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    Aortic Regurgitation

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    Pukar Ghimire
    This document discusses aortic regurgitation (AR), including its causes such as rheumatic fever, bicuspid aortic valve disease, aortic root disease, and infective endocarditis. It describes the pathophysiology and clinical features of both acute and chronic AR. Treatment options are also summarized, focusing on using diuretics and vasodilators medically, while urgent surgery is needed for acute severe AR. For chronic AR, careful monitoring is important to determine the optimal timing of aortic valve replacement or root reconstruction surgery before symptoms become severe or left ventricular dysfunction progresses.

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    Aortic Regurgitation

    Uploaded by

    Pukar Ghimire
    13 views18 pages
    This document discusses aortic regurgitation (AR), including its causes such as rheumatic fever, bicuspid aortic valve disease, aortic root disease, and infective endocarditis. It describes the pathophysiology and clinical features of both acute and chronic AR. Treatment options are also summarized, focusing on using diuretics and vasodilators medically, while urgent surgery is needed for acute severe AR. For chronic AR, careful monitoring is important to determine the optimal timing of aortic valve replacement or root reconstruction surgery before symptoms become severe or left ventricular dysfunction progresses.

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    This document discusses aortic regurgitation (AR), including its causes such as rheumatic fever, bicuspid aortic valve disease, aortic root disease, and infective endocarditis. It describes the pathophysiology and clinical features of both acute and chronic AR. Treatment options are also summarized, focusing on using diuretics and vasodilators medically, while urgent surgery is needed for acute severe AR. For chronic AR, careful monitoring is important to determine the optimal timing of aortic valve replacement or root reconstruction surgery before symptoms become severe or left ventricular dysfunction progresses.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    13 views18 pages

    Aortic Regurgitation

    Uploaded by

    Pukar Ghimire
    This document discusses aortic regurgitation (AR), including its causes such as rheumatic fever, bicuspid aortic valve disease, aortic root disease, and infective endocarditis. It describes the pathophysiology and clinical features of both acute and chronic AR. Treatment options are also summarized, focusing on using diuretics and vasodilators medically, while urgent surgery is needed for acute severe AR. For chronic AR, careful monitoring is important to determine the optimal timing of aortic valve replacement or root reconstruction surgery before symptoms become severe or left ventricular dysfunction progresses.

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    Aortic Regurgitation

    Dr Pukar Ghimire
    MBBS, MD
    Causes
    Primary valve disease
    • A rheumatic origin is much less common in
    patients with isolated AR who do not have
    associated rheumatic mitral valve disease.
    • Patients with congenital BAV disease may
    develop predominant AR
    • The coexistence of hemodynamically significant
    AS with AR usually excludes all the rarer forms
    of AR because it occurs almost exclusively in
    patients with rheumatic or congenital AR.
    Primary aortic root disease
    • AR also may be due entirely to marked
    • aortic annular dilation, i.e., aortic root disease,
    without primary involvement of the valve
    leaflets; widening of the aortic annulus and
    separation of the aortic leaflets are
    responsible for the AR
    Pathophysiology of
    chronic AR
    Clinical features: History
    • Approximately 3/4 of patients with pure or
    predominant valvular AR are men; women
    predominate among patients with primary
    valvular AR who have associated rheumatic
    mitral valve disease.
    • Acute severe AR
    – May occur in infective endocarditis, aortic
    dissection, or trauma,
    – the LV cannot dilate sufficiently to maintain stroke
    volume, and LV diastolic pressure rises rapidly with
    associated marked elevations of LA and PA wedge
    pressures.
    – Pulmonary edema and/or cardiogenic shock may
    develop rapidly.
    Chronic AR: Symptoms
    • Long latent period
    • Relative Asymptomatic for 10-15 yrs
    • However, uncomfortable awareness of the heartbeat, especially on lying
    down, may be an early complaint.
    • Sinus tachycardia, during exertion or with emotion, or premature ventricular
    contractions may produce particularly uncomfortable palpitations as well as
    head pounding.
    • Yrs later, exertional SOB develop, which is the 1st symptom of
    dimininished cardiac reserve
    • Followed by orthopnea, PND
    • Anginal chest pain during rest or exertion
    • Nocturnal angina is particularly troublesome
    • Late in course of diseaem congestive hepatomegaly and edema
    Signs
    Treatment
    • Acute AR
    – Patients with acute severe AR may respond to
    intravenous diuretics and vasodilators (such as
    sodium nitroprusside), but stabilization is usually
    short-lived and operation is indicated urgently.
    Chronic AR
    • Medical management
    – Diuretics
    – Vasodilators (ACE inhibitors, dihydropyridine calcium channel
    blockers, or hydralazine)

    • It is often difficult to achieve adequate BP control


    because of the increased stroke volume that
    accompanies severe AR.
    • Cardiac arrhythmias and systemic infections are poorly
    tolerated in patients with severe AR and must be treated
    promptly and vigorously.
    Surgical management
    • In deciding on the advisability and proper
    timing of surgical treatment, two points
    should be kept in mind:
    – Patients with chronic severe AR usually do not
    become symptomatic until after the development
    of myocardial dysfunction;
    – When delayed too long (defined as >1 year from
    onset of symptoms or LV dysfunction), surgical
    treatment often does not restore normal LV
    function.
    • Therefore, in patients with chronic severe AR,
    careful clinical follow-up and noninvasive
    testing with echocardiography at
    approximately 6- to 12-month intervals are
    necessary if operation is to be undertaken at
    the optimal time, i.e., after the onset of LV
    dysfunction but prior to the development of
    severe symptoms.
    • Surgeries
    – Aortic Valve Replacement with mechanical or
    tissue prosthesis
    – Valve-sparing aortic root reconstruction can be
    possible when AR is due to aneurysmal dilation of
    the root or proximal ascending aorta rather than
    to primary valve involvement

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