Aortic regurgitation causes: Difference between revisions
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**[[Aortic valve#Disease of the aortic valve|Unicuspid aortic valve]] | **[[Aortic valve#Disease of the aortic valve|Unicuspid aortic valve]] | ||
*Connective tissue disorders | *Connective tissue disorders | ||
**[[Ehlers-Danlos syndrome]] | **[[Ehlers-Danlos syndrome]]<ref name="Wunderlich-2005">{{Cite journal | last1 = Wunderlich | first1 = C. | last2 = Schulze | first2 = MR. | last3 = Strasser | first3 = RH. | title = Severe aortic regurgitation in Ehlers-Danlos syndrome type IV. | journal = Heart | volume = 91 | issue = 1 | pages = 126 | month = Jan | year = 2005 | doi = 10.1136/hrt.2004.035097 | PMID = 15604357 }}</ref> | ||
**[[Marfan syndrome]] | **[[Marfan syndrome]]<ref name="Brown-1975">{{Cite journal | last1 = Brown | first1 = OR. | last2 = DeMots | first2 = H. | last3 = Kloster | first3 = FE. | last4 = Roberts | first4 = A. | last5 = Menashe | first5 = VD. | last6 = Beals | first6 = RK. | title = Aortic root dilatation and mitral valve prolapse in Marfan's syndrome: an ECHOCARDIOgraphic study. | journal = Circulation | volume = 52 | issue = 4 | pages = 651-7 | month = Oct | year = 1975 | doi = | PMID = 1157278 }}</ref> | ||
**[[Rheumatoid arthritis]] | **[[Rheumatoid arthritis]]<ref name="Levine-1999">{{Cite journal | last1 = Levine | first1 = AJ. | last2 = Dimitri | first2 = WR. | last3 = Bonser | first3 = RS. | title = Aortic regurgitation in rheumatoid arthritis necessitating aortic valve replacement. | journal = Eur J Cardiothorac Surg | volume = 15 | issue = 2 | pages = 213-4 | month = Feb | year = 1999 | doi = | PMID = 10219558 }}</ref> | ||
**[[Systemic lupus erythematosus]]<ref name="Miyashita-2010">{{Cite journal | last1 = Miyashita | first1 = T. | last2 = Abe | first2 = Y. | last3 = Kato | first3 = Y. | last4 = Nakagawa | first4 = E. | last5 = Komatsu | first5 = R. | last6 = Hattori | first6 = K. | last7 = Shibata | first7 = T. | last8 = Yoshioka | first8 = K. | last9 = Naruko | first9 = T. | title = Aortic aneurysm with severe aortic regurgitation in a patient with systemic lupus erythematosus. | journal = Intern Med | volume = 49 | issue = 20 | pages = 2263-6 | month = | year = 2010 | doi = | PMID = 20962447 }}</ref> | **[[Systemic lupus erythematosus]]<ref name="Miyashita-2010">{{Cite journal | last1 = Miyashita | first1 = T. | last2 = Abe | first2 = Y. | last3 = Kato | first3 = Y. | last4 = Nakagawa | first4 = E. | last5 = Komatsu | first5 = R. | last6 = Hattori | first6 = K. | last7 = Shibata | first7 = T. | last8 = Yoshioka | first8 = K. | last9 = Naruko | first9 = T. | title = Aortic aneurysm with severe aortic regurgitation in a patient with systemic lupus erythematosus. | journal = Intern Med | volume = 49 | issue = 20 | pages = 2263-6 | month = | year = 2010 | doi = | PMID = 20962447 }}</ref> | ||
*Drugs | *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> | **[[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]] | **[[Fenfluramine]]<ref name="Jollis-2000">{{Cite journal | last1 = Jollis | first1 = JG. | last2 = Landolfo | first2 = CK. | last3 = Kisslo | first3 = J. | last4 = Constantine | first4 = GD. | last5 = Davis | first5 = KD. | last6 = Ryan | first6 = T. | title = Fenfluramine and phentermine and cardiovascular findings: effect of treatment duration on prevalence of valve abnormalities. | journal = Circulation | volume = 101 | issue = 17 | pages = 2071-7 | month = May | year = 2000 | doi = | PMID = 10790349 }}</ref> | ||
**[[Phentermine]] | **[[Phentermine]]<ref name="Jollis-2000">{{Cite journal | last1 = Jollis | first1 = JG. | last2 = Landolfo | first2 = CK. | last3 = Kisslo | first3 = J. | last4 = Constantine | first4 = GD. | last5 = Davis | first5 = KD. | last6 = Ryan | first6 = T. | title = Fenfluramine and phentermine and cardiovascular findings: effect of treatment duration on prevalence of valve abnormalities. | journal = Circulation | volume = 101 | issue = 17 | pages = 2071-7 | month = May | year = 2000 | doi = | PMID = 10790349 }}</ref> | ||
*Endocrinal | *Endocrinal | ||
**[[Acromegaly]] | **[[Acromegaly]]<ref name="Pereira-2004">{{Cite journal | last1 = Pereira | first1 = AM. | last2 = van Thiel | first2 = SW. | last3 = Lindner | first3 = JR. | last4 = Roelfsema | first4 = F. | last5 = van der Wall | first5 = EE. | last6 = Morreau | first6 = H. | last7 = Smit | first7 = JW. | last8 = Romijn | first8 = JA. | last9 = Bax | first9 = JJ. | title = Increased prevalence of regurgitant valvular heart disease in acromegaly. | journal = J Clin Endocrinol Metab | volume = 89 | issue = 1 | pages = 71-5 | month = Jan | year = 2004 | doi = | PMID = 14715829 }}</ref> | ||
*Inflammatory | *Inflammatory | ||
**[[Bacterial endocarditis]] | **[[Bacterial endocarditis]]<ref name="Stiles-1980">{{Cite journal | last1 = Stiles | first1 = GL. | last2 = Friesinger | first2 = GC. | title = Bacterial endocarditis with aortic regurgitation: implications of embolism. | journal = South Med J | volume = 73 | issue = 5 | pages = 582-6 | month = May | year = 1980 | doi = | PMID = 7375973 }}</ref> | ||
**[[Rheumatic fever]]<ref name="Spagnuolo-1971">{{Cite journal | last1 = Spagnuolo | first1 = M. | last2 = Kloth | first2 = H. | last3 = Taranta | first3 = A. | last4 = Doyle | first4 = E. | last5 = Pasternack | first5 = B. | title = Natural history of rheumatic aortic regurgitation. Criteria predictive of death, congestive heart failure, and angina in young patients. | journal = Circulation | volume = 44 | issue = 3 | pages = 368-80 | month = Sep | year = 1971 | doi = | PMID = 4255488 }}</ref> | **[[Rheumatic fever]]<ref name="Spagnuolo-1971">{{Cite journal | last1 = Spagnuolo | first1 = M. | last2 = Kloth | first2 = H. | last3 = Taranta | first3 = A. | last4 = Doyle | first4 = E. | last5 = Pasternack | first5 = B. | title = Natural history of rheumatic aortic regurgitation. Criteria predictive of death, congestive heart failure, and angina in young patients. | journal = Circulation | volume = 44 | issue = 3 | pages = 368-80 | month = Sep | year = 1971 | doi = | PMID = 4255488 }}</ref> | ||
Revision as of 19:59, 21 November 2013
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Aortic Regurgitation Microchapters |
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Diagnosis |
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Treatment |
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Acute Aortic regurgitation |
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Chronic Aortic regurgitation |
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Special Scenarios |
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Case Studies |
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Aortic regurgitation causes On the Web |
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American Roentgen Ray Society Images of Aortic regurgitation causes |
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Risk calculators and risk factors for Aortic regurgitation causes |
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
- Congenital
- Connective tissue disorders
- Drugs
- Endocrinal
- Inflammatory
Aortic Root Diseases
- Aortic dissection
- Collagen vascualr disease
- Connective tissue disorders
- Hypertension
- Inflammatory
- 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.[15]
- A type A aortic dissection may disrupt the integrity of the valve leaflets causing malcoaptation of the aortic leaflets.
- In bacterial endocarditis the infection can erode the valve and cause a leaflet to become flail, or a vegetation can prevent coaptation of the leaflets.
- Blunt chest trauma can disrupt the supporting apparatus of the aortic valve.
- Myxomatous aortic valve can degenerate, leading to insufficiency.
- Prosthetic valve dysfunction[16]
- Rheumatic fever
- Rupture of a congenitally fenestrated cusp.[17]
Causes of Chronic Aortic Insufficiency
- Ankylosing spondylitis can be associated with inflammation of the aorta (aortitis).[18] The inflammatory process can also involve the septum and cause conduction disease.
- A type A aortic dissection may disrupt the integrity of the valve leaflets causing malcoaptation of the aortic leaflets.
- Bechterew's disease
- Rarely, in 5% of cases with Behcet disease there is an aortitis that involves the ascending aorta and in some cases the coronary arteries are involved.
- Bicuspid aortic valve 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.[19]
- Cystic medial necrosis of the aorta
- Ehlers-Danlos syndrome
- Giant cell arteritis may also be associated with an aortitis as well as coronary artery disease.[20]
- Hypertension
- Marfan Syndrome
- Myxomatous aortic valve
- Polymyalgia rheumatica
- Pseudoxanthoma elasticum
- Reiter's syndrome
- 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 rarely causes symptomatic AR, but it can cause granulomatous nodules on the aortic leaflets which leads to clinical aortic regurgitation.[21]
- Sinus of valsalva aneurysm
- Syphilis
- Systemic lupus erythematosus can cause AR by tow mechanisms. SLE can cause inflammation and fibrosis of the aortic leaflets leading to their damage and retraction.[22] SLE can also be associated with the development of sterile verrucous vegetations on the valves called Libman-Sacks endocarditis.[23][24]
- Takayasu arteritis can involve the aorta in an aortitis, the aortic valve itself, and the coronary arteries.[25]
- 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.[26]
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
- Worldwide the most common cause of aortic insufficiency is the rheumatic heart disease.
- In the United States, senile degenerative calcific aortic valve disease and bicuspid aortic valve disease are the most common causes.
- 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.
Causes by Organ System
Causes in Alphabetical Order
References
- ↑ Roberts, WC.; Vowels, TJ.; Ko, JM. (2012). "Natural history of adults with congenitally malformed aortic valves (unicuspid or bicuspid)". Medicine (Baltimore). 91 (6): 287–308. doi:10.1097/MD.0b013e3182764b84. PMID 23117850. Unknown parameter
|month=ignored (help) - ↑ Wunderlich, C.; Schulze, MR.; Strasser, RH. (2005). "Severe aortic regurgitation in Ehlers-Danlos syndrome type IV". Heart. 91 (1): 126. doi:10.1136/hrt.2004.035097. PMID 15604357. Unknown parameter
|month=ignored (help) - ↑ Brown, OR.; DeMots, H.; Kloster, FE.; Roberts, A.; Menashe, VD.; Beals, RK. (1975). "Aortic root dilatation and mitral valve prolapse in Marfan's syndrome: an ECHOCARDIOgraphic study". Circulation. 52 (4): 651–7. PMID 1157278. Unknown parameter
|month=ignored (help) - ↑ Levine, AJ.; Dimitri, WR.; Bonser, RS. (1999). "Aortic regurgitation in rheumatoid arthritis necessitating aortic valve replacement". Eur J Cardiothorac Surg. 15 (2): 213–4. PMID 10219558. Unknown parameter
|month=ignored (help) - ↑ Miyashita, T.; Abe, Y.; Kato, Y.; Nakagawa, E.; Komatsu, R.; Hattori, K.; Shibata, T.; Yoshioka, K.; Naruko, T. (2010). "Aortic aneurysm with severe aortic regurgitation in a patient with systemic lupus erythematosus". Intern Med. 49 (20): 2263–6. PMID 20962447.
- ↑ 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) - ↑ 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) - ↑ 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) - ↑ 9.0 9.1 Jollis, JG.; Landolfo, CK.; Kisslo, J.; Constantine, GD.; Davis, KD.; Ryan, T. (2000). "Fenfluramine and phentermine and cardiovascular findings: effect of treatment duration on prevalence of valve abnormalities". Circulation. 101 (17): 2071–7. PMID 10790349. Unknown parameter
|month=ignored (help) - ↑ Pereira, AM.; van Thiel, SW.; Lindner, JR.; Roelfsema, F.; van der Wall, EE.; Morreau, H.; Smit, JW.; Romijn, JA.; Bax, JJ. (2004). "Increased prevalence of regurgitant valvular heart disease in acromegaly". J Clin Endocrinol Metab. 89 (1): 71–5. PMID 14715829. Unknown parameter
|month=ignored (help) - ↑ Stiles, GL.; Friesinger, GC. (1980). "Bacterial endocarditis with aortic regurgitation: implications of embolism". South Med J. 73 (5): 582–6. PMID 7375973. Unknown parameter
|month=ignored (help) - ↑ Spagnuolo, M.; Kloth, H.; Taranta, A.; Doyle, E.; Pasternack, B. (1971). "Natural history of rheumatic aortic regurgitation. Criteria predictive of death, congestive heart failure, and angina in young patients". Circulation. 44 (3): 368–80. PMID 4255488. Unknown parameter
|month=ignored (help) - ↑ Lamanna, A.; Fayers, T.; Clarke, S.; Parsonage, W. (2013). "Valvular and aortic diseases in osteogenesis imperfecta". Heart Lung Circ. 22 (10): 801–10. doi:10.1016/j.hlc.2013.05.640. PMID 23791715. Unknown parameter
|month=ignored (help) - ↑ 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.
- ↑ 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) - ↑ 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.
- ↑ Stout, KK.; Verrier, ED. (2009). "Acute valvular regurgitation". Circulation. 119 (25): 3232–41. doi:10.1161/CIRCULATIONAHA.108.782292. PMID 19564568. Unknown parameter
|month=ignored (help) - ↑ 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.
- ↑ 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.
- ↑ Eberhardt RT, Dhadly M. Giant cell arteritis: diagnosis, management, and cardiovascular implications. Cardiol Rev. Mar-Apr 2007;15(2):55-61.
- ↑ 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.
- ↑ Jain D, Halushka MK. Cardiac pathology of systemic lupus erythematosus. J Clin Pathol. Jul 2009;62(7):584-92.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ Jeserich M, Ihling C, Holubarsch C. Aortic valve endocarditis with Whipple disease. Ann Intern Med. Jun 1 1997;126(11):920.