Aortic Regurgitation, Adult (Aortic Insufficiency)

Description

• Aortic regurgitation, incompetence or insufficiency “AR/AI” is abnormal back flow of blood from the aorta to the left ventricle during diastole due to pathology affecting the valve or the aorta leading to inadequate closure of the valve leaflets.
• It can be acute or chronic.

Epidemiology

Incidence

• No data are available.
• Trace aortic incompetence is common even in healthy subjects.

Prevalence

• Less prevalent than other valvular regurgitation
• Male > female: 13:8.5% (1)
• In United States, estimates of the prevalence of AR of any severity range from 2% to 30%, but only 5–10% of patients with AR have severe disease, resulting in an overall prevalence of severe AR of <1% in the general population.
• Prevalence increases with age.

Etiology and Pathophysiology

• According to presentation
  • Acute AR: endocarditis, dissection, and trauma. No time for adaptation leads to pulmonary edema and decreased cardiac output.
  • Chronic AR: gradual hypertrophy and dilatation of the left ventricle that progresses to pulmonary edema then heart failure, if untreated
• Geographical variation
  • Developed countries: annular dilatation due to Marfan syndrome, type A aortic dissection and bicuspid valve (2)
  • Developing countries: rheumatic heart disease, endocarditis (2)
• Other causes: idiopathic aortic dilation, cystic medial necrosis, senile aortic ectasia and dilatation, syphilitic aortitis, inflammatory vascular diseases, and postsurgical

Genetics

• Marfan syndrome: autosomal dominant connective tissue disorder; mutation in the FBN1 gene
• Bicuspid valve

Risk Factors

• Uncontrolled blood pressure (BP)
• Intravenous drug use that may lead to endocarditis
• Aortic stenosis
• Old age

General Prevention

Control risk factors:

• Control BP.
• Stop smoking; exercising and healthy diet
• Avoid drug abuse.
• Infective endocarditis prophylaxis when appropriate

Commonly Associated Conditions

Bicuspid aortic valve