Aortic Regurgitation

Also known as aortic insufficiency.

Aortic regurgitation

Epidemiology and Risk Factors

Pathophysiology

Aetiology

Regurgitation may occur due to disease of the:

Valve
- Rheumatic
- Degenerative
- Bicuspid
Root
Resulting in annular dilation.
- Marfans
- Degenerative
- Syphilitic
- Dissection

Assessment

Chronic regurgitation:

Usually has a long symptom free period
Significant dilatation and impairment leads to:
- Dyspnoea
- Palpitations
- Fatigue
- Angina

Chronic regurgitation:

Typically leads to acute fulminant heart failure
Requires urgent intervention

History

Examination

Investigations

Bedside:

Laboratory:

Imaging:

Other:

Diagnostic Approach and DDx

Management

Goals of management

Resuscitation:

Specific therapy:

Pharmacological
Procedural
Physical

Supportive care:

Disposition:

Preventative:

Marginal and Ineffective Therapies

Anaesthetic Considerations

In mixed valvular disease, management should prioritise the most haemodynamically significant lesion. That said, in general:

In mixed AS and AR
Poorly tolerated combination due to combination of pressure and volume overload. Symptomatic prognosis similar to pure AS.
In mixed AR and MR
Similar haemodynamic goals, best defended by maintaining forward flow through ↓ SVR and defending BP through ↑ CO.

C
- Maintain preload
- Cautious use of venodilators
- High-normal heart rate to maintain forward flow
- Maintain inotropy
- Minimise afterload
  ↓ Regurgitant fraction.
- IABP is contraindicated
- May be more difficult to wean from CPB
  - Myocardial protection is more difficult to establish
  - Coronary air embolism more likely