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Heart Valve Disease pp 47–64Cite as

Aortic Regurgitation

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Abstract

Aortic regurgitation is a common valvular heart disease. Aortic regurgitation may be caused by an acute mechanism of valve failure (endocarditis, aortic dissection), but most cases are secondary to chronic disease of the aortic valve or ascending aorta abnormalities. Patients remain asymptomatic for a long period before symptoms (dyspnea and angina) develop. Physical examination raises clinical suspicion but diagnosis is confirmed by echocardiography which determines mechanism, aetiology, and severity of the AR. Cardiac magnetic resonance and cardiac computed tomography may also be useful. No medical treatment has proved clinical benefit and surgery by aortic valve repair or replacement is the only effective treatment.

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References

  1. Singh JP, Evans JC, Levy D, Larson MG, Freed LA, Fuller DL, Lehman B, Benjamin EJ. Prevalence and clinical determinants of mitral, tricuspid, and aortic regurgitation (the Framingham Heart Study). Am J Cardiol. 1999;83(6):897–902.

    Article  CAS  PubMed  Google Scholar 

  2. Iung B, Baron G, Butchart EG, Delahaye F, Gohlke-Bärwolf C, Levang OW, Tornos P, Vanoverschelde JL, Vermeer F, Boersma E, Ravaud P, Vahanian A. A prospective survey of patients with valvular heart disease in Europe: the Euro Heart Survey on Valvular Heart Disease. Eur Heart J. 2003;24(13):1231–43.

    Article  PubMed  Google Scholar 

  3. Akinseye OA, Aradhana Pathak A, Ibebuogu UN. Aortic valve regurgitation: a comprehensive review. Curr Probl Cardiol. 2018;43:315–34.

    Article  PubMed  Google Scholar 

  4. Tornos P, Evangelista A, Bonow RO. Aortic regurgitation. In: Otto C, Bonow RO, editors. Valvular heart disease: a companion to Braunwald’s heart disease. 4th ed. Philadelphia: Saunders; 2013. p. 163–78.

    Google Scholar 

  5. Maurer G. Aortic regurgitation. Heart. 2006;92:994–1000.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Zoghbi WA, Adams D, Bonow RO, et al. Recommendations for noninvasive evaluation of native valvular regurgitation: a report from the American Society of Echocardiography developed in collaboration with the Society for Cardiovascular Magnetic Resonance. J Am Soc Echocardiogr. 2017;30:303–71.

    Article  PubMed  Google Scholar 

  7. Lancellotti P, Tribouilloy C, Hagendorff A, et al. Recommendations for the echocardiographic assessment of native valvular regurgitation: an executive summary from the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2013;14:611–44.

    Article  PubMed  Google Scholar 

  8. Nienaber CA, von KY, Nicholas V, et al. The diagnosis of thoracic aortic dissection by noninvasive imaging procedures. N Engl J Med. 1993;328:1–9.

    Article  CAS  PubMed  Google Scholar 

  9. Cigarroa JE, Isselbacher EM, DeSanctis RW, et al. Diagnostic imaging in the evaluation of suspected aortic dissection: old standards and new directions. N Engl J Med. 1993;328:35–43.

    Article  CAS  PubMed  Google Scholar 

  10. Habib G, Lancellotti P, Antunes MJ, et al. The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). 2015 ESC Guidelines for the management of infective endocarditis. Eur Heart J. 2015;36:3075–123.

    Article  PubMed  Google Scholar 

  11. Kallenbach K, Oelze T, Salcher R, et al. Evolving strategies for treatment of acute aortic dissection type A. Circulation. 2004;110(Suppl II):II-243–9.

    Google Scholar 

  12. Habib G, Avierinos JF, Thuny F. Aortic valve endocarditis: is there an optimal surgical timing? Curr Opin Cardiol. 2007;22:77–83.

    PubMed  Google Scholar 

  13. Cabell CH, Abrutyn E, Fowler VG, et al. Use of surgery in patients with native valve endocarditis: results from the international collaboration on endocarditis merged database. Am Heart J. 2005;150:1092–8.

    Article  PubMed  Google Scholar 

  14. Aksoy O, Sexton DJ, Wang A, et al. Early surgery in patients with infective endocarditis: a propensity score analysis. Clin Infect Dis. 2007;44:364–72.

    Article  PubMed  Google Scholar 

  15. Roberts WC, KO JM, Moore TR, et al. Causes of pure aortic regurgitation in patients having isolated aortic valve replacement in a single US tertiary hospital (1993-2005). Circulation. 2006;114:422–9.

    Article  PubMed  Google Scholar 

  16. Desjardin VA, Enriquez Sarano M, Tajik AJ, et al. Intensity of murmurs correlates with severity of valvular regurgitation. Am J Med. 1996;100:149–56.

    Article  Google Scholar 

  17. Jost CHA, Turina J, Mayer K, et al. Echocardiography in the evaluation of systolic murmurs of unknown cause. Am J Med. 2000;108:614–20.

    Article  Google Scholar 

  18. Baumgartner H, Falk V, Bax JJ, et al. The Task Force for the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS)2017 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J. 2017;38:2739–91.

    Article  PubMed  Google Scholar 

  19. Boodhwani M, de Kerchove L, Glineur D, et al. Repair-oriented classification of aortic insufficiency: impact on surgical techniques and clinical outcomes. J Thorac Cardiovasc Surg. 2009;137:286–94.

    Article  PubMed  Google Scholar 

  20. Ewe SH, Haeck ML, Ng AC, et al. Detection of subtle left ventricular systolic dysfunction in patients with significant aortic regurgitation and preserved left ventricular ejection fraction: speckle tracking echocardiographic analysis. Eur Heart J Cardiovasc Imaging. 2015;16:992–9.

    PubMed  Google Scholar 

  21. Smedsrud MK, Pettersen E, Gjesdal O, et al. Detection of left ventricular dysfunction by global longitudinal systolic strain in patients with chronic aortic regurgitation. J Am Soc Echocardiogr. 2011;24:1253–9.

    Article  PubMed  Google Scholar 

  22. Mizariene V, Grybauskiene R, Vaskelyte J, Jonkaitiene R, Pavilioniene J, Jurkevicius R. Strain value in the assessment of left ventricular function and prediction of heart failure markers in aortic regurgitation. Echocardiography. 2011;28:983–92.

    Article  PubMed  Google Scholar 

  23. Olsen NT, Sogaard P, Larsson HBW, et al. Speckle-tracking echocardiography for predicting outcome in chronic aortic regurgitation during conservative management and after surgery. JACC Cardiovasc Imaging. 2011;4:223–30.

    Article  PubMed  Google Scholar 

  24. Alashi A, Mentias A, Abdallah A, et al. Incremental prognostic utility of left ventricular global longitudinal strain in asymptomatic patients with significant chronic aortic regurgitation and preserved left ventricular ejection fraction. J Am Coll Cardiol Img. 2018;11:673–82.

    Article  Google Scholar 

  25. Detaint D, Messika-Zeitoun D, Maalouf J, et al. Quantitative echocardiographic determinants of clinical outcome in asymptomatic patients with aortic regurgitation: a prospective study. JACC Cardiovasc Imaging. 2008;1:1–11.

    Article  PubMed  Google Scholar 

  26. Amano M, Izumi C, Imamura S, et al. Pre- and postoperative predictors of long-term prognosis after aortic valve replacement for severe chronic aortic regurgitation. Circ J. 2016;80:2460–7.

    Article  PubMed  Google Scholar 

  27. Lee JC, Branch KR, Hamilton-Craig C, Eric V, Krieger EV. Evaluation of aortic regurgitation with cardiac magnetic resonance imaging: a systematic review. Heart. 2018;104:103–10.

    Article  PubMed  Google Scholar 

  28. Chambers JB, Garbi M, Nieman K, et al. Appropriateness criteria for the use of cardiovascular imaging in heart valve disease in adults: a European Association of Cardiovascular Imaging report of literature review and current practice. Eur Heart J Cardiovasc Imaging. 2017;18:489–98.

    Article  PubMed  Google Scholar 

  29. Harris AW, Krieger EW, Kim M, et al. Cardiac magnetic resonance imaging versus transesophagealthoracic echocardiography for prediction of outcomes in chronic aortic or mitral regurgitation. Am J Cardiol. 2017;119:1074–81.

    Article  PubMed  Google Scholar 

  30. Myerson SG, d’Arcy J, Mohiaddin R, et al. Aortic regurgitation quantification using cardiovascular magnetic resonance: association with clinical outcome. Circulation. 2012;126:1452–60.

    Article  PubMed  Google Scholar 

  31. Azevedo CF, Nigri M, Higuchi ML, et al. Prognostic significance of myocardial fibrosis quantification by histopathology and magnetic resonance imaging in patients with severe aortic valve disease. J Am Coll Cardiol. 2010;56:278–87.

    Article  PubMed  Google Scholar 

  32. Podlesnikar T, Delgado V, Bax JJ. Cardiovascular magnetic resonance imaging to assess myocardial fibrosis in valvular heart disease. Int J Cardiovasc Imaging. 2018;34:97–112.

    Article  PubMed  Google Scholar 

  33. Erbel R, Aboyans V, Boileau C, et al. The Task Force for the diagnosis and treatment of aortic diseases of the European Society of Cardiology (ESC). 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases. Eur Heart J. 2014;35:2873–926.

    Article  PubMed  Google Scholar 

  34. Lancellotti P, Pellikka P, Budts W, et al. The clinical use of stress echocardiography in non-ischaemic heart disease: recommendations from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. EHJCV Imaging. 2016;17:1191–229.

    Google Scholar 

  35. Garbi M, Chambers J, Vannan MA, Lancellotti P. Valve stress echocardiography a practical guide for referral, procedure, reporting, and clinical implementation of results from the HAVEC Group. J Am Coll Cardiol Imaging. 2015;8:724–36.

    Article  Google Scholar 

  36. Lancellotti P, Dulgheru R, Go YY, et al. Stress echocardiography in patients with native valvular heart disease. Heart. 2018;104:807–13.

    Article  PubMed  Google Scholar 

  37. Sato Y, Izumo M, Suzuki K, et al. Prognostic value of exercise left ventricular end-systolic volume index in patients with asymptomatic aortic regurgitation: an exercise echocardiography study. J Echocardiogr. 2017;15:70–8.

    Article  PubMed  Google Scholar 

  38. Wahi S, Haluska B, Pasquet A, Case C, Rimmerman CM, Marwick TH. Exercise echocardiography predicts development of left ventricular dysfunction in medically and surgically treated patients with asymptomatic severe aortic regurgitation. Heart. 2000;84:606–14.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Lee JKT, Franzone A, Lanz J, et al. Early detection of subclinical myocardial damage in chronic aortic regurgitation and strategies for timely treatment of asymptomatic patients. Circulation. 2018;137(2):184–96.

    Article  PubMed  Google Scholar 

  40. Nishimura RA, Otto CM, Bonow RO, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;129:e521–643.

    PubMed  Google Scholar 

  41. Tornos MP, Olona M, Permanyer-Miralda G, et al. Clinical outcome of severe asymptomatic chronic aortic regurgitation: a long-term prospective follow-up study. Am Heart J. 1995;130:333–9.

    Article  CAS  PubMed  Google Scholar 

  42. Evangelista A, Tornos P, Sambola A, Permanyer-Miralda G, Soler-Soler J. Long-term vasodilator therapy in patients with severe aortic regurgitation. N Engl J Med. 2005;353:1342–9.

    Article  CAS  PubMed  Google Scholar 

  43. Elder DH, Wei L, Szwejkowski BR, et al. The impact of renin-angiotensin-aldosterone system blockade on heart failure outcomes and mortality in patients identified to have aortic regurgitation: a large population cohort study. J Am Coll Cardiol. 2011;58:2084–91.

    Article  CAS  PubMed  Google Scholar 

  44. Brooke BS, Habashi JP, Judge DP, Patel N, Loeys B, Dietz HC III. Angiotensin II blockade and aortic-root dilation in Marfan’s syndrome. N Engl J Med. 2008;358:2787–95.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  45. Bisleri G. Aortic valve repair. Curr Opin Cardiol. 2016;31:581–4.

    Article  PubMed  Google Scholar 

  46. Treasure T, Takkenberg JJ, Pepper J. Surgical management of aortic root disease in Marfan syndrome and other congenital disorders associated with aortic root aneurysms. Heart. 2014;100:1571–6.

    Article  PubMed  Google Scholar 

  47. Franzone A, Piccolo R, Siontis GC, et al. Transesophageal catheter aortic valve replacement for the treatment of pure native aortic valve regurgitation: a systematic review. JACC Cardiovasc Interv. 2016;9:2308–17.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Cardiology Department Carretera de Colmenar, Hospital Universitario Ramón y Cajal, Madrid, Spain

    Covadonga Fernández-Golfín

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  1. Covadonga Fernández-Golfín
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Editor information

Editors and Affiliations

  1. Hospital Universitario Ramón y Cajal, Madrid, Spain

    Jose Zamorano

  2. Cardiology, University Hospital Sart Tilman Cardiology, Liège, Belgium

    Patrizio Lancellotti

  3. University of Liège, Liège, Belgium

    Luc Pierard

  4. Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec Heart & Lung Institute, QC, Canada

    Philippe Pibarot

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Fernández-Golfín, C. (2020). Aortic Regurgitation. In: Zamorano, J., Lancellotti, P., Pierard, L., Pibarot, P. (eds) Heart Valve Disease. Springer, Cham. https://doi.org/10.1007/978-3-030-23104-0_4

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  • DOI: https://doi.org/10.1007/978-3-030-23104-0_4

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-23103-3

  • Online ISBN: 978-3-030-23104-0

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