Aortic regurgitation

Aortic regurgitation refers to when the aortic valve closes incompletely during systole, causing blood to flow back from the ascending aorta into the left ventricle. It’s a rare valvular disease, and the most common cause is age-related degeneration of the valve.

Like MR, aortic regurgitation can be primary, due to direct involvement of the valve itself, or secondary, due to dilation of the ascending aorta, making it impossible for the anatomically normal aortic valve to close properly. It can also be either acute or chronic.

Etiology

• Primary
  • Infective endocarditis
  • Aortic dissection affecting the ascending aorta
  • Congenital bicuspid aortic valve (mostly younger adults)
  • Calcific aortic valve disease (mostly older adults, coexists with aortic stenosis)
• Secondary
  • Connective tissue disorders (Marfan syndrome, etc.)

Clinical features

Acute aortic regurgitation causes sudden severe dyspnoea due to acute heart failure and pulmonary oedema. Chronic aortic regurgitation progresses slowly from asymptomatic to heart failure.

Treatment

Surgery is the definitive treatment for both acute and chronic aortic regurgitation and is indicated for symptomatic disease, AR which has lead to heart failure, indication for another type of heart surgery (one might as well replace the aortic valve simultaneously), Marfan syndrome, and if the aortic root diameter is > 55 mm.