Aortic regurgitation causes: Difference between revisions

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{{Aortic insufficiency}}
{{Aortic insufficiency}}


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Aortic insufficiency can be an acute illness or a chronic illness and the causes differ depending upon the acuity of the disease.  In general, aortic insufficiency is due to abnormalities of the aortic valve itself or the aortic root.  Aortic regurgitation secondary to dilation of the ascending aorta has overtaken valvular aortic disease as the most common cause of aortic regurgitation.
Aortic insufficiency can be an acute illness or a chronic illness and the causes differ depending upon the acuity of the disease.  In general, aortic insufficiency is due to abnormalities of the aortic valve itself or the aortic root.  Aortic regurgitation secondary to dilation of the ascending aorta has overtaken valvular aortic disease as the most common cause of aortic regurgitation.


==Common Causes==
==Causes==
===Common Causes===
*Worldwide the most common cause of aortic insufficiency is [[rheumatic heart disease]].
*Worldwide the most common cause of aortic insufficiency is [[rheumatic heart disease]].
*In the United States, senile degenerative calcific aortic valve disease and bicuspid aortic valve disease are the most common causes.
*In the United States, senile degenerative calcific aortic valve disease and bicuspid aortic valve disease are the most common causes.
*Aortic regurgitation secondary to dilation of the ascending aorta has overtaken valvular aortic disease as the most common cause of aortic regurgitation.
*Aortic regurgitation secondary to dilation of the ascending aorta has overtaken valvular aortic disease as the most common cause of aortic regurgitation.


==Differential Diagnosis of the Causes of Aortic Insufficiency==
===Causes By Organ System===
===By Organ System===


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==Differential Diagnosis of the Causes of Acute Aortic Insufficiency==
===Causes in Alphabetical Order===
In alphabetical order:
====Causes of Acute Aortic Insufficiency====
* After [[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>
* After [[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>
* [[Aortic dissection]]: A type A dissection may disrupt the integrity of the valve leaflets causing malcoaptation of the aortic leaflets.
* [[Aortic dissection]]: A type A dissection may disrupt the integrity of the valve leaflets causing malcoaptation of the aortic leaflets.
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* [[Rheumatic Fever]]
* [[Rheumatic Fever]]


==Differential Diagnosis of the Causes of Chronic Aortic Insufficiency==
====Causes of Chronic Aortic Insufficiency====
In alphabetical order:
* [[Ankylosing Spondylitis]]: 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]].
* [[Ankylosing Spondylitis]]: 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]].
* [[Aortic Dissection]]: A type A dissection may disrupt the integrity of the valve leaflets causing malcoaptation of the aortic leaflets.
* [[Aortic Dissection]]: A type A dissection may disrupt the integrity of the valve leaflets causing malcoaptation of the aortic leaflets.
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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>
* [[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>


==Differential Diagnosis Based Upon Aortic Valvular Causes==
====Differential Diagnosis Based Upon Aortic Valvular Causes====
*[[Bicuspid aortic valve]]
*[[Bicuspid aortic valve]]
*[[Collagen vascular disease]]
*[[Collagen vascular disease]]
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*[[Weight loss]] medications
*[[Weight loss]] medications


==Differential Diagnosis Based Upon Abnormalities of the Ascending Aorta==
====Differential Diagnosis Based Upon Abnormalities of the Ascending Aorta====
*[[Ankylosing spondylitis]]
*[[Ankylosing spondylitis]]
*[[Aortic dissection]]
*[[Aortic dissection]]
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==References==
==References==
{{reflist|2}}
{{reflist|2}}
[[Category:Valvular heart disease]]
[[Category:Cardiology]]
[[Category:Mature chapter]]
[[Category:Cardiac surgery]]
[[Category:Surgery]]


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Revision as of 19:50, 15 August 2012

Aortic Regurgitation Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Varun Kumar, M.B.B.S.; Lakshmi Gopalakrishnan, M.B.B.S.

Overview

Aortic insufficiency can be an acute illness or a chronic illness and the causes differ depending upon the acuity of the disease. In general, aortic insufficiency is due to abnormalities of the aortic valve itself or the aortic root. Aortic regurgitation secondary to dilation of the ascending aorta has overtaken valvular aortic disease as the most common cause of aortic regurgitation.

Causes

Common Causes

  • Worldwide the most common cause of aortic insufficiency is rheumatic heart disease.
  • In the United States, senile degenerative calcific aortic valve disease and bicuspid aortic valve disease are the most common causes.
  • Aortic regurgitation secondary to dilation of the ascending aorta has overtaken valvular aortic disease as the most common cause of aortic regurgitation.

Causes By Organ System

Cardiovascular After aortic valvuloplasty[1], Aortic dissection, Arteriosclerosis, Bacterial Endocarditis, Bicuspid aortic valve, Prosthetic valve dysfunction[2], Hypertension, Myxomatous aortic valve, Rheumatic Fever, Senile aortic ectasia and dilation, Senile or degenerative calcific aortic valve disease, Sinus of Valsalva Aneurysm, Ventricular Septal Defect
Chemical / poisoning No underlying causes
Dermatologic Psoriatic arthritis
Drug Side Effect Fenfluramine and Dexfenfluramine: These drugs have been associated with degeneration of the aortic valve.
Ear Nose Throat No underlying causes
Endocrine No underlying causes
Environmental No underlying causes
Gastroenterologic Ulcerative colitis, Whipple disease[3]
Genetic Ankylosing Spondylitis[4], Ehlers-Danlos Syndrome, Marfan Syndrome, Osteogenesis imperfecta, Pseudoxanthoma Elasticum, Reiter's Syndrome, Rheumatoid Arthritis[5], Systemic Lupus Erythematosus, Takayasu arteritis, Turner's Syndrome
Hematologic No underlying causes
Iatrogenic After aortic valvuloplasty[1], Prosthetic valve dysfunction
Infectious Disease Bacterial Endocarditis, Rheumatic Fever, Syphilis
Musculoskeletal / Ortho Ankylosing Spondylitis, Collagen vascular disease, Ehlers-Danlos Syndrome, Osteogenesis imperfecta, Psoriatic arthritis, Reiter's Syndrome, Relapsing polychondritis, Rheumatoid Arthritis[6], Spondyloarthropathy, Systemic Lupus Erythematosus
Neurologic No underlying causes
Nutritional / Metabolic No underlying causes
Obstetric/Gynecologic No underlying causes
Oncologic No underlying causes
Opthalmologic No underlying causes
Overdose / Toxicity No underlying causes
Psychiatric No underlying causes
Pulmonary No underlying causes
Renal / Electrolyte No underlying causes
Rheum / Immune / Allergy Ankylosing Spondylitis[7], Bechterew's Disease, Behcet disease, Collagen vascular disease, Cystic medial necrosis, Ehlers-Danlos Syndrome, Giant cell arteritis, Marfan Syndrome, Myxomatous aortic valve: The valvular structure can degenerate, Osteogenesis imperfecta, Polymyalgia Rheumatica, Pseudoxanthoma Elasticum, Psoriatic arthritis, Reiter's Syndrome, Rheumatic Fever, Rheumatoid Arthritis[8], Spondyloarthropathy, Systemic Lupus Erythematosus, Takayasu arteritis, Ulcerative colitis, Whipple disease[9]
Sexual Syphilis
Trauma Blunt chest trauma disrupting the supporting apparatus of the aortic valve.
Urologic No underlying causes
Miscellaneous Myxomatous aortic valve

Causes in Alphabetical Order

Causes of Acute Aortic Insufficiency

Causes of Chronic Aortic Insufficiency

Differential Diagnosis Based Upon Aortic Valvular Causes

Differential Diagnosis Based Upon Abnormalities of the Ascending Aorta

References

  1. 1.0 1.1 1.2 Isner JM (1991). "Acute catastrophic complications of balloon aortic valvuloplasty. The Mansfield Scientific Aortic Valvuloplasty Registry Investigators". Journal of the American College of Cardiology. 17 (6): 1436–44. PMID 2016464. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)
  2. 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.
  3. Jeserich M, Ihling C, Holubarsch C. Aortic valve endocarditis with Whipple disease. Ann Intern Med. Jun 1 1997;126(11):920.
  4. 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.
  5. 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.
  6. 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.
  7. 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.
  8. 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.
  9. Jeserich M, Ihling C, Holubarsch C. Aortic valve endocarditis with Whipple disease. Ann Intern Med. Jun 1 1997;126(11):920.
  10. 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.
  11. 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.
  12. 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.
  13. Eberhardt RT, Dhadly M. Giant cell arteritis: diagnosis, management, and cardiovascular implications. Cardiol Rev. Mar-Apr 2007;15(2):55-61.
  14. 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.
  15. Jain D, Halushka MK. Cardiac pathology of systemic lupus erythematosus. J Clin Pathol. Jul 2009;62(7):584-92.
  16. 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.
  17. 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.
  18. 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.
  19. Jeserich M, Ihling C, Holubarsch C. Aortic valve endocarditis with Whipple disease. Ann Intern Med. Jun 1 1997;126(11):920.

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