [[Myxomatous]] aortic valve
* [[Polymyalgia rheumatica]]
* [[Pseudoxanthoma elasticum]]
* [[Reiter's syndrome]]
* [[Rheumatic fever]]: Rheumatic fever remains a cause of [[AS]] in the Middle East, Northern Africa and Asia as well as some immigrant populations in the United States. It is less prevalent in the US than it was in the 20th century. AR occurs as a result of [[fibrosis]] of the valve that is associated with thickening and retraction of the leaflets of the [[aortic valve]]. This retraction results in regurgitation in the center of the valve. At the same time, there may also be fusion of the aortic leaflets which results in concurrent [[aortic stenosis]]. It should be noted that rheumatic disease of the [[mitral valve]] is usually present in the same patient.
* [[Rheumatoid arthritis]]: [[RA]] rarely causes symptomatic AR, but it can cause [[granulomatous]] nodules on the aortic leaflets which leads to clinical aortic regurgitation.<ref>Chand EM, Freant LJ, Rubin JW. Aortic valve rheumatoid nodules producing clinical aortic regurgitation and a review of the literature. Cardiovasc Pathol. Nov-Dec 1999;8(6):333-8.</ref>
* Sinus of Valsalva aneurysm
* [[Syphilis]]
* [[Systemic lupus erythematosus]]: There are tow mechanisms by which [[SLE]] can cause AR. SLE can cause [[inflammation]] and [[fibrosis]] of the aortic leaflets leading to their damage and retraction.<ref>Jain D, Halushka MK. Cardiac pathology of systemic lupus erythematosus. J Clin Pathol. Jul 2009;62(7):584-92.</ref> SLE can also be associated with the development of sterile verrucous vegetations on the valves called [[Libman-Sacks endocarditis]].<ref>Moyssakis I, Tektonidou MG, Vasilliou VA, Samarkos M, Votteas V, Moutsopoulos HM. Libman-Sacks endocarditis in systemic lupus erythematosus: prevalence, associations, and evolution. Am J Med. Jul 2007;120(7):636-42.</ref><ref>Lee JL, Naguwa SM, Cheema GS, Gershwin ME. Revisiting Libman-Sacks endocarditis: a historical review and update. Clin Rev Allergy Immunol. Jun 2009;36(2-3):126-30.</ref>
* [[Takayasu arteritis]]: [[Takayasu arteritis]] can involve the [[aorta]] in an [[aortitis]], the [[aortic valve]] itself, and the [[coronary arteries]].<ref>Adachi O, Saiki Y, Akasaka J, Oda K, Iguchi A, Tabayashi K. Surgical management of aortic regurgitation associated with takayasu arteritis and other forms of aortitis. Ann Thorac Surg. Dec 2007;84(6):1950-3.</ref>
* [[Turner's syndrome]]
* [[Ventricular septal defect]]
* [[Weight loss]] medications including [[fenfluramine]] and [[dexfenfluramine]] (a.k.a. [[Phen-Fen]]). These drugs have been associated with degeneration of the aortic valve.
* [[Whipple disease]]: Can involve the aortic valve.<ref>Jeserich M, Ihling C, Holubarsch C. Aortic valve endocarditis with Whipple disease. Ann Intern Med. Jun 1 1997;126(11):920.</ref>
==Complete Differential Diagnosis for the Causes of Aortic Insufficiency==
===Life Threatening Causes===
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.
===Common Causes===
===Common Causes===
*Worldwide the most common cause of aortic insufficiency is the [[rheumatic heart disease]].
*Worldwide the most common cause of aortic insufficiency is the [[rheumatic heart disease]].
Line 12: Line 92:
*Aortic regurgitation secondary to dilation of the [[ascending aorta]] has overtaken valvular aortic disease as the most common cause of aortic regurgitation.
*Aortic regurgitation secondary to dilation of the [[ascending aorta]] has overtaken valvular aortic disease as the most common cause of aortic regurgitation.
*In general, aortic insufficiency is due to abnormalities of the [[aortic valve]] itself or the [[aortic root]].
*In general, aortic insufficiency is due to abnormalities of the [[aortic valve]] itself or the [[aortic root]].
====Aortic Valve Diseases====
*[[Rheumatic fever]] causes retraction of the cusps with resultant mixed [[aortic stenosis]] and aortic insufficiency with involvement of [[mitral valve disease]].
*[[Infective endocarditis]]
*[[Traumatic aortic rupture]] following blunt chest trauma or deceleration injury.
*[[Congenital]] [[bicuspid aortic valve]] associated with increased risk of [[aortic dissection]] which then leads to aortic insufficiency.
*[[Dopamine agonist]]s<ref name="pmid17202453">{{cite journal |author=Schade R, Andersohn F, Suissa S, Haverkamp W, Garbe E |title=Dopamine agonists and the risk of cardiac-valve regurgitation |journal=[[The New England Journal of Medicine]] |volume=356 |issue=1 |pages=29–38 |year=2007 |month=January |pmid=17202453 |doi=10.1056/NEJMoa062222 |url=http://dx.doi.org/10.1056/NEJMoa062222 |accessdate=2011-03-28}}</ref><ref name="pmid11104741">{{cite journal |author=Rothman RB, Baumann MH, Savage JE, Rauser L, McBride A, Hufeisen SJ, Roth BL |title=Evidence for possible involvement of 5-HT(2B) receptors in the cardiac valvulopathy associated with fenfluramine and other serotonergic medications |journal=[[Circulation]] |volume=102 |issue=23 |pages=2836–41 |year=2000 |month=December |pmid=11104741 |doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=11104741 |accessdate=2011-03-28}}</ref><ref name="pmid16092580">{{cite journal |author=Waller EA, Kaplan J, Heckman MG |title=Valvular heart disease in patients taking pergolide |journal=[[Mayo Clinic Proceedings. Mayo Clinic]] |volume=80 |issue=8 |pages=1016–20 |year=2005 |month=August |pmid=16092580 |doi= |url=http://www.mayoclinicproceedings.com/cgi/pmidlookup?view=long&pmid=16092580 |accessdate=2011-03-28}}</ref>
====Aortic Root Diseases====
*[[Hypertension]]
*[[Aortic dissection]]
*[[Marfan syndrome]]
*[[HLA-B27]] positive conditions: [[psoriatic arthritis]], [[ankylosing spondylitis]], [[Reiter's syndrome]]
*[[Giant cell arteritis]]
*[[Syphilitic aortitis]]


===Causes by Organ System===
===Causes by Organ System===
Line 138: Line 205:


===Causes in Alphabetical Order===
===Causes in Alphabetical Order===
====Causes of Acute Aortic Insufficiency====
* After [[aortic valvuloplasty]]<ref name="pmid2016464">{{cite journal |author=Isner JM |title=Acute catastrophic complications of balloon aortic valvuloplasty. The Mansfield Scientific Aortic Valvuloplasty Registry Investigators |journal=[[Journal of the American College of Cardiology]] |volume=17 |issue=6 |pages=1436–44 |year=1991 |month=May |pmid=2016464 |doi= |url= |accessdate=2011-03-28}}</ref>
* [[Aortic dissection]]: A type A dissection may disrupt the integrity of the valve leaflets causing malcoaptation of the aortic leaflets.
* [[Bacterial endocarditis]]: The [[infection]] can erode the valve, can cause a leaflet to become flail, or a vegetation can prevent coaptation of the leaflets.
* Blunt [[chest trauma]]: Trauma can disrupt the supporting apparatus of the [[aortic valve]].
* [[Myxomatous]] [[aortic valve]]: The valvular structure can degenerate.
* [[Prosthetic valve]] dysfunction
* [[Rheumatic fever]]


====Causes of Chronic Aortic Insufficiency====
* [[Ankylosing spondylitis]]: Ankylosing spondylitis can be associated with inflammation of the [[aorta]] ([[aortitis]]).<ref>Palazzi C, D' Angelo S, Lubrano E, Olivieri I. Aortic involvement in ankylosing spondylitis. Clin Exp Rheumatol. May-Jun 2008;26(3 Suppl 49):S131-4.</ref>  The inflammatory process can also involve the septum and cause [[conduction disease]].
* [[Aortic dissection]]: A type A dissection may disrupt the integrity of the valve leaflets causing malcoaptation of the aortic leaflets.
* [[Arteriosclerosis]]
* [[Bechterew's Disease|Bechterew's disease]]
* [[Behcet disease]]: Rarely, in 5% of Behcet's cases there is an [[aortitis]] that involves the [[ascending aorta]] and in some cases the [[coronary arteries]].
* [[Bicuspid aortic valve]]: This is the most common congenital abnormality of the [[heart]].  It is the most common cause of isolated aortic insufficiency requiring surgical repair.  Bicuspid aortic valve is also associated with [[inflammation]] of the [[aorta]] (an aortopathy) which may lead to dilation of the [[aorta]] and/or [[aortic dissection]] that can worsen the aortic insufficiency.<ref>Friedman T, Mani A, Elefteriades JA. Bicuspid aortic valve: clinical approach and scientific review of a common clinical entity. Expert Rev Cardiovasc Ther. Feb 2008;6(2):235-48.</ref>
* [[Cystic medial necrosis]] of the aorta
* [[Ehlers-Danlos syndrome]]
* [[Giant cell arteritis]]: [[GCA]] may also be associated with an [[aortitis]] as well as [[coronary artery disease]].<ref>Eberhardt RT, Dhadly M. Giant cell arteritis: diagnosis, management, and cardiovascular implications. Cardiol Rev. Mar-Apr 2007;15(2):55-61.</ref>
* [[Hypertension]]
* [[Marfan Syndrome]]
* [[Myxomatous]] aortic valve
* [[Polymyalgia rheumatica]]
* [[Pseudoxanthoma elasticum]]
* [[Reiter's syndrome]]
* [[Rheumatic fever]]: Rheumatic fever remains a cause of [[AS]] in the Middle East, Northern Africa and Asia as well as some immigrant populations in the United States. It is less prevalent in the US than it was in the 20th century. AR occurs as a result of [[fibrosis]] of the valve that is associated with thickening and retraction of the leaflets of the [[aortic valve]].  This retraction results in regurgitation in the center of the valve. At the same time, there may also be fusion of the aortic leaflets which results in concurrent [[aortic stenosis]]. It should be noted that rheumatic disease of the [[mitral valve]] is usually present in the same patient.
* [[Rheumatoid arthritis]]: [[RA]] rarely causes symptomatic AR, but it can cause [[granulomatous]] nodules on the aortic leaflets which leads to clinical aortic regurgitation.<ref>Chand EM, Freant LJ, Rubin JW. Aortic valve rheumatoid nodules producing clinical aortic regurgitation and a review of the literature. Cardiovasc Pathol. Nov-Dec 1999;8(6):333-8.</ref>
* Sinus of Valsalva aneurysm
* [[Syphilis]]
* [[Systemic lupus erythematosus]]: There are tow mechanisms by which [[SLE]] can cause AR. SLE can cause [[inflammation]] and [[fibrosis]] of the aortic leaflets leading to their damage and retraction.<ref>Jain D, Halushka MK. Cardiac pathology of systemic lupus erythematosus. J Clin Pathol. Jul 2009;62(7):584-92.</ref> SLE can also be associated with the development of sterile verrucous vegetations on the valves called [[Libman-Sacks endocarditis]].<ref>Moyssakis I, Tektonidou MG, Vasilliou VA, Samarkos M, Votteas V, Moutsopoulos HM. Libman-Sacks endocarditis in systemic lupus erythematosus: prevalence, associations, and evolution. Am J Med. Jul 2007;120(7):636-42.</ref><ref>Lee JL, Naguwa SM, Cheema GS, Gershwin ME. Revisiting Libman-Sacks endocarditis: a historical review and update. Clin Rev Allergy Immunol. Jun 2009;36(2-3):126-30.</ref>
* [[Takayasu arteritis]]: [[Takayasu arteritis]] can involve the [[aorta]] in an [[aortitis]], the [[aortic valve]] itself, and the [[coronary arteries]].<ref>Adachi O, Saiki Y, Akasaka J, Oda K, Iguchi A, Tabayashi K. Surgical management of aortic regurgitation associated with takayasu arteritis and other forms of aortitis. Ann Thorac Surg. Dec 2007;84(6):1950-3.</ref>
* [[Turner's syndrome]]
* [[Ventricular septal defect]]
* [[Weight loss]] medications including [[fenfluramine]] and [[dexfenfluramine]] (a.k.a. [[Phen-Fen]]). These drugs have been associated with degeneration of the aortic valve.
* [[Whipple disease]]: Can involve the aortic valve.<ref>Jeserich M, Ihling C, Holubarsch C. Aortic valve endocarditis with Whipple disease. Ann Intern Med. Jun 1 1997;126(11):920.</ref>


==References==
==References==

Revision as of 02:15, 20 November 2013

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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.; Vendhan Ramanujam M.B.B.S [3]

Overview

Aortic insufficiency can be an acute illness or a chronic illness and the causes differ depending upon the acuity of the disease. In general, aortic insufficiency is due to abnormalities of the aortic valve itself or the aortic root. Aortic regurgitation secondary to dilation of the ascending aorta has overtaken the valvular aortic disease as the most common cause of aortic regurgitation.

Causes

Causes of Aortic Insufficiency as of Site of Diseases

Aortic Valve Diseases

Aortic Root Diseases

Causes of Aortic Insufficiency as of Type of Onset

Causes of Acute Aortic Insufficiency

Causes of Chronic Aortic Insufficiency

Complete Differential Diagnosis for the Causes of Aortic Insufficiency

Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.

Common Causes

Causes by Organ System

Cardiovascular After aortic valvuloplasty,[4] Aortic dissection, Arteriosclerosis, Bacterial endocarditis, Bicuspid aortic valve, Prosthetic valve dysfunction,[14] Hypertension, Myxomatous aortic valve, Rheumatic fever, Senile aortic ectasia and dilation, Senile or degenerative calcific aortic valve disease, Sinus of Valsalva aneurysm, Ventricular septal defect
Chemical / poisoning No underlying causes
Dermatologic Psoriatic arthritis
Drug Side Effect Fenfluramine and Dexfenfluramine: These drugs have been associated with degeneration of the aortic valve.
Ear Nose Throat No underlying causes
Endocrine No underlying causes
Environmental No underlying causes
Gastroenterologic Ulcerative colitis, Whipple disease[15]
Genetic Ankylosing spondylitis,[16] Ehlers-Danlos syndrome, Marfan syndrome, Osteogenesis imperfecta, Pseudoxanthoma elasticum, Reiter's syndrome, Rheumatoid arthritis,[17] Systemic lupus erythematosus, Takayasu arteritis, Turner's syndrome
Hematologic No underlying causes
Iatrogenic After aortic valvuloplasty,[4] Prosthetic valve dysfunction
Infectious Disease Bacterial endocarditis, Rheumatic fever, Syphilis
Musculoskeletal / Ortho Ankylosing spondylitis, Collagen vascular disease, Ehlers-Danlos syndrome, Osteogenesis imperfecta, Psoriatic arthritis, Reiter's Syndrome, Relapsing polychondritis, Rheumatoid arthritis,[18] Spondyloarthropathy, Systemic lupus erythematosus
Neurologic No underlying causes
Nutritional / Metabolic No underlying causes
Obstetric/Gynecologic No underlying causes
Oncologic No underlying causes
Opthalmologic No underlying causes
Overdose / Toxicity No underlying causes
Psychiatric No underlying causes
Pulmonary No underlying causes
Renal / Electrolyte No underlying causes
Rheum / Immune / Allergy Ankylosing spondylitis,[19] Bechterew's disease, Behcet disease, Collagen vascular disease, Cystic medial necrosis, Ehlers-Danlos syndrome, Giant cell arteritis, Marfan syndrome, Myxomatous aortic valve: The valvular structure can degenerate, Osteogenesis imperfecta, Polymyalgia rheumatica, Pseudoxanthoma elasticum, Psoriatic arthritis, Reiter's syndrome, Rheumatic fever, Rheumatoid arthritis,[20] Spondyloarthropathy, Systemic lupus erythematosus, Takayasu arteritis, Ulcerative colitis, Whipple disease[21]
Sexual Syphilis
Trauma Blunt chest trauma disrupting the supporting apparatus of the aortic valve.
Urologic No underlying causes
Miscellaneous Myxomatous aortic valve

Causes in Alphabetical Order

References

  1. ↑ Schade R, Andersohn F, Suissa S, Haverkamp W, Garbe E (2007). "Dopamine agonists and the risk of cardiac-valve regurgitation". The New England Journal of Medicine. 356 (1): 29–38. doi:10.1056/NEJMoa062222. PMID 17202453. Retrieved 2011-03-28. Unknown parameter |month= ignored (help)
  2. ↑ Rothman RB, Baumann MH, Savage JE, Rauser L, McBride A, Hufeisen SJ, Roth BL (2000). "Evidence for possible involvement of 5-HT(2B) receptors in the cardiac valvulopathy associated with fenfluramine and other serotonergic medications". Circulation. 102 (23): 2836–41. PMID 11104741. Retrieved 2011-03-28. Unknown parameter |month= ignored (help)
  3. ↑ Waller EA, Kaplan J, Heckman MG (2005). "Valvular heart disease in patients taking pergolide". Mayo Clinic Proceedings. Mayo Clinic. 80 (8): 1016–20. PMID 16092580. Retrieved 2011-03-28. Unknown parameter |month= ignored (help)
  4. ↑ 4.0 4.1 4.2 Isner JM (1991). "Acute catastrophic complications of balloon aortic valvuloplasty. The Mansfield Scientific Aortic Valvuloplasty Registry Investigators". Journal of the American College of Cardiology. 17 (6): 1436–44. PMID 2016464. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)
  5. ↑ Palazzi C, D' Angelo S, Lubrano E, Olivieri I. Aortic involvement in ankylosing spondylitis. Clin Exp Rheumatol. May-Jun 2008;26(3 Suppl 49):S131-4.
  6. ↑ Friedman T, Mani A, Elefteriades JA. Bicuspid aortic valve: clinical approach and scientific review of a common clinical entity. Expert Rev Cardiovasc Ther. Feb 2008;6(2):235-48.
  7. ↑ Eberhardt RT, Dhadly M. Giant cell arteritis: diagnosis, management, and cardiovascular implications. Cardiol Rev. Mar-Apr 2007;15(2):55-61.
  8. ↑ Chand EM, Freant LJ, Rubin JW. Aortic valve rheumatoid nodules producing clinical aortic regurgitation and a review of the literature. Cardiovasc Pathol. Nov-Dec 1999;8(6):333-8.
  9. ↑ Jain D, Halushka MK. Cardiac pathology of systemic lupus erythematosus. J Clin Pathol. Jul 2009;62(7):584-92.
  10. ↑ Moyssakis I, Tektonidou MG, Vasilliou VA, Samarkos M, Votteas V, Moutsopoulos HM. Libman-Sacks endocarditis in systemic lupus erythematosus: prevalence, associations, and evolution. Am J Med. Jul 2007;120(7):636-42.
  11. ↑ Lee JL, Naguwa SM, Cheema GS, Gershwin ME. Revisiting Libman-Sacks endocarditis: a historical review and update. Clin Rev Allergy Immunol. Jun 2009;36(2-3):126-30.
  12. ↑ Adachi O, Saiki Y, Akasaka J, Oda K, Iguchi A, Tabayashi K. Surgical management of aortic regurgitation associated with takayasu arteritis and other forms of aortitis. Ann Thorac Surg. Dec 2007;84(6):1950-3.
  13. ↑ Jeserich M, Ihling C, Holubarsch C. Aortic valve endocarditis with Whipple disease. Ann Intern Med. Jun 1 1997;126(11):920.
  14. ↑ Friedman T, Mani A, Elefteriades JA. Bicuspid aortic valve: clinical approach and scientific review of a common clinical entity. Expert Rev Cardiovasc Ther. Feb 2008;6(2):235-48.
  15. ↑ Jeserich M, Ihling C, Holubarsch C. Aortic valve endocarditis with Whipple disease. Ann Intern Med. Jun 1 1997;126(11):920.
  16. ↑ Palazzi C, D' Angelo S, Lubrano E, Olivieri I. Aortic involvement in ankylosing spondylitis. Clin Exp Rheumatol. May-Jun 2008;26(3 Suppl 49):S131-4.
  17. ↑ Chand EM, Freant LJ, Rubin JW. Aortic valve rheumatoid nodules producing clinical aortic regurgitation and a review of the literature. Cardiovasc Pathol. Nov-Dec 1999;8(6):333-8.
  18. ↑ Chand EM, Freant LJ, Rubin JW. Aortic valve rheumatoid nodules producing clinical aortic regurgitation and a review of the literature. Cardiovasc Pathol. Nov-Dec 1999;8(6):333-8.
  19. ↑ Palazzi C, D' Angelo S, Lubrano E, Olivieri I. Aortic involvement in ankylosing spondylitis. Clin Exp Rheumatol. May-Jun 2008;26(3 Suppl 49):S131-4.
  20. ↑ Chand EM, Freant LJ, Rubin JW. Aortic valve rheumatoid nodules producing clinical aortic regurgitation and a review of the literature. Cardiovasc Pathol. Nov-Dec 1999;8(6):333-8.
  21. ↑ Jeserich M, Ihling C, Holubarsch C. Aortic valve endocarditis with Whipple disease. Ann Intern Med. Jun 1 1997;126(11):920.

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