AORTIC REGURGITATION

AORTIC REGURGITATION ETIOLOGY LEAFLETS: RHEUMATIC H.D. CALCIFIED PROLAPSE ENDOCARDITIS TRAUMA RHEUMATOID ARTHRITIS ANNULUS, ROOT MARFAN ANNULOAORTIC ECTASIA SYPHILLIS ANKYLOSING SPONDYLITIS DISSECTION

AORTIC INCOMPETENCE- ETIOLOGY

AORTIC REGURGITATION PATHOPHYSIOLOGY VOLUME OVERLOAD : L.V.MASS ECCENTRIC LVH L.V.E.D.P L.V. AORTA

AORTIC REGURGITATION PATHOPHYSIOLOGY

COMPENSATED A.R. DECOMPENSATED A.R.

AORTIC REGURGITATION PATHOPHYSIOLOGY Pressure curves obtained from a 63-year-old man with symptoms of left ventricular failure and a loud decrescendo diastolic murmur. The femoral arterial pressure tracing demonstrates a widened pulse pressure and equalization with LV pressure late in diastole. The LV pressure curve exhibits elevated end-diastolic pressure of 45 mm Hg.

AORTIC REGURGITATION SYMPTOMS CONGESTIVE HEART FAILURE ANGINA PECTORIS AFTER LONG LATENT PERIOD

AORTIC REGURGITAION PHYSICAL EXAMINATION 1 PULSE : COLLAPSING (CORRIGAN WATERHAMMER) DE MUSSET QUINCKE DUROZIER APEX : DISPLACED DILATED COR BOVINUM

AORTIC REGURGITATION DUROZIER SIGN FEMORAL ART. LISTEN TO DIASTOLIC MURMUR!

AORTIC REGURGITATION PHYSICAL EXAMINATION 2 AUSCULTATION S1S(P)2 S3 S4 M.S.M.E.D.M.

AORTIC REGURGITATION EVALUATION 1. PHYSICAL EXAMINATION: APEX LENGTH OF MURMUR! DUROZIER 2. ECHODOPPLER: L.V. SIZE WIDTH OF COLOR JET

Aortic Incompetence- ECG Left Ventricular Hypertrophy & Strain, Wide QRS

AORTIC REGURGITATION ECHODOPPLER

BICUSPID AORTIC VALVE TRANSESOPHAGEAL ECHO

AORTIC REGURGITATION ECHODOPPLER Continuous-wave spectral recordings of patients with mild (top) and severe (bottom) aortic insufficiency. Note the relatively flat slope pressure decay and faint spectral signal intensity in the mild insufficiency and a denser spectral signal and steeper slope of pressure decay,denoting near equalization of aortic and left ventricular diastolic pressures,seen in severe aortic insufficiency.

AORTIC REGURGITATION NATURAL HISTORY Bonow and associates (blue line) and Borer and colleagues (magenta line), each enrolling 104 patients. At 11 years, 45 to 58 percent of patients remained asymptomatic with normal LV function, such that the risk of developing symptoms, LV dysfunction, or death is 4 to 6 percent per year.

AORTIC REGURGITATION NATURAL HISTORY Survival without surgery in 242 patients with chronic aortic regurgitation, demonstrating the importance of symptoms in determining outcome.

AORTIC REGURGITATION TREATMENT 1 VASODILATORS DIURETICS DIGOXIN AORTIC VALVE REPLACEMENT

AORTIC REGURGITATION TREATMENT 2 Randomized clinical trial of nifedipine versus digoxin in asymptomatic patients with chronic aortic regurgitation and normal left ventricular (LV) function.

AORTIC REGURGITATION TREATMENT 3 INDICATIONS FOR SURGERY : SYMPTOMS L.V. DILATATION > 7.5 / 5.5 CM INTRA AORTIC BALLOON PUMP CONTRAINDICATED!!!!

INDICATION FOR AVR IN ASYMPTOMATIC PATIENTS WITH A.R. ACC/AHA LVEF < 49% (classI) L.E.S.D. >55mm (classII) ESC LVEF < 50% L.E.S.D. > 50mm L.E.D.D. > 70mm

AORTIC REGURGITATION TREATMENT 4 Long-term postoperative survival in patients with aortic regurgitation, stratified according to the severity of preoperative symptoms and preoperative left ventricular ejection fraction

AORTIC REGURGITATION TREATMENT 5 The same for patients with LVEF < 50%

PROSTHETIC MECHANICAL VALVES Starr-Edwards caged-ball valve. The Medtronic-Hall valve The St. Jude bileaflet valve.

PROSTHETIC BIOLOGICAL VALVES

ACUTE AORTIC REGURGITATION 1 SHOCK TACHYCARDIA PULMONARY EDEMA NO PERIPHERAL SIGNS SHORT E.D.M. S3

ACUTE AORTIC REGURGITATION 2 HIGH INDEX OF SUSPICION!! ECHODOPPLER CATHETERIZATION - HEMODYNAMICS AORTOGRAM

תודה מכל הלב !!

ACUTE VERSUS CHRONIC AORTIC REGURGITATION