From the Guidelines
Aortic regurgitation is primarily caused by degeneration of the valve, often accelerated in the context of a bicuspid aortic valve, as well as distortion and dilatation of the aortic root.
Causes of Aortic Regurgitation
The causes of aortic regurgitation can be categorized into:
- Primary causes: intrinsic disease of the aortic valve leaflets, such as degeneration, bicuspid aortic valve, or rheumatic heart disease 1
- Secondary causes: distortion and dilatation of the aortic root, often due to conditions like Marfan syndrome, idiopathic or hypertensive dilation of the ascending aorta, or aortic dissection 1
- Mixed pathology: combination of primary and secondary causes, especially in bicuspid aortic valve disease 1 Other less common causes include infective endocarditis, systemic hypertension, myxomatous degeneration, traumatic injuries to the aortic valve, ankylosing spondylitis, syphilitic aortitis, and rheumatoid arthritis 1.
Diagnosis and Severity
The diagnosis of aortic regurgitation is often suggested by physical examination and confirmed by Doppler echocardiography, which can also grade the severity of the condition 1. The severity of aortic regurgitation can be estimated using parameters such as vena contracta measurement and the proximal isovelocity surface area (PISA) method 1.
Clinical Implications
Aortic regurgitation can lead to significant cardiovascular morbidity and mortality, with severe cases resulting in left ventricular decompensation and increased risk of death or requirement for aortic valve replacement 1.
From the Research
Causes of Aortic Regurgitation
Aortic regurgitation (AR) is characterized by the backflow of blood from the aorta to the left ventricle. The causes of AR can be diverse and may result from various etiologies affecting the aortic valve cusps or the aortic root. Some of the causes of AR include:
- Problems with the aortic valve, such as congenital malformation, infective endocarditis, and probable rheumatic heart disease 2
- Conditions affecting the ascending aorta, such as dissection, the Marfan syndrome, and aortitis 2
- Transcatheter aortic valve replacement (TAVR)-related acute AR, which seems to be a new and common cause of AR 3
Etiologies of Aortic Regurgitation
The etiologies of AR can be categorized into two main groups:
- Valve-related causes, which account for approximately 46% of cases, and include congenital malformation, infective endocarditis, and probable rheumatic heart disease 2
- Aorta-related causes, which account for approximately 54% of cases, and include dissection, the Marfan syndrome, and aortitis 2
Clinical Presentation of Aortic Regurgitation
The clinical presentation of AR depends on the severity of the regurgitation and whether it develops acutely or chronically. Acute AR is a medical emergency, while chronic AR may progress gradually, leading to heart failure symptoms due to left ventricular remodeling 4. The diagnosis of AR relies on electrocardiography, chest radiographs, and echocardiography, with cardiac magnetic resonance imaging potentially being incorporated in chronic AR diagnosis 4.