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Revision as of 20:52, 22 April 2014

Aortic Regurgitation Microchapters

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Patient Information

Overview

Historical Pesrpective

Pathophysiology

Causes

Stages

Differentiating Aortic Regurgitation from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Cardiac Stress Test

Electrocardiogram

Chest X Ray

Echocardiography

Cardiac MRI

Treatment

Acute Aortic regurgitation

Medical Therapy
Surgery

Chronic Aortic regurgitation

Medical Therapy
Surgery

Precautions and Prophylaxis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Raviteja Guddeti, M.B.B.S. [2]

Natural History

There are two main parameters that reflect the overall outcome in patients with aortic insufficiency:

Left ventricular dysfunction develops in patients with aortic insufficiency after decades of the onset of the symptoms. This lag period is longer than that of mitral regurgitation.

Diagnosis

Symptoms

Acute aortic insufficiency may present with the following symptoms:

Chronic aortic insufficiency causes:

Patients having bicuspid aortic valve should be evaluated for coarctation of aorta if hypertension is present and for dissection of aorta if chest pain is present. Therefore the entire aorta should be scanned either by magnetic resonance angiogram (MRA) or computed tomography (CT).

Physical Examination

Imaging

Echocardiography is used to assess the following parameters:

Echocardiography can also be used to assess the ascending aorta (root) and/or valve causes of insufficiency.

Echocardiographic findings correlated with severe AR include:

  • AR color jet dimension/left ventricular outflow tract diameter >60%
  • Flow reversal in proximal descending thoracic aorta
  • Regurgitant volume > 60 ml
  • Regurgitant fraction > 55%

If the color flow on echocardiography is solely taken into consideration during the evaluation of aortic regurgitation, echocardiographic findings might underestimate or overestimate the severity of the regurgitation. Thus, it is recommended to use cardiac catheterization as an imaging modality. When discrepancy exists between the findings of echocardiography and that of the cardiac catheterization, it is recommended to do a left ventriculogram.

Treatment

Acute Severe Aortic Insufficiency

Chronic Aotic Insufficiency

Indications for Surgery

Indications for surgery in aortic insufficiency include:

  • Very severe insufficiency
  • Any symptoms
  • Ejection fraction < 50%
  • End systolic dimension > 50 mm

References

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