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Aortic Regurgitation

Current Cardiology Reports volume 21, Article number: 65 (2019) Cite this article

Abstract

Purpose of Review

Aortic regurgitation (AR) is a common form of valvular disease which is characterized by reflux of blood from the aorta into the left ventricle (LV) during diastole. AR results from various etiologies, affecting the aortic valve cusps or the aortic root. The clinical presentation of patients with AR depends on the severity of the regurgitation and differs whether AR develops acutely or if it progresses over a prolonged period, allowing the cardiac chambers to adapt. Echocardiography is the primary method to determine the etiology of AR and to define its severity. We review the current data regarding the diagnosis and treatment of AR.

Recent Findings

No single parameter is sufficient to determine AR severity; thus, an integrative, multi-parametric approach is required. Echocardiography is key for imaging the aortic valve morphology and flow as well as aortic root and ascending aorta. Determining LV ejection fraction and dimensions is essential for patient management and optimizing timing for intervention. Three-dimensional (3D) echocardiography is useful in the evaluation of AR etiology and severity. The use of Trasncatheter aortic valve replacement (TAVR) has emerged as an alternative to surgery in patients at high operative risk.

Summary

The diagnosis and management of AR requires a comprehensive approach and routine clinical and echocardiographic follow-up. Surgical or percutaneous therapy is indicated when symptoms develop and in those who have LV dysfunction or LV dilation.

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Affiliations

  1. Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA

    Nir Flint, Hezzy Shmueli & Robert J. Siegel

  2. Department of Cardiology, Tel-Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Nir Flint & Hezzy Shmueli

  3. Cardiovascular Center Darmstadt, Darmstadt, Germany

    Nina C. Wunderlich

  4. The Leviev Heart Center, Sheba Medical Center, Tel-Hashomer, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel

    Sagit Ben-Zekry & Roy Beigel

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  1. Nir Flint
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Correspondence to Roy Beigel.

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Nir Flint, Nina C. Wunderlich, Hezzy Shmueli, Sagit Ben-Zekry, Robert J. Siegel, and Roy Beigel declare that they have no conflict of interest.

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Electronic Supplementary Material

Transesophageal echo long-axis view with and without color Doppler showing thickened aortic cusps and malcoaptation secondary to a flail right aortic cusp. There is severe aortic regurgitation with an eccentric regurgitant jet directed towards the anterior mitral leaflet. (AVI 6084 kb)

Transesophageal echo long-axis view showing malcoaptation of the aortic valve cusps secondary to severe dilation of the aortic root and ascending aorta. (AVI 14969 kb)

Color Doppler from the same patient as in video 2 showing severe aortic regurgitation (AR). Note the large flow convergence and vena contracta as well as the regurgitant jet which fills most of the left ventricular outflow tract, all consistent with severe AR. (AVI 8915 kb)

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Flint, N., Wunderlich, N.C., Shmueli, H. et al. Aortic Regurgitation. Curr Cardiol Rep 21, 65 (2019). https://doi.org/10.1007/s11886-019-1144-6

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Keywords

  • Aortic regurgitation
  • Etiology
  • Diagnosis
  • Echocardiography
  • Treatment
  • Surgical therapy
  • TAVR