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Acute aortic regurgitation in adults

Author
Catherine M Otto, MD
Section Editor
William H Gaasch, MD
Deputy Editor
Susan B Yeon, MD, JD, FACC

INTRODUCTION

The acute onset of severe aortic regurgitation (AR, also called aortic insufficiency) is usually a medical emergency due to the inability of the left ventricle to quickly adapt to the rapid increase in end-diastolic volume caused by regurgitant blood. If not surgically corrected, acute severe AR commonly results in cardiogenic shock. In contrast, clinical symptoms are a relatively late feature of chronic AR, since the gradually dilating left ventricle and compensatory mechanisms dampen many of the hemodynamic abnormalities resulting from chronically increased diastolic volumes [1,2].

Issues related to acute AR will be reviewed here. Chronic AR is discussed separately. (See "Clinical manifestations and diagnosis of chronic aortic regurgitation in adults" and "Natural history and management of chronic aortic regurgitation in adults".)

ETIOLOGY

The causes of acute aortic regurgitation (AR) with a native aortic valve are limited and include:

Endocarditis – Endocarditis results in valve destruction and leaflet perforation. In addition, aortic perivalvular abscess may rupture into the left ventricle, resulting in AR, or into the left atrium or right ventricular outflow tract, with a clinical presentation that mimics acute aortic regurgitation. (See "Complications and outcome of infective endocarditis", section on 'Perivalvular abscess'.)

Aortic dissection – Aortic dissection can result in AR by four mechanisms: dilation of the sinuses with incomplete coaptation of the leaflets at the center of the valve; involvement of a valve commissure resulting in inadequate leaflet support; direct extension of the dissection into the base of a leaflet, resulting in a flail valve leaflet; and prolapse of the dissection flap across the aortic valve into the left ventricular outflow tract in diastole impeding leaflet closure. Patients with a bicuspid aortic valve are at higher risk of aortic dissection [3]. (See "Clinical features and diagnosis of acute aortic dissection" and "Clinical manifestations and diagnosis of bicuspid aortic valve in adults", section on 'Aortic regurgitation'.)

          

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Literature review current through: Nov 2016. | This topic last updated: Wed Apr 22 00:00:00 GMT+00:00 2015.
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References
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  1. Stout KK, Verrier ED. Acute valvular regurgitation. Circulation 2009; 119:3232.
  2. Mokadam NA, Stout KK, Verrier ED. Management of acute regurgitation in left-sided cardiac valves. Tex Heart Inst J 2011; 38:9.
  3. Fedak PW, Verma S, David TE, et al. Clinical and pathophysiological implications of a bicuspid aortic valve. Circulation 2002; 106:900.
  4. Blaszyk H, Witkiewicz AJ, Edwards WD. Acute aortic regurgitation due to spontaneous rupture of a fenestrated cusp: report in a 65-year-old man and review of seven additional cases. Cardiovasc Pathol 1999; 8:213.
  5. Prêtre R, Faidutti B. Surgical management of aortic valve injury after nonpenetrating trauma. Ann Thorac Surg 1993; 56:1426.
  6. Onorati F, De Santo LS, Carozza A, et al. Marfan syndrome as a predisposing factor for traumatic aortic insufficiency. Ann Thorac Surg 2004; 77:2192.
  7. Isner JM. Acute catastrophic complications of balloon aortic valvuloplasty. The Mansfield Scientific Aortic Valvuloplasty Registry Investigators. J Am Coll Cardiol 1991; 17:1436.
  8. Roberts WC, Ko JM, Moore TR, Jones WH 3rd. Causes of pure aortic regurgitation in patients having isolated aortic valve replacement at a single US tertiary hospital (1993 to 2005). Circulation 2006; 114:422.
  9. Zoghbi WA, Enriquez-Sarano M, Foster E, et al. Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography. J Am Soc Echocardiogr 2003; 16:777.
  10. Nishimura RA, Otto CM, Bonow RO, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2014; 63:e57.
  11. Grande RD, Katz WE. Acute aortic regurgitation secondary to disk embolization of a Björk-Shiley prosthetic aortic valve. J Am Soc Echocardiogr 2011; 24:350.e5.
  12. Saranteas T, Christodoulaki K, Rinaki D, Kostopanagiotou G. Transthoracic echocardiography for the identification of acute aortic regurgitation in the intensive care unit. J Cardiothorac Vasc Anesth 2011; 25:204.