Aortic regurgitation risk factors

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Varun Kumar, M.B.B.S. [2], Lakshmi Gopalakrishnan, M.B.B.S. [3], Mohammed A. Sbeih, M.D. [4]

Overview

In the past, the most common risk factor for aortic valvular disease had been rheumatic fever, with subsequent fibrosis of the scarred valve then leading to retraction of the aortic valve cusps and prevention of their apposition during diastole. In the modern era, a more common risk factor for acquired aortic regurgitation is degenerative disease of the aorta and aortic valve in which case there is calcification and fibrosis of the cusps. Infective endocarditis remains an important risk factor and cause of aortic insufficiency. Congenital conditions such as congenital bicuspid aortic valve or a ventricular septal defect can also result in aortic insufficiency. Patients with bicuspid aortic valve are at increased risk of developing aortic dissection .

Risk factors

Risk Factors for Aortic Root Disease

Risk factors for the development of aortic insufficiency due to aortic root disease include:

• Ankylosing spondylitis
• Aortic dissection
• Arteriosclerosis
• Bechterew's Disease
• Behcet's syndrome
• Cystic medial necrosis of the aorta
• Ehlers-Danlos Syndrome
• Giant cell arteritis
• Hypertension
• Idiopathic dilation of the ascending aorta
• Marfan syndrome
• Osteogenesis imperfecta
• Polymyalgia Rheumatica
• Pseudoxanthoma Elasticum
• Psoriatic arthritis
• Reiter's syndrome
• Relapsing polychondritis
• Senile aortic ectasia and dilation
• Spondyloarthropathy
• Syphilitic aortitis
• Takayasu arteritis
• Trauma
• Ulcerative colitis
• Whipple's disease

Risk Factors for Aortic Valve Disease

Risk factors for the development of aortic insufficiency due to aortic valve disease include:

• Bicuspid aortic valve
• Collagen vascular disease
• Senile or degenerative calcific aortic valve disease
• Endocarditis
• Myxomatous aortic valve
• Rheumatic fever
• Rheumatoid arthritis
• Sinus of Valsalva Aneurysm
• Systemic Lupus Erythematosus
• Trauma
• Turner's Syndrome
• Ventricular Septal Defect
• Weight loss medications

Risk factors for Acute Aortic Insufficiency

• After aortic valvuloplasty
• Aortic dissection
• Bacterial Endocarditis
• Blunt chest trauma
• Myxomatous aortic valve
• Rheumatic Fever

Risk Factors for Chronic Aortic Insufficiency

• Ankylosing Spondylitis
• Aortic Dissection
• Arteriosclerosis
• Bacterial Endocarditis
• Bechterew's Disease
• Bicuspid aortic valve
• Cystic medial necrosis of the aorta
• Ehlers-Danlos Syndrome
• Hypertension
• Marfan Syndrome
• Myxomatous aortic valve
• Polymyalgia Rheumatica
• Pseudoxanthoma Elasticum
• Reiter's Syndrome
• Rheumatic Fever
• Rheumatoid Arthritis
• Sinus of Valsalva Aneurysm
• Syphilis
• Systemic Lupus Erythematosus
• Turner's Syndrome
• Ventricular Septal Defect
• Weight loss medications

Precautions

People with aortic insufficiency of any aetiology are at risk for the development of infection of their damaged valve, i.e. infective endocarditis. To lessen the chance of developing that serious complication, people with AI are usually advised to take antibiotic prophylaxis around the time of certain dental/medical/surgical procedures. Routine upper and lower GI endoscopy (i.e. gastroscopy and colonoscopy), with or without biopsy, are not usually considered indications for antibiotic prophylaxis.

Not withstanding the foregoing, the American Heart Association has recently changed its recommendations regarding antibiotic prophylaxis for endocarditis. Specifically, as of 2007, it is recommended that such prophylaxis be limited only to:

• Those with prosthetic heart valves.
• Those with previous episode(s) of endocarditis.
• Those with certain types of congenital heart disease .