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AORTIC REGURGITATIONETIOLOGY
• LEAFLETS:
RHEUMATIC H.D.
CALCIFIED
PROLAPSE
ENDOCARDITIS
TRAUMA
RHEUMATOID ARTHRITIS
• ANNULUS , ROOT
MARFAN
ANNULOAORTIC ECTASIA
SYPHILLIS
ANKYLOSING SPONDYLITIS
DISSECTION
AORTIC REGURGITATIONPATHOPHYSIOLOGY
• VOLUME OVERLOAD : L.V.MASS + + +
ECCENTRIC LVH
L.V.E.D.P. + + +
L.V.
AORTA
AORTIC REGURGITAIONPHYSICAL EXAMINATION 1
• PULSE : COLLAPSING (CORRIGAN WATERHAMMER)
• DE MUSSET
• QUINCKE
• DUROZIER
• APEX : DISPLACED + + + +
DILATED + + + +
COR BOVINUM
AORTIC REGURGITATIONEVALUATION
• 1. PHYSICAL EXAMINATION:
APEX
LENGTH OF MURMUR!
DUROZIER
• 2. ECHODOPPLER:
L.V. SIZE
WIDTH OF COLOR JET
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 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
PROSTHETIC MECHANICAL VALVES
Starr-Edwards caged-ball valve
.
The Medtronic-Hall valve
The St. Jude bileaflet valve.
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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