Aortic regurgitation

 

Disease:

Causes

Dilated aorta:

·      Idiopathic

·      Hypertension

·      Connective tissue disease

·      Dissection

Aortic valve disease:

·      Bicuspid valve

·      Infective endocarditis

Severity

·      Size of jet (doppler quantification)

·      Size of orifice (vena contracta)

·      Size of convergence zone (PISA shell radius)

Complications

·      Left atrial enlargement (volume overload)

·      LV failure

·      Pulmonary hypertension

·      RV failure

·      Arrhythmias

·      Ischaemia (supply-demand mismatch)

Treatment

·      Indication: onset of LV impairment (EF <55%), even if no symptoms

·      If dilated root: replace root ± valve

·      If valve: replace valve only

Haemodynamic goals

·      “Full, fast, forward”

·      Euvolaemia/hypervolaemia

·      Tachycardia: shortens time for regurgitation

·      Vasodilation: reduces pressure gradient for regurgitation

 

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