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AORTIC REGURGITATION. LEAFLETS: RHEUMATIC H.D. CALCIFIED PROLAPSE ENDOCARDITIS TRAUMA RHEUMATOID ARTHRITIS. ANNULUS , ROOT MARFAN ANNULOAORTIC ECTASIA SYPHILLIS ANKYLOSING SPONDYLITIS DISSECTION. AORTIC REGURGITATION ETIOLOGY. AORTIC INCOMPETENCE- ETIOLOGY.
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LEAFLETS: RHEUMATIC H.D. CALCIFIED PROLAPSE ENDOCARDITIS TRAUMA RHEUMATOID ARTHRITIS ANNULUS , ROOT MARFAN ANNULOAORTIC ECTASIA SYPHILLIS ANKYLOSING SPONDYLITIS DISSECTION AORTIC REGURGITATIONETIOLOGY
AORTIC REGURGITATIONPATHOPHYSIOLOGY L.V.MASS + + + ECCENTRIC LVH L.V.E.D.P. + + + • VOLUME OVERLOAD : AORTA L.V.
AORTIC REGURGITATIONSYMPTOMS • CONGESTIVE HEART FAILURE • ANGINA PECTORIS AFTER LONG LATENT PERIOD
AORTIC REGURGITAIONPHYSICAL EXAMINATION 1 • PULSE : COLLAPSING (CORRIGAN WATERHAMMER) • DE MUSSET • QUINCKE • DUROZIER • APEX : DISPLACED + + + + DILATED + + + + COR BOVINUM
AORTIC REGURGITATIONDUROZIER SIGN FEMORAL ART. LISTEN TO DIASTOLIC MURMUR!
AORTIC REGURGITATIONPHYSICAL EXAMINATION 2 AUSCULTATION S4 M.S.M. E.D.M. S3 S1 S(P)2
AORTIC REGURGITATIONEVALUATION • 1. PHYSICAL EXAMINATION: APEX LENGTH OF MURMUR! DUROZIER • 2. ECHODOPPLER: L.V. SIZE WIDTH OF COLOR JET
Aortic Incompetence- ECG Left Ventricular Hypertrophy & Strain , Wide QRS
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 REGURGITATION ECHODOPPLER
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 REGURGITATIONNATURAL HISTORY
AORTIC REGURGITATIONTREATMENT 1 • VASODILATORS • DIURETICS • DIGOXIN • AORTIC VALVE REPLACEMENT
Randomized clinical trial of nifedipine versus digoxin in asymptomatic patients with chronic aortic regurgitation and normal left ventricular (LV) function. AORTIC REGURGITATIONTREATMENT 2
AORTIC REGURGITATIONTREATMENT 3 • INDICATIONS FOR SURGERY : • SYMPTOMS • L.V. DILATATION > 7.5 / 5.5 CM • INTRA AORTIC BALLOON PUMP CONTRAINDICATED!!!!
ACC/AHA LVEF < 49% (classI) L.E.S.D. >55mm (classII) ESC LVEF < 50% L.E.S.D. > 50mm L.E.D.D. > 70mm INDICATION FOR AVR IN ASYMPTOMATIC PATIENTS WITH A.R.
Long-term postoperative survival in patients with aortic regurgitation, stratified according to the severity of preoperative symptoms and preoperative left ventricular ejection fraction AORTIC REGURGITATIONTREATMENT 4
AORTIC REGURGITATIONTREATMENT 5 The same for patients with LVEF < 50%
. The St. Jude bileaflet valve. PROSTHETIC MECHANICAL VALVES Starr-Edwards caged-ball valve The Medtronic-Hall 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
