Q. Define Aortic regurgitation?

Aortic regurgitation is a common valvular disease that may present chronically or acutely. Normally the integrity of valve closure depends upon the anatomy of valve leaflets and on three dimensional geometry of aortic root and sinuses of Valsalva. Wide variety of causes may lead to aortic regurgitation. Usually 50 per cent of valve replacements are due to diseases of valve and 50 per cent due to root disease. However, in India predominant cause of aortic valve replacement is still rheumatic.

Table : Causes of Aortic Regurgitation

                                                                  Acute                                             - Aortic dissection
                                                                                                                       - Trauma
                                                                                                                       - Leaflet perforation due to endocarditis
Chronic

                                                                 Valve leaflet disease                         - Congenital
                                                                                                                              Bicuspid
                                                                                                                              Unicuspid
                                                                                                                              Quadricuspid
                                                                                                                              Fenestrations
                                                                                                                         - Rheumatic
                                                                                                                         - Infective endocarditis
                                                                                                                         - Myxomatous degeneration
                                                                                                                         - Fibro calcific degeneration
                                                                                                                         - Systemic Lupus Erythematosus

                                                                                                                          - Rheumatoid
                                                                                                                          - Pharmacological agents

                                                                Aortic Root Disease                          - Hypertension
                                                                                                                          - Idiopathic root dilatation
                                                                                                                          - Marfan's Syndrome
                                                                                                                          - Aortic dissection
                                                                                                                          - Annuloaortic ecstasia
                                                                                                                          - Cystic medial necrosis
                                                                                                                          - Syphilis
                                                                                                                          - Ankylosing spondylosis
                                                                                                                          - Takayasu arteritis
                                                                                                                          - Psoriatic arthritis
                                                                                                                          - Reiter's Syndrome
                                                                                                                          - Relapsing Polychondritis
                                                                                                                          - Kawasaki disease
                                                                                                                          - Osteogeneses imperfecta
                                                                                                                          - Giant cell Arteritis
                                                                                                                          - Ehlers - Danlos Syndrome

Sub Valvular                                                                                                      - Discrete sub aortic stenosis

                                                                                                                          - VSD with aortic regurgitation due to prolapse

Majority of elderly hypertensive patients have trivial to mild aortic regurgitation due to varying degrees of root dilatation due to hypertension and degenerative changes in the valve. However, they are rarely of clinical importance and may not progress to severe aortic regurgitation.