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| ==Causes== | | ==Causes== |
| ===Causes of Aortic Insufficiency as of Site of Diseases===
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| ====Aortic Valve Diseases====
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| *Congenital
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| **[[Bicuspid aortic valve]]<ref name="Roberts-2012">{{Cite journal | last1 = Roberts | first1 = WC. | last2 = Vowels | first2 = TJ. | last3 = Ko | first3 = JM. | title = Natural history of adults with congenitally malformed aortic valves (unicuspid or bicuspid). | journal = Medicine (Baltimore) | volume = 91 | issue = 6 | pages = 287-308 | month = Nov | year = 2012 | doi = 10.1097/MD.0b013e3182764b84 | PMID = 23117850 }}</ref>
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| **[[Aortic valve#Disease of the aortic valve|Unicuspid aortic valve]]
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| *Connective tissue disorders
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| **[[Ehlers-Danlos syndrome]]<ref name="Wunderlich-2005">{{Cite journal | last1 = Wunderlich | first1 = C. | last2 = Schulze | first2 = MR. | last3 = Strasser | first3 = RH. | title = Severe aortic regurgitation in Ehlers-Danlos syndrome type IV. | journal = Heart | volume = 91 | issue = 1 | pages = 126 | month = Jan | year = 2005 | doi = 10.1136/hrt.2004.035097 | PMID = 15604357 }}</ref>
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| **[[Marfan syndrome]]<ref name="Brown-1975">{{Cite journal | last1 = Brown | first1 = OR. | last2 = DeMots | first2 = H. | last3 = Kloster | first3 = FE. | last4 = Roberts | first4 = A. | last5 = Menashe | first5 = VD. | last6 = Beals | first6 = RK. | title = Aortic root dilatation and mitral valve prolapse in Marfan's syndrome: an ECHOCARDIOgraphic study. | journal = Circulation | volume = 52 | issue = 4 | pages = 651-7 | month = Oct | year = 1975 | doi = | PMID = 1157278 }}</ref>
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| **[[Rheumatoid arthritis]]<ref name="Levine-1999">{{Cite journal | last1 = Levine | first1 = AJ. | last2 = Dimitri | first2 = WR. | last3 = Bonser | first3 = RS. | title = Aortic regurgitation in rheumatoid arthritis necessitating aortic valve replacement. | journal = Eur J Cardiothorac Surg | volume = 15 | issue = 2 | pages = 213-4 | month = Feb | year = 1999 | doi = | PMID = 10219558 }}</ref>
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| **[[Systemic lupus erythematosus]]<ref name="Miyashita-2010">{{Cite journal | last1 = Miyashita | first1 = T. | last2 = Abe | first2 = Y. | last3 = Kato | first3 = Y. | last4 = Nakagawa | first4 = E. | last5 = Komatsu | first5 = R. | last6 = Hattori | first6 = K. | last7 = Shibata | first7 = T. | last8 = Yoshioka | first8 = K. | last9 = Naruko | first9 = T. | title = Aortic aneurysm with severe aortic regurgitation in a patient with systemic lupus erythematosus. | journal = Intern Med | volume = 49 | issue = 20 | pages = 2263-6 | month = | year = 2010 | doi = | PMID = 20962447 }}</ref>
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| *Drugs
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| **[[Dopamine agonists]]<ref name="pmid17202453">{{cite journal |author=Schade R, Andersohn F, Suissa S, Haverkamp W, Garbe E |title=Dopamine agonists and the risk of cardiac-valve regurgitation |journal=[[The New England Journal of Medicine]] |volume=356 |issue=1 |pages=29–38 |year=2007 |month=January |pmid=17202453 |doi=10.1056/NEJMoa062222 |url=http://dx.doi.org/10.1056/NEJMoa062222 |accessdate=2011-03-28}}</ref><ref name="pmid11104741">{{cite journal |author=Rothman RB, Baumann MH, Savage JE, Rauser L, McBride A, Hufeisen SJ, Roth BL |title=Evidence for possible involvement of 5-HT(2B) receptors in the cardiac valvulopathy associated with fenfluramine and other serotonergic medications |journal=[[Circulation]] |volume=102 |issue=23 |pages=2836–41 |year=2000 |month=December |pmid=11104741 |doi= |url=http://circ.ahajourals.org/cgi/pmidlookup?view=long&pmid=11104741 |accessdate=2011-03-28}}</ref><ref name="pmid16092580">{{cite journal |author=Waller EA, Kaplan J, Heckman MG |title=Valvular heart disease in patients taking pergolide |journal=[[Mayo Clinic Proceedings. Mayo Clinic]] |volume=80 |issue=8 |pages=1016–20 |year=2005 |month=August |pmid=16092580 |doi= |url=http://www.mayoclinicproceedings.com/cgi/pmidlookup?view=long&pmid=16092580 |accessdate=2011-03-28}}</ref>
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| **[[Fenfluramine]]<ref name="Jollis-2000">{{Cite journal | last1 = Jollis | first1 = JG. | last2 = Landolfo | first2 = CK. | last3 = Kisslo | first3 = J. | last4 = Constantine | first4 = GD. | last5 = Davis | first5 = KD. | last6 = Ryan | first6 = T. | title = Fenfluramine and phentermine and cardiovascular findings: effect of treatment duration on prevalence of valve abnormalities. | journal = Circulation | volume = 101 | issue = 17 | pages = 2071-7 | month = May | year = 2000 | doi = | PMID = 10790349 }}</ref>
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| **[[Phentermine]]<ref name="Jollis-2000">{{Cite journal | last1 = Jollis | first1 = JG. | last2 = Landolfo | first2 = CK. | last3 = Kisslo | first3 = J. | last4 = Constantine | first4 = GD. | last5 = Davis | first5 = KD. | last6 = Ryan | first6 = T. | title = Fenfluramine and phentermine and cardiovascular findings: effect of treatment duration on prevalence of valve abnormalities. | journal = Circulation | volume = 101 | issue = 17 | pages = 2071-7 | month = May | year = 2000 | doi = | PMID = 10790349 }}</ref>
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| *Endocrinal
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| **[[Acromegaly]]<ref name="Pereira-2004">{{Cite journal | last1 = Pereira | first1 = AM. | last2 = van Thiel | first2 = SW. | last3 = Lindner | first3 = JR. | last4 = Roelfsema | first4 = F. | last5 = van der Wall | first5 = EE. | last6 = Morreau | first6 = H. | last7 = Smit | first7 = JW. | last8 = Romijn | first8 = JA. | last9 = Bax | first9 = JJ. | title = Increased prevalence of regurgitant valvular heart disease in acromegaly. | journal = J Clin Endocrinol Metab | volume = 89 | issue = 1 | pages = 71-5 | month = Jan | year = 2004 | doi = | PMID = 14715829 }}</ref>
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| *Inflammatory
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| **[[Bacterial endocarditis]]<ref name="Stiles-1980">{{Cite journal | last1 = Stiles | first1 = GL. | last2 = Friesinger | first2 = GC. | title = Bacterial endocarditis with aortic regurgitation: implications of embolism. | journal = South Med J | volume = 73 | issue = 5 | pages = 582-6 | month = May | year = 1980 | doi = | PMID = 7375973 }}</ref>
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| **[[Rheumatic fever]]<ref name="Spagnuolo-1971">{{Cite journal | last1 = Spagnuolo | first1 = M. | last2 = Kloth | first2 = H. | last3 = Taranta | first3 = A. | last4 = Doyle | first4 = E. | last5 = Pasternack | first5 = B. | title = Natural history of rheumatic aortic regurgitation. Criteria predictive of death, congestive heart failure, and angina in young patients. | journal = Circulation | volume = 44 | issue = 3 | pages = 368-80 | month = Sep | year = 1971 | doi = | PMID = 4255488 }}</ref>
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| ====Aortic Root Diseases====
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| *[[Aortic dissection]]
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| *Collagen vascualr disease
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| **[[Giant cell arteritis]]
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| *Connective tissue disorders
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| **[[Annuloaortic ectasia]]
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| **[[Ehlers-Danlos syndrome]]
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| **[[Marfan syndrome]]
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| **[[Osteogenesis imperfecta]]<ref name="Lamanna-2013">{{Cite journal | last1 = Lamanna | first1 = A. | last2 = Fayers | first2 = T. | last3 = Clarke | first3 = S. | last4 = Parsonage | first4 = W. | title = Valvular and aortic diseases in osteogenesis imperfecta. | journal = Heart Lung Circ | volume = 22 | issue = 10 | pages = 801-10 | month = Oct | year = 2013 | doi = 10.1016/j.hlc.2013.05.640 | PMID = 23791715 }}</ref>
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| **[[Pseudoxanthoma elasticum]]<ref name="COFFMAN-1959">{{Cite journal | last1 = COFFMAN | first1 = JD. | last2 = SOMMERS | first2 = SC. | title = Familial pseudoxanthoma elasticum and valvular heart disease. | journal = Circulation | volume = 19 | issue = 2 | pages = 242-50 | month = Feb | year = 1959 | doi = | PMID = 13629785 }}</ref>
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| *[[Hypertension]]<ref name="Kim-1996">{{Cite journal | last1 = Kim | first1 = M. | last2 = Roman | first2 = MJ. | last3 = Cavallini | first3 = MC. | last4 = Schwartz | first4 = JE. | last5 = Pickering | first5 = TG. | last6 = Devereux | first6 = RB. | title = Effect of hypertension on aortic root size and prevalence of aortic regurgitation. | journal = Hypertension | volume = 28 | issue = 1 | pages = 47-52 | month = Jul | year = 1996 | doi = | PMID = 8675263 }}</ref>
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| *Inflammatory
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| **[[Ankylosing spondylitis]]<ref>Palazzi C, D' Angelo S, Lubrano E, Olivieri I. Aortic involvement in ankylosing spondylitis. Clin Exp Rheumatol. May-Jun 2008;26(3 Suppl 49):S131-4.</ref>
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| **[[Inflammatory bowel disease]]
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| **[[Psoriatic arthritis]]
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| **[[Reiter's syndrome]]
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| **[[Syphilitic aortitis]]<ref name="Aizawa-1998">{{Cite journal | last1 = Aizawa | first1 = H. | last2 = Hasegawa | first2 = A. | last3 = Arai | first3 = M. | last4 = Naganuma | first4 = F. | last5 = Hatori | first5 = M. | last6 = Kanda | first6 = T. | last7 = Suzuki | first7 = T. | last8 = Murata | first8 = K. | last9 = Satoh | first9 = Y. | title = Bilateral coronary ostial stenosis and aortic regurgitation due to syphilitic aortitis. | journal = Intern Med | volume = 37 | issue = 1 | pages = 56-9 | month = Jan | year = 1998 | doi = | PMID = 9510401 }}</ref>
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| *[[Traumatic aortic rupture]] following blunt chest trauma or deceleration injury
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| ===Causes of Aortic Insufficiency as of Type of Onset===
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| ====Causes of Acute Aortic Insufficiency====
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| *[[Aortic valvuloplasty]]<ref name="pmid2016464">{{cite journal |author=Isner JM |title=Acute catastrophic complications of balloon aortic valvuloplasty. The Mansfield Scientific Aortic Valvuloplasty Registry Investigators |journal=[[Journal of the American College of Cardiology]] |volume=17 |issue=6 |pages=1436–44 |year=1991 |month=May |pmid=2016464 |doi= |url= |accessdate=2011-03-28}}</ref>
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| *A [[Aortic dissection classification#Stanford Classification System|type A aortic dissection]] may disrupt the integrity of the valve leaflets causing malcoaptation of the aortic leaflets.<ref name="Lai-2003">{{Cite journal | last1 = Lai | first1 = DT. | last2 = Miller | first2 = DC. | last3 = Mitchell | first3 = RS. | last4 = Oyer | first4 = PE. | last5 = Moore | first5 = KA. | last6 = Robbins | first6 = RC. | last7 = Shumway | first7 = NE. | last8 = Reitz | first8 = BA. | title = Acute type A aortic dissection complicated by aortic regurgitation: composite valve graft versus separate valve graft versus conservative valve repair. | journal = J Thorac Cardiovasc Surg | volume = 126 | issue = 6 | pages = 1978-86 | month = Dec | year = 2003 | doi = 10.1016/S0022 | PMID = 14688716 }}</ref>
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| *In [[bacterial endocarditis]] the [[infection]] can erode the valve and cause a leaflet to become flail, or a vegetation can prevent coaptation of the leaflets.
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| *Blunt [[chest trauma]] can disrupt the supporting apparatus of the [[aortic valve]].
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| *[[Myxomatous degeneration|Myxomatous aortic valve]] can degenerate, leading to insufficiency.
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| *[[Prosthetic valve|Prosthetic valve dysfunction]]<ref>Friedman T, Mani A, Elefteriades JA. Bicuspid aortic valve: clinical approach and scientific review of a common clinical entity. Expert Rev Cardiovasc Ther. Feb 2008;6(2):235-48.</ref>
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| *[[Rheumatic fever]]<ref name="Spagnuolo-1971">{{Cite journal | last1 = Spagnuolo | first1 = M. | last2 = Kloth | first2 = H. | last3 = Taranta | first3 = A. | last4 = Doyle | first4 = E. | last5 = Pasternack | first5 = B. | title = Natural history of rheumatic aortic regurgitation. Criteria predictive of death, congestive heart failure, and angina in young patients. | journal = Circulation | volume = 44 | issue = 3 | pages = 368-80 | month = Sep | year = 1971 | doi = | PMID = 4255488 }}</ref>
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| *Rupture of a [[Aortic valve#Disease of the aortic valve|congenitally fenestrated cusp]]<ref name="Stout-2009">{{Cite journal | last1 = Stout | first1 = KK. | last2 = Verrier | first2 = ED. | title = Acute valvular regurgitation. | journal = Circulation | volume = 119 | issue = 25 | pages = 3232-41 | month = Jun | year = 2009 | doi = 10.1161/CIRCULATIONAHA.108.782292 | PMID = 19564568 }}</ref>
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| ====Causes of Chronic Aortic Insufficiency====
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| *[[Ankylosing spondylitis]] can be associated with inflammation of the [[aorta]] ([[aortitis]]).<ref>Palazzi C, D' Angelo S, Lubrano E, Olivieri I. Aortic involvement in ankylosing spondylitis. Clin Exp Rheumatol. May-Jun 2008;26(3 Suppl 49):S131-4.</ref> The inflammatory process can also involve the septum and cause [[conduction disease]].
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| *A [[Aortic dissection classification#Stanford Classification System|type A aortic dissection]] may disrupt the integrity of the valve leaflets causing malcoaptation of the aortic leaflets.
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| *[[Bechterew's Disease|Bechterew's disease]]
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| *Rarely, in 5% of cases with [[Behcet disease]] there is an [[aortitis]] that involves the [[ascending aorta]] and in some cases the [[coronary arteries]] are involved.
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| *[[Bicuspid aortic valve]] is the most common congenital abnormality of the [[heart]]. It is the most common cause of isolated aortic insufficiency requiring surgical repair. Bicuspid aortic valve is also associated with [[inflammation]] of the [[aorta]] (an aortopathy) which may lead to dilation of the [[aorta]] and/or [[aortic dissection]] that can worsen the aortic insufficiency.<ref>Friedman T, Mani A, Elefteriades JA. Bicuspid aortic valve: clinical approach and scientific review of a common clinical entity. Expert Rev Cardiovasc Ther. Feb 2008;6(2):235-48.</ref>
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| *[[Cystic medial necrosis]] of the aorta
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| *[[Ehlers-Danlos syndrome]]
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| *[[Giant cell arteritis]] may also be associated with an [[aortitis]] as well as [[coronary artery disease]].<ref>Eberhardt RT, Dhadly M. Giant cell arteritis: diagnosis, management, and cardiovascular implications. Cardiol Rev. Mar-Apr 2007;15(2):55-61.</ref>
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| *[[Hypertension]]
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| *[[Marfan Syndrome]]
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| *[[Myxomatous degeneration|Myxomatous aortic valve]]
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| *[[Polymyalgia rheumatica]]
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| *[[Pseudoxanthoma elasticum]]
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| *[[Reiter's syndrome]]
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| *[[Rheumatic fever]] remains a cause of [[AS]] in the Middle East, Northern Africa and Asia as well as some immigrant populations in the United States. It is less prevalent in the US than it was in the 20th century. AR occurs as a result of [[fibrosis]] of the valve that is associated with thickening and retraction of the leaflets of the [[aortic valve]]. This retraction results in regurgitation in the center of the valve. At the same time, there may also be fusion of the aortic leaflets which results in concurrent [[aortic stenosis]]. It should be noted that rheumatic disease of the [[mitral valve]] is usually present in the same patient.
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| *[[Rheumatoid arthritis]] rarely causes symptomatic AR, but it can cause [[granulomatous]] nodules on the aortic leaflets which leads to clinical aortic regurgitation.<ref>Chand EM, Freant LJ, Rubin JW. Aortic valve rheumatoid nodules producing clinical aortic regurgitation and a review of the literature. Cardiovasc Pathol. Nov-Dec 1999;8(6):333-8.</ref>
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| *[[Aneurysm of sinus of valsalva|Sinus of valsalva aneurysm]]
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| *[[Syphilis]]
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| *[[Systemic lupus erythematosus]] can cause AR by tow mechanisms. SLE can cause [[inflammation]] and [[fibrosis]] of the aortic leaflets leading to their damage and retraction.<ref>Jain D, Halushka MK. Cardiac pathology of systemic lupus erythematosus. J Clin Pathol. Jul 2009;62(7):584-92.</ref> SLE can also be associated with the development of sterile verrucous vegetations on the valves called [[Libman-Sacks endocarditis]].<ref>Moyssakis I, Tektonidou MG, Vasilliou VA, Samarkos M, Votteas V, Moutsopoulos HM. Libman-Sacks endocarditis in systemic lupus erythematosus: prevalence, associations, and evolution. Am J Med. Jul 2007;120(7):636-42.</ref><ref>Lee JL, Naguwa SM, Cheema GS, Gershwin ME. Revisiting Libman-Sacks endocarditis: a historical review and update. Clin Rev Allergy Immunol. Jun 2009;36(2-3):126-30.</ref>
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| *[[Takayasu arteritis]] can involve the [[aorta]] in an [[aortitis]], the [[aortic valve]] itself, and the [[coronary arteries]].<ref>Adachi O, Saiki Y, Akasaka J, Oda K, Iguchi A, Tabayashi K. Surgical management of aortic regurgitation associated with takayasu arteritis and other forms of aortitis. Ann Thorac Surg. Dec 2007;84(6):1950-3.</ref>
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| *[[Turner's syndrome]]
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| *[[Ventricular septal defect]]<ref name="Schmaltz-2004">{{Cite journal | last1 = Schmaltz | first1 = AA. | last2 = Schaefer | first2 = M. | last3 = Hentrich | first3 = F. | last4 = Neudorf | first4 = U. | last5 = Brecher | first5 = AM. | last6 = Asfour | first6 = B. | last7 = Urban | first7 = AE. | title = [Ventricular septal defect and aortic regurgitation-pathophysiological aspects and therapeutic consequences]. | journal = Z Kardiol | volume = 93 | issue = 3 | pages = 194-200 | month = Mar | year = 2004 | doi = 10.1007/s00392-004-0015-2 | PMID = 15024586 }}</ref>
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| *[[Weight loss]] medications including [[fenfluramine]] and [[dexfenfluramine]] (a.k.a. [[Phen-Fen]]). These drugs have been associated with degeneration of the aortic valve.
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| * [[Whipple disease]] can involve the aortic valve.<ref>Jeserich M, Ihling C, Holubarsch C. Aortic valve endocarditis with Whipple disease. Ann Intern Med. Jun 1 1997;126(11):920.</ref>
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| ==Complete Differential Diagnosis for the Causes of Aortic Insufficiency== | | ==Complete Differential Diagnosis for the Causes of Aortic Insufficiency== |