From the Guidelines
Aortic regurgitation is primarily caused by conditions that damage the aortic valve or the aortic root, with degeneration of the valve being the most common etiology of chronic aortic regurgitation, often accelerated in the context of a bicuspid aortic valve. The causes of aortic regurgitation can be broadly categorized into primary disease of the aortic valve leaflets and abnormalities of the aortic root geometry 1.
Common Causes
- Congenital abnormalities, such as bicuspid aortic valve, which affects about 1-2% of the population and predisposes to valve dysfunction 1
- Degenerative changes with aging leading to valve calcification and dysfunction
- Aortic root dilation from hypertension, Marfan syndrome, or aortic aneurysms can prevent proper valve closure
- Other causes include connective tissue disorders like Ehlers-Danlos syndrome, inflammatory conditions like rheumatoid arthritis, trauma, and iatrogenic causes from procedures like transcatheter aortic valve replacement
- Certain medications like ergotamine, methysergide, and some appetite suppressants have also been linked to aortic regurgitation Understanding these causes is crucial for prevention, risk assessment, and determining appropriate treatment strategies, which may include valve repair or replacement depending on severity and underlying etiology 1.
Clinical Implications
The management of patients with aortic regurgitation depends on an accurate diagnosis of the underlying cause and the stage of the disease, with guidelines providing a framework for assessment and treatment 1. Severe aortic regurgitation is associated with significant cardiovascular morbidity and mortality, emphasizing the need for timely and appropriate intervention 1.
From the Research
Causes of Aortic Regurgitation
- Aortic regurgitation (AR) is a valvular disease characterized by retrograde blood flow from the aorta to the left ventricle, resulting from various etiologies 2.
- One of the common causes of pure AR in adults is a congenitally bicuspid aortic valve (BAV) unassociated with infective endocarditis or aortic dissection 3.
- BAV is a common congenital cardiac malformation that increases the risk of thoracic aortic aneurysm and dissection, infective endocarditis, and sudden cardiac death 4.
- The evaluation of AR in BAV is challenging due to the eccentricity of the jet, which may under/overestimate the regurgitation, and requires a multimodality imaging approach 5.
Associated Conditions
- BAV may be associated with other valvular abnormalities and aortopathies, increasing the risk of complications such as thoracic aortic aneurysm and dissection 4.
- Patients with BAV require regular surveillance for progressive valvular disease and aortopathy, and first-degree relatives should be evaluated and genetic counseling considered 4.
- Acute AR is a medical emergency caused by sudden increases in left ventricular volume, while chronic AR progresses gradually, leading to heart failure symptoms due to left ventricular remodeling 2.