Natural History of Aortic Regurgitation

  • Charles R. McKay
  • Shahbudin H. Rahimtoola
Part of the Developments in Cardiovascular Medicine book series (DICM, volume 85)


Aortic regurgitation was described by Cowper in 1705, who noted progressive heart failure associated with calcified insufficient aortic valves and very large hearts [1]. The clinical findings of increased pulse pressure with rapid diastolic collapse were associated with aortic valve incompetence by Corrigan in 1832 [2]. Austin Flint described the associated functional mitral middiastolic and presystolic murmurs in 1870 and noted that medical treatment with digitalis and diuretics could be helpful in these patients [3], Seventy-four years later, White [4] noted that once overt heart failure occurred, the prognosis was poor despite medical treatment with these same drugs. Hufnagel described the first “direct” mechanical treatment of aortic insufficiency by placing a ball valve prosthesis in the descending aorta [5]. It remained for Harken [6] and Lillehei [7] to actually replace the incompetent aortic valve with prosthetic devices. Aortic valve replacement with prosthetic valves has dramatically improved the clinical status of these patients[8].


Aortic Valve Infective Endocarditis Aortic Valve Replacement Aortic Regurgitation Bicuspid Aortic Valve 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Cowper W. Of ossifications or petrifications in the coats of arteries, particularly in the valves of the great artery. Philosoph Trans Lond 24:1705, 1790.Google Scholar
  2. 2.
    Corrigan DJ. On the permanent patency of the mouth of the aorta, or inadequacy of the aortic valves. Edinburgh Med Surg J 7:225, 1832.Google Scholar
  3. 3.
    Austin Flint. Diseases of the Heart, Sherman and Co., Philadelphia, 1870.Google Scholar
  4. 4.
    White PD. Heart Disease, MacMillan and Co., New York, 1944.Google Scholar
  5. 5.
    Hufnagel CA, Harvey WP, McDermott TF. Surgical correction of aortic insufficiency. Surgery 35:673–683, 1954.PubMedGoogle Scholar
  6. 6.
    Harken DE, Soroff HS, Taylor WJ, Lefemine AA, Gupta SK, Lunzer S. Partial and complete prosthesis in aortic insufficiency. J Thorac Cardiovasc Surg 40:744–761, 1960.PubMedGoogle Scholar
  7. 7.
    Lillehei CW. Surgical treatment of stenotic and regurgitant lesions of the mitral and aortic valves by direct vision utilizing a pump oxygenator. J Thorac Surg 35:154, 1958.PubMedGoogle Scholar
  8. 8.
    Rahimtoola SH. Valvular heart disease: A perspective. J Am Coll Cardiol 1:199–215, 1983.PubMedCrossRefGoogle Scholar
  9. 9.
    Edwards J. Pathology of aortic incompetence. In Silver MD (ed) Cardiovascular Pathology, Livingston, 1983, pp 619–631.Google Scholar
  10. 10.
    Waller BF. Morphologic aspects of valvular heart disease: Part I. Current Problems in Cardiology 9(7): 1–66, 1984.CrossRefGoogle Scholar
  11. 11.
    Roberts WC, Morrow AG, Mcintosh CL, Jones M, Epstein SE. Congenitally bicuspid aortic valve causing severe, pure aortic regurgitation without superimposed infective endocarditis: Analysis of 13 patients requiring aortic valve replacement. Am J Cardiol 47: 206–209, 1981.PubMedCrossRefGoogle Scholar
  12. 12.
    Davies MJ. Pathology of cardiac valves, Butterworth, Boston, 1980, pp 37–61.Google Scholar
  13. 13.
    Olson LJ, Subramanian R, Edwards WD. Surgical pathology of pure aortic insufficiency: A study of 225 cases. Mayo Clin Proc 59:835–841, 1984.PubMedGoogle Scholar
  14. 14.
    Lakier JB, Copans H, Rosman HS, Lam R, Fine G, Khaja F, Goldstein S. Idiopathic degeneration of the aortic valve: A common cause of isolated aortic regurgitation. J Am Coll Cardiol 5:347–351, 1985.PubMedCrossRefGoogle Scholar
  15. 15.
    Allen WM, Matloff J, Fishbein MC. Myxoid degeneration of the aortic valve and isolated severe aortic regurgitation. Am J Cardiol 55:439–444, 1985.PubMedCrossRefGoogle Scholar
  16. 16.
    Tonnemacher D, Reid C, Kawanishi D, Cummings T, Chandrasoma P, McKay CR, Rahimtoola SH, Chandraratna PA. Frequency of myxomatous degeneration of the aortic valve as a cause of isolated aortic regurgitation severe enough to warrant aortic valve replacement. Am J Cardiol, 60:1194–1196, 1987.PubMedCrossRefGoogle Scholar
  17. 17.
    Roberts WC. Anatomically isolated aortic valvular disease: The case against its being of rheumatic etiology. Am J Med 49:151–159, 1970.PubMedCrossRefGoogle Scholar
  18. 18.
    Reid CL. McKay CR, Kawanishi DT, Edwards C, Rahimtoola SH, Chandraratna PAN. False aneurysms of the mitral-aortic intervalvular fibrosa: Diagnosis by two-dimensional contrast echocardiography at cardiac catheterization. Am J Cardiol 51:1801–1802, 1983.PubMedCrossRefGoogle Scholar
  19. 19.
    Roberts WC, Buchbinder NA. Healed left-sided infective endocarditis: A clinicopathologic study of 59 patients. Am J Cardiol 40:876–888, 1977.PubMedCrossRefGoogle Scholar
  20. 20.
    Waller BF, Carter JB, Williams HJ, Wang K, Edwards JE: Bicuspid aortic valve. Comparison of congenital and acquired types. Circulation 48:1140–1151, 1973.PubMedGoogle Scholar
  21. 21.
    McKay R, Yacoub MH. Clinical and pathologic findings in patients with “floppy” valves treated surgically. Circulation 47–48:(S-III)-63–73, 1973Google Scholar
  22. 22.
    Frable WJ. Mucinous degeneration of the cardiac valves: The “floppy valve” syndrome. J Thorac Cardiovasc Surg 58:62–70, 1969.PubMedGoogle Scholar
  23. 23.
    Carter JB, Sethi S, Lee GB, Edwards JE. Prolapse of semilunar cusps a cause of aortic insufficiency. Circulation 43:922–932, 1971.PubMedGoogle Scholar
  24. 24.
    Waller BF, Reis RL, Mcintosh CL, Epstein Se, Roberts WG. Marfan cardiovascular disease without Marfan syndrome: Fusiform ascending aortic aneurysm with aortic and mitral valve regurgitation. Chest 77:533–540, 1980.PubMedCrossRefGoogle Scholar
  25. 25.
    Waller BF, Zoltick JM, Rosen JH, Katz NM, Gomes MH, Fletcher RD, Wallace RB, Roberts WC. Severe aortic regurgitation from systemic hypertension (without dissection) requiring aortic valve replacement: Analysis of four patients. Am J Cardiol 49:473–477, 1982.PubMedCrossRefGoogle Scholar
  26. 26.
    Kotlewski A, McKay C, Harrison EC, Kawanishi D, Reid C, Chandraratna PAN, Bhandari A, Elkayam U, Weiss J, Rahimtoola SH. Incremental value of clinical examination, echocardiography, and cardiac catheterization in the evaluation of aortic valve disease. J Am Coll Cardiol 9:20A, 1987.Google Scholar
  27. 27.
    Frank MJ, Casanegra P, Migliori AJ, Levinson GE. The clinical evaluation of aortic regurgitation. Arch Int Med 116:357–365, 1965.Google Scholar
  28. 28.
    Cohn LH, Mann DT, Ross J Jr, Morrow A, Braunwald E. Preoperative assessment of aortic regurgitation in patients with mitral valve disease. Am J Cardiol 19:177–182.Google Scholar
  29. 29.
    Goldschlager N, Pfeifer J, Cohn K, Popper R, Selzer R. Natural history of aortic regurgitation: A clinical and hemodynamic study. Am J Med 54:577–588, 1973.PubMedCrossRefGoogle Scholar
  30. 30.
    Basta LL, Raines D, Najjar S, Kioschos JM. Clinical hemodynamics and coronary angioraphic correlates of angina pectoris in patients with severe aortic valve disease. Br Heart J 37:150–157, 1975.PubMedCrossRefGoogle Scholar
  31. 31.
    Karaian CH, Greenberg BH, Rahimtoola SH. The relationship between functional class and cardiac performance in patients with chronic aortic insufficiency. Chest 88:553–557, 1985.PubMedCrossRefGoogle Scholar
  32. 32.
    Edwards JE. Lesions causing or simulating aortic insufficiency. Cardiovasc Clin 5:128–148, 1973.Google Scholar
  33. 33.
    Abdulla AM, Frank MJ, Erdim RA, Canedo MI. Clinical significance and hemodynamic correlates of the third heart sound gallop in aortic regurgitation: A guide to optimal timing of cardiac catheterization. Circulation 64:464–471, 1981.PubMedCrossRefGoogle Scholar
  34. 34.
    Fortuin NJ, Craig E. On the mechanism of the Austin Flint murmur. Circulation 45:558–570, 1972.PubMedGoogle Scholar
  35. 35.
    Schaefer RA, McAnulty JH, Starr A, Rahimtoola SH. Diastolic murmurs in the presence of Starr-Edwards mitral prosthesis: With emphasis on the genesis of the Austin Flint murmur. Circulation 51:402–409, 1975.Google Scholar
  36. 36.
    Scott RW. Symptoms and clinical course of syphilitic aortic insufficiency. Am Heart J 6:86–90, 1930.CrossRefGoogle Scholar
  37. 37.
    Reader GG, Romeo BJ, Webster B, McDermott W. The prognosis of syphilitic aortic insufficiency. Ann Int Med 27:584–595, 1947.PubMedGoogle Scholar
  38. 38.
    Segal J, Harvey WP, Hufnagel C. Clinical study of 100 cases of severe aortic insufficiency. Am J Med 21:200–210, 1956.PubMedCrossRefGoogle Scholar
  39. 39.
    Bland EF, Wheeler EO. Severe aortic regurgitation in young people. A long-term perspective with references to prognosis and prosthesis. N Engl J Med 256:667–672, 1957.PubMedCrossRefGoogle Scholar
  40. 40.
    Haravon A, Delman A, Rosenblum R. Aortic insufficiency: Clinical course under medical therapy. NY State J Med 34:657–661, 1969.Google Scholar
  41. 41.
    Spagnuolo M, Kloth H, Taranta A, Doyle E, Pasternack B. Natural history of rheumatic aortic regurgitation: Criteria predictive of death, congestive heart failure, and angina in young patients. Circulation 44:368–380, 1971.PubMedGoogle Scholar
  42. 42.
    Bonow RO, Rosing DR, Mcintosh CL, Jones M, Maron BJ, Lan G, Lakotos E, Bacharach SL, Green MV, Epstein SE. The natural history of asymptomatic patients with aortic regurgitation and normal left ventricular function. Circulation 68:509–517, 1983.PubMedCrossRefGoogle Scholar
  43. 43.
    Shen WF, Roubin GS, Choong CY-P, Hutton BF, Harris PJ, Fletcher PJ, Kelly DT. Evaluation of relationship between myocardial contractile state and left ventricular function in patients with aortic regurgitation. Circulation 71:31, 1985.PubMedCrossRefGoogle Scholar
  44. 44.
    Kawanishi DT, McKay CR, Chandraratna PA, Nanna M, Reid CL, Elkayam U, Siegel M, Rahimtoola SH. Cardiovascular response to dynamic exercise in patients with chronic symptomatic mild-to-moderate and severe aortic regurgitation. Circulation 73:62, 1986.PubMedCrossRefGoogle Scholar
  45. 45.
    Grant RT. After-histories for 10 years of a thousand men suffering from heart disease. Heart 16:275–334, 1933.Google Scholar
  46. 46.
    Padget P, Moore JE. Results of treatment of cardiovascular syphilis. Am Heart J 10:1017–1024, 1935.CrossRefGoogle Scholar
  47. 47.
    Webster B, Rich C, Densen PM, Moore JE, Nicol CS, Padget P. Studies in cardiovascular syphilis, natural history of syphilitic aortic insufficiency. Am Heart J 46:117–145, 1953.PubMedCrossRefGoogle Scholar
  48. 48.
    Masseil BF, Amezoua FJ, Czoniczer G. Prognosis of patients with pure or predominant aortic regurgitation in the absence of surgery. Circulation (Suppl III) 34:111–164, 1966.Google Scholar
  49. 49.
    Hegglin R, Scheutt H, Rothlin M. Aortic insufficiency. Circulation 37(v):77–92, 1968.Google Scholar
  50. 50.
    Rotman W, Morris J, Behar V, Peter RH, Kong H. Aortic valvular disease: Comparison of types and their medical and surgical management. Am J Med 51:241–257, 1971.PubMedCrossRefGoogle Scholar
  51. 51.
    Rapaport E. Natural history of aortic and mitral valve disease. Am J Cardiol 35:221–227, 1975.PubMedCrossRefGoogle Scholar
  52. 52.
    Munoz S, Gallardo J, Diaz-Gorrin J, Medina O. Influence of surgery on the natural history of rheumatic mitral and aortic valve disease. Am J Cardiol 35:234–242, 1975.PubMedCrossRefGoogle Scholar
  53. 53.
    Smith HJ, Neutz JM, Roche AH, Agnew TM, Barratt-Boyes BG. The natural history of rheumatic aortic regurgitation and the indications for surgery. Br Heart J 38:147–154, 1976.PubMedCrossRefGoogle Scholar

Copyright information

© Kluwer Academic Publishers 1988

Authors and Affiliations

  • Charles R. McKay
  • Shahbudin H. Rahimtoola

There are no affiliations available

Personalised recommendations