ISSN: 1305-385X
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Aortic Regurgitation
Dr. Niyazi GÜLER,a Dr. Cenap ÖZKARAb
aKardiyoloji AD, Yüzüncü Yıl Üniversitesi Tıp Fakültesi, VANbKalp Damar Cerrahisi Kliniği, Çorlu Şifa Hastanesi, TEKİRDAĞ
Aortic regurgitation (AR) results from mal coaptation of the aortic leaflets due to abnormalities of the aortic leaflets, their supporting structures (aortic root and annulus), or both. Acute AR is most commonly caused by bacterial endocarditis, aortic dissection, or blunt chest trauma. Acute AR typically causes severe pulmonary edema and hypotension and is a surgical emergency. Chronic severe AR causes combined left ventricle (LV) volume and pressure overload. Diseases that primarily affect the leaflets include bicuspid aortic valve and other congenital abnormalities, atherosclerotic degeneration, infective endocarditis, rheumatic heart disease, connective tissue or inflammatory diseases, antiphospholipid syndrome, and use of anorectic drugs. In chronic severe AR, the elevated stroke volume and systolic hypertension produce a variety of interesting physical findings. The most important diagnostic test for evaluation of AR is echocardiography. It allows (1) assessment of the anatomy of the aortic leaflets and the aortic root, (2) detection of the presence and severity of AR, and (3) characterization of LV size and function. Many patients with chronic severe AR may remain clinically compensated for years with normal LV function and no symptoms. Symptomatic patients should undergo surgery unless there are excessive comorbidities or other contraindications. The more difficult issue is when to operate on asymptomatic patients to prevent irreversible LV dysfunction from occurring. Outcomes are better in patients with an LVEF-55% or an end-systolic LV diameter-55 mm. This has been termed the “55 rule.” The role of medical therapy, particularly vasodilators, is primarily to decrease systolic hypertension and delay the onset of LV dysfunction in asymptomatic patients.Keywords: Aortic regurgitation, diagnosis, therapyTurkiye Klinikleri J Int Med Sci 2006, 2(15):35-38
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