Aortic regurgitation causes: Difference between revisions
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**[[Acromegaly]] | **[[Acromegaly]] | ||
*Inflammatory | *Inflammatory | ||
**[[ | **[[Bacterial endocarditis]] | ||
**[[Rheumatic fever]] | **[[Rheumatic fever]] | ||
| Line 48: | Line 48: | ||
===Causes of Aortic Insufficiency as of Type of Onset=== | ===Causes of Aortic Insufficiency as of Type of Onset=== | ||
====Causes of Acute Aortic Insufficiency==== | ====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> | *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 [[Aortic dissection classification#Stanford Classification System|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]] | *Blunt [[chest trauma]] can disrupt the supporting apparatus of the [[aortic valve]]. | ||
*[[Myxomatous | *[[Myxomatous degeneration|Myxomatous aortic valve]] can degenerate, leading to insufficiency. | ||
*[[Prosthetic valve]] | *[[Prosthetic valve|prosthetic valve dysfunction]]<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> | ||
*[[Rheumatic fever]] | *[[Rheumatic fever]] | ||
*Rupture of a [[Aortic valve#Disease of the aortic valve|congenitally fenestrated cusp]] | *Rupture of a [[Aortic valve#Disease of the aortic valve|congenitally fenestrated cusp]]. | ||
====Causes of Chronic Aortic Insufficiency==== | ====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 [[Aortic dissection classification#Stanford Classification System|type A aortic dissection]] may disrupt the integrity of the valve leaflets causing malcoaptation of the aortic leaflets. | ||
*[[Bechterew's Disease|Bechterew's disease]] | |||
* [[Bechterew's Disease|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.<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> | ||
* [[Bicuspid aortic valve]] | *[Cystic medial necrosis]] of the aorta | ||
* | *[[Ehlers-Danlos syndrome]] | ||
* [[Ehlers-Danlos syndrome]] | *[[Giant cell arteritis]] 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> | ||
* [[Giant cell arteritis | *[[Hypertension]] | ||
* [[Hypertension]] | *[[Marfan Syndrome]] | ||
* [[Marfan Syndrome]] | *[[Myxomatous degeneration|Myxomatous aortic valve]] | ||
* [[Myxomatous]] | *[[Polymyalgia rheumatica]] | ||
* [[Polymyalgia rheumatica]] | *[[Pseudoxanthoma elasticum]] | ||
* [[Pseudoxanthoma elasticum]] | *[[Reiter's syndrome]] | ||
* [[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. | ||
* [[Rheumatic fever]] | *[[Rheumatoid arthritis]] 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> | ||
* [[Rheumatoid arthritis | *[[Aneurysm of sinus of valsalva|Sinus of valsalva aneurysm]] | ||
* Sinus of | *[[Syphilis]] | ||
* [[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.<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> | ||
* [[Systemic lupus erythematosus | *[[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]] | ||
* [[Turner's syndrome]] | *[[Ventricular septal defect]] | ||
* [[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. | ||
* [[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> | ||
* [[Whipple disease]] | |||
==Complete Differential Diagnosis for the Causes of Aortic Insufficiency== | ==Complete Differential Diagnosis for the Causes of Aortic Insufficiency== | ||
Revision as of 20:01, 20 November 2013
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Aortic Regurgitation Microchapters |
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Acute Aortic regurgitation |
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Chronic Aortic regurgitation |
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Aortic regurgitation causes On the Web |
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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
- 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.[5]
- 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[6]
- Rheumatic fever
- Rupture of a congenitally fenestrated cusp.
Causes of Chronic Aortic Insufficiency
- Ankylosing spondylitis can be associated with inflammation of the aorta (aortitis).[7] 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.[8]
- [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.[9]
- 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.[10]
- 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.[11] SLE can also be associated with the development of sterile verrucous vegetations on the valves called Libman-Sacks endocarditis.[12][13]
- Takayasu arteritis can involve the aorta in an aortitis, the aortic valve itself, and the coronary arteries.[14]
- 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.[15]
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
- ↑ 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) - ↑ 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.
- ↑ 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.