Background
Aortic regurgitation (AR) is the diastolic flow of blood from the aorta into the left ventricle (LV). Regurgitation is due to incompetence of the aortic valve or any disturbance of the valvular apparatus (eg, leaflets, annulus of the aorta) resulting in the diastolic flow of blood into the left ventricular chamber. (See Pathophysiology and Etiology.)
Valvular abnormalities that may result in AR can be caused by the following (see Etiology, Presentation, and Workup):
Congenital causes – Bicuspid aortic valve is the most common congenital cause
Acquired causes:
Rheumatic fever
Infective endocarditis
Collagen vascular diseases
Degenerative aortic valve disease
Traumatic
Postsurgical (including post-transcatheter aortic valve replacement)
Abnormalities of the ascending aorta, in the absence of valve pathology, may also cause AR. Such abnormalities may occur with the following conditions:
Longstanding, uncontrolled hypertension
Marfan syndrome
Idiopathic aortic dilation
Cystic medial necrosis
Senile aortic ectasia and dilation
Syphilitic aortitis
Giant cell arteritis
Takayasu arteritis
Ankylosing spondylitis
Whipple disease
Other spondyloarthropathies
Aortic regurgitation may be a chronic disease process or it may occur acutely, presenting as heart failure.
The most common cause of chronic aortic regurgitation used to be rheumatic heart disease, but presently it is most commonly caused by bacterial endocarditis.
In developed countries, it is caused by dilation of the ascending aorta (eg, aortic root disease, aortoannular ectasia). (See Presentation and Workup.)
Three fourths of patients with significant aortic regurgitation survive 5 years after diagnosis; half survive for 10 years. Patients with mild to moderate regurgitation survive 10 years in 80-95% of the cases. Average survival after the onset of congestive heart failure (CHF) is less than 2 years. (See Prognosis, Treatment, and Medication.)
Acute aortic regurgitation is associated with significant morbidity, which can progress from pulmonary edema to refractory heart failure and cardiogenic shock.
Patient education
The 2014 American College of Cardiology/American Heart Association (ACC/AHA) guidelines for valvular heart disease, including for AR, are available to the public online for free.
Additionally, educational and support organizations, such as the National Marfan Foundation and the Bicuspid Aortic Foundation, exist for many of the underlying conditions.