Aortic regurgitation in young patients

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Congenital aortic insufficiency rarely occurs alone and is often associated with aortic stenosis or ventricular septal defect. Although it may occasionally be seen in adolescents and young adults with a bicuspid aortic valve, discrete subaortic obstruction, or prolapse of one of the aortic cusp into a ventricular septal defect. Turner syndrome, osteogenesis imperfecta, tetralogy of Fallot, and truncus arteriosus are other congenital disorders that are associated with aortic insufficiency in young patients.

Rheumatic heart disease is one of the important causes for acquired aortic insufficiency in young patients in developing countries. It can also occur following an episode of infective endocarditis or as a consequence of attempts to relieve aortic stenosis by either balloon valvuloplasty or surgical valvulotomy, or when the pulmonary artery is relocated in the aortic position during repair of transposition of great vessels.

AHA/ACC guidelines for treatment of aortic insufficiency in adolescent or young adults

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Class I An adolescent or young adult with chronic severe aortic insufficiency with onset of symptoms of angina, syncope, or dyspnea on exertion should receive aortic valve repair or replacement. (Level of Evidence: C) Asymptomatic adolescent or young adult patients with chronic severe aortic insufficiency with left ventricular systolic dysfunction (ejection fraction less than 0.50) on serial studies 1 to 3 months apart should receive aortic valve repair or replacement. (Level of Evidence: C) Asymptomatic adolescent or young adult patients with chronic severe aortic insufficiency with progressive left ventricualr enlargement (end-diastolic dimension greater than 4 standard deviations above normal) should receive aortic valve repair or replacement. (Level of Evidence: C) Coronary angiography is recommended before AVR in adolescent or young adult patients with aortic insufficiency in whom a pulmonary autograft (Ross operation) is contemplated when the origin of the coronary arteries has not been identified by noninvasive techniques. (Level of Evidence: C) Class IIb An asymptomatic adolescent with chronic severe aortic insufficiency with moderate aortic stenosis (peak left ventricle–to–peak aortic gradient greater than 40 mm Hg at cardiac catheterization) may be considered for aortic valve repair or replacement. (Level of Evidence: C) An asymptomatic adolescent with chronic severe aortic insufficiency with onset of ST depression or T-wave inversion over the left precordium on electrocardiogram at rest may be considered for aortic valve repair or replacement. (Level of Evidence: C)

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The Ross Procedure

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