2. AORTIC REGURGITATION

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

4. AORTIC INCOMPETENCE- ETIOLOGY

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

7. AORTIC REGURGITATION PATHOPHYSIOLOGY

8. COMPENSATED A.R. DECOMPENSATED A.R.

9. 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.

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

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

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

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

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

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

16. AORTIC REGURGITATION ECHODOPPLER

17. BICUSPID AORTIC VALVE TRANSESOPHAGEAL ECHO

18. 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.

19. 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.

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

21. AORTIC REGURGITATION TREATMENT 1 VASODILATORS DIURETICS DIGOXIN AORTIC VALVE REPLACEMENT

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

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

24. 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

25. 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

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

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

28. PROSTHETIC BIOLOGICAL VALVES

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

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

31. תודה מכל הלב !!

32. ACUTE VERSUS CHRONIC AORTIC REGURGITATION