AORTIC REGURGITATION

AORTIC REGURGITATIONETIOLOGY

• LEAFLETS:

RHEUMATIC H.D.

CALCIFIED

PROLAPSE

ENDOCARDITIS

TRAUMA

RHEUMATOID ARTHRITIS

• ANNULUS , ROOT

MARFAN

ANNULOAORTIC ECTASIA

SYPHILLIS

ANKYLOSING SPONDYLITIS

DISSECTION

AORTIC INCOMPETENCE- ETIOLOGY

AORTIC INCOMPETENCE- ETIOLOGY

AORTIC REGURGITATIONPATHOPHYSIOLOGY

• VOLUME OVERLOAD : L.V.MASS + + +

ECCENTRIC LVH

L.V.E.D.P. + + +

L.V.

AORTA

AORTIC REGURGITATIONPATHOPHYSIOLOGY

AORTIC REGURGITATIONSYMPTOMS

• CONGESTIVE HEART FAILURE

• ANGINA PECTORIS

AFTER LONG LATENT PERIOD

AORTIC REGURGITAIONPHYSICAL EXAMINATION 1

• PULSE : COLLAPSING (CORRIGAN WATERHAMMER)

• DE MUSSET

• QUINCKE

• DUROZIER

• APEX : DISPLACED + + + +

DILATED + + + +

COR BOVINUM

AORTIC REGURGITATIONDUROZIER SIGN

FEMORAL ART.

LISTEN TO DIASTOLIC MURMUR!

AORTIC REGURGITATIONPHYSICAL EXAMINATION 2

AUSCULTATION

S1 S(P)2 S3

S4 M.S.M. E.D.M.

AORTIC REGURGITATIONEVALUATION

• 1. PHYSICAL EXAMINATION:

APEX

LENGTH OF MURMUR!

DUROZIER

• 2. ECHODOPPLER:

L.V. SIZE

WIDTH OF COLOR JET

Aortic Incompetence- ECG

Left Ventricular Hypertrophy & Strain , Wide QRS

AORTIC REGURGITATION ECHODOPPLER

BICUSPID AORTIC VALVE TRANSESOPHAGEAL ECHO

AORTIC REGURGITATION ECHODOPPLER

Continuous-wave spectral recordings of patients with mild (top) and severe (bottom) aortic insufficiency. Note the relatively flat slope pressure decay and faint spectral signal intensity in the mild insufficiency and a denser spectral signal and steeper slope of pressure decay,denoting near equalization of aortic and left ventricular diastolic pressures,seen in severe aortic insufficiency.

AORTIC REGURGITATIONNATURAL HISTORY

Bonow and associates (blue line) and Borer and colleagues (magenta line), each enrolling 104 patients. At 11 years, 45 to 58 percent of patients remained asymptomatic with normal LV function, such that the risk of developing symptoms, LV dysfunction, or death is 4 to 6 percent per year.

AORTIC REGURGITATIONNATURAL HISTORY

Survival without surgery in 242 patients with chronic aortic regurgitation, demonstrating the importance of symptoms in determining outcome.

AORTIC REGURGITATIONTREATMENT 1

• VASODILATORS

• DIURETICS

• DIGOXIN

• AORTIC VALVE REPLACEMENT

AORTIC REGURGITATIONTREATMENT 2

 Randomized clinical trial of nifedipine versus digoxin in asymptomatic patients with chronic aortic regurgitation and normal left ventricular (LV) function.

AORTIC REGURGITATIONTREATMENT 3

• INDICATIONS FOR SURGERY :

• SYMPTOMS

• L.V. DILATATION > 7.5 / 5.5 CM

• INTRA AORTIC BALLOON PUMP

CONTRAINDICATED!!!!

INDICATION FOR AVR IN ASYMPTOMATIC PATIENTS

WITH A.R.ACC/AHA

• LVEF < 49% (classI)

• L.E.S.D. >55mm (classII)

ESC

• LVEF < 50%

• L.E.S.D. > 50mm

• L.E.D.D. > 70mm

AORTIC REGURGITATIONTREATMENT 4

Long-term postoperative survival in patients with aortic regurgitation, stratified according to the severity of preoperative symptoms and preoperative left ventricular ejection fraction

AORTIC REGURGITATIONTREATMENT 5

The same for patients with LVEF < 50%

PROSTHETIC MECHANICAL VALVES

Starr-Edwards caged-ball valve

.

The Medtronic-Hall valve

The St. Jude bileaflet valve.

PROSTHETIC BIOLOGICAL VALVES

ACUTE AORTIC REGURGITATION 1

• SHOCK

• TACHYCARDIA

• PULMONARY EDEMA

• NO PERIPHERAL SIGNS

• SHORT E.D.M.

• S3

ACUTE AORTIC REGURGITATION 2

• HIGH INDEX OF SUSPICION!!

• ECHODOPPLER

• CATHETERIZATION -

HEMODYNAMICS

AORTOGRAM

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