Advertisement

Aortic Regurgitation

  • Piera Capranzano
  • Corrado Tamburino
Chapter

Abstract

Aortic regurgitation (AR) is characterized by blood regurgitation from the aorta into the left ventricle (LV) due to the failure of the valve leaflets to adequately close during the diastolic phase of the cardiac cycle. AR is usually an acquired valve disease, while the congenital etiologies, mainly bicuspid morphology, are rarer. Acquired AR can be caused by primary disease of the aortic valve leaflets and/or abnormalities of the aortic root. The alterations of the aortic valve leaflets are more often of a calcific-degenerative nature, or a result of acute or chronic endocarditic valve processes, or due to myxomatous degeneration. There has been a progressive reduction in primary valve disease of rheumatic origin, which is now a rare event. Systemic arterial hypertension, aortic dissection, and connectivopathies such as Marfan’s syndrome, Reiter’s syndrome, Ehlers-Danlos syndrome, or rheumatoid arthritis alter the aortic root, leading to dilation and subsequent valve closure dysfunction [1]. Pure AR is far less common than aortic stenosis, affecting about 13% of patients with isolated, native left-sided valvular heart disease [2].

References

  1. 1.
    Braunwald E, Goldman L. Primary cardiology. 2nd ed. New York: Elsevier Science; 2003.Google Scholar
  2. 2.
    Iung B, Baron G, Butchart EG, et al. A prospective survey of patients with valvular heart disease in Europe: the euro heart survey on Valvular heart disease. Eur Heart J. 2003;24:1231–43.CrossRefPubMedGoogle Scholar
  3. 3.
    Ti M, Sayeed MR, Stamou SC, et al. Pathophysiology of aortic valve disease. In: Cohn LH, editor. Cardiac surgery in the adult. New York: McGraw-Hill; 2008. p. 825–40.Google Scholar
  4. 4.
    Braunwald E, Fauci AS, Kasper DL, et al. Harrison’s principles of internal medicine. 15th ed. New York: McGraw Hill; 2002.Google Scholar
  5. 5.
    Zoghbi WA, Chambers JB, Dumesnil JG, et al. Recommendations for evaluation of prosthetic valves with echocardiography and Doppler ultrasound. J Am Soc Echocardiogr. 2009;22:975–1014.CrossRefPubMedGoogle Scholar
  6. 6.
    Zoghbi WA, Eriquez-Sarano M, Foster E, et al. Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography. J Am Soc Echocardiogr. 2003;16:777–802.CrossRefPubMedGoogle Scholar
  7. 7.
    Perry GJ, Helmcke F, Nanda NC, et al. Evaluation of aortic insufficiency by Doppler color flow mapping. J Am Coll Cardiol. 1987;9:952–9.CrossRefPubMedGoogle Scholar
  8. 8.
    Bonow RO, Carabello BA, Chatteljee K, et al. ACC/AHA 2006 guidelines for the management of patients with valvular heart disease. J Am Coll Cardiol. 2006;48:1–148.CrossRefGoogle Scholar
  9. 9.
    Vahanian A, Baumgartner H, Bax J, et al. Guidelines on the Management of Valvular Heart Disease: the task force on the management of Valvular heart disease of the European Society of Cardiology. Eur Heart J. 2007;28:230–68.PubMedGoogle Scholar
  10. 10.
    Tribouilloy CM, Enriquez-Sarano M, Fett SL, et al. Application of the proximal flow convergence method to calculate the effective regurgitant orifice area in aortic regurgitation. J Am Coll Cardiol. 1998;32:1032–9.CrossRefPubMedGoogle Scholar
  11. 11.
    Lancellotti P, Tribouilloy C, Hagendorff A, et al. European Association of Echocardiography recommendations for the assessment of valvular regurgitation. Part 1: aortic and pulmonary regurgitation (native valve disease). Eur J Echocardiogr. 2010;11:223–44.CrossRefPubMedGoogle Scholar
  12. 12.
    Enriquez-Sarano M, Bailey KR, Seward JB, et al. Quantitative Doppler assessment of valvular regurgitation. Circulation. 1993;87:841–8.CrossRefPubMedGoogle Scholar
  13. 13.
    Teague SM, Heinsimer JA, Anderson JL, et al. Quantification of aortic regurgitation utilizing continuous wave Doppler ultrasound. J Am Coil Cardiol. 1986;8:592–9.CrossRefGoogle Scholar
  14. 14.
    Bonow RO. Chronic aortic regurgitation. Role of medical therapy and optimal timing for surgery. Cardiol Clin. 1998;16:449–61.CrossRefPubMedGoogle Scholar
  15. 15.
    Borer JS, Hochreiter C, Herrold EM, et al. Prediction of indications for valve replacement among asymptomatic or minimally symptomatic patients with chronic aortic regurgitation and normal left ventricular performance. Circulation. 1998;97:525–34.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Tarasoutchi F, Grinberg M, Spina GS, et al. Ten-year clinical laboratory follow-up after application of a symptom-based therapeutic strategy to patients with severe chronic aortic regurgitation of predominant rheumatic etiology. J Am Coil Cardiol. 2003;41:1316–24.CrossRefGoogle Scholar
  17. 17.
    Dujardin KS, Enriquez-Sarano M, Schaff HV, et al. Mortality and morbidity of aortic regurgitation in clinical practice. A long-term follow-up study. Circulation. 1999;99:1851–7.CrossRefPubMedGoogle Scholar
  18. 18.
    Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC), European Association for Cardio-Thoracic Surgery (EACTS), Vahanian A, Alfieri O, Andreotti F, et al. Guidelines on the management of valvular heart disease (version 2012). Eur Heart J. 2012;33:2451–96.CrossRefGoogle Scholar
  19. 19.
    Roy DA, Schaefer U, Guetta V, et al. Transcatheter aortic valve implantation for pure severe native aortic valve regurgitation. J Am Coll Cardiol. 2013;61:1577–84.CrossRefPubMedGoogle Scholar
  20. 20.
    Wendt D, Kahlert P, Pasa S, et al. Transapical transcatheter aortic valve for severe aortic regurgitation: expanding the limits. J Am Coll Cardiol Intv. 2014;7:1159–67.CrossRefGoogle Scholar
  21. 21.
    Wöhrle J, Rodewald C, Rottbauer W. Transfemoral aortic valve implantation in pure native aortic valve insufficiency using the repositionable and retrievable lotus valve. Catheter Cardiovasc Interv. 2016;87:993–5.CrossRefPubMedGoogle Scholar
  22. 22.
    Seiffert M, Diemert P, Koschyk D, et al. Transapical implantation of a second-generation transcatheter heart valve in patients with noncalcified aortic regurgitation. J Am Coll Cardiol Intv. 2013;6:590–7.CrossRefGoogle Scholar
  23. 23.
    Zhu D, Chen Y, Guo Y, et al. Transapical transcatheter aortic valve implantation using a new second-generation TAVI system - J-valve for high-risk patients with aortic valve diseases: initial results with 90-day follow-up. Int J Cardiol. 2015;199:155–62.CrossRefPubMedGoogle Scholar
  24. 24.
    Barbanti M, Ye J, Pasupati S, El-Gamel A, Webb JG. The Helio transcatheter aortic dock for patients with aortic regurgitation. EuroIntervention. 2013;9(Suppl):S91–4.CrossRefPubMedGoogle Scholar
  25. 25.
    Seiffert M, Bader R, Kappert U, et al. Initial German experience with transapical implantation of a second-generation transcatheter heart valve for the treatment of aortic regurgitation. J Am Coll Cardiol Intv. 2014;7:1168–74.CrossRefGoogle Scholar
  26. 26.
    Wei L, Liu H, Zhu L, et al. A new transcatheter aortic valve replacement system for predominant aortic regurgitation implantation of the J-valve and early outcome. JACC Cardiovasc Interv. 2015;8:1831–41.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  1. 1.Cardiovascular department, Ferrarotto HospitalUniversity of CataniaCataniaItaly

Personalised recommendations