Aortic regurgitation natural history, complications and prognosis: Difference between revisions
Varun Kumar (talk | contribs) (New page: {{SI}} {{CMG}} '''Associate Editor-in-Chief:''' Varun Kumar, M.B.B.S.; Lakshmi Gopalakrishnan, M.B.B.S. {{EH}} ==Complications== Acute severe aortic insufficiency if left u...) |
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'''Symptomatic patients:''' | '''Symptomatic patients:''' | ||
:*[[NYHA | :*[[NYHA class]] I - 3.0% per year | ||
:*[[NYHA | :*[[NYHA class]] II - 6.3% per year | ||
:*[[NYHA | :*[[NYHA class]] III-IV - 24.6% per year | ||
==References== | ==References== | ||
Revision as of 17:14, 19 April 2011
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Associate Editor-in-Chief: Varun Kumar, M.B.B.S.; Lakshmi Gopalakrishnan, M.B.B.S.
Please Take Over This Page and Apply to be Editor-In-Chief for this topic: There can be one or more than one Editor-In-Chief. You may also apply to be an Associate Editor-In-Chief of one of the subtopics below. Please mail us [2] to indicate your interest in serving either as an Editor-In-Chief of the entire topic or as an Associate Editor-In-Chief for a subtopic. Please be sure to attach your CV and or biographical sketch.
Complications
Acute severe aortic insufficiency if left untreated can increase risk of morbidity and mortality by causing:
- Left ventricular dysfunction leading to hemodynamic compromise
- Infective endocarditis
- Aortic dissection
Chronic aortic insufficiency if untreated can lead to:
- Heart failure
- Arrhythmia
- Myocardial ischemia
- aortic dissection in patients with bicuspid aortic valve
- Infective endocarditis
Prognosis
Prognosis for patients with aortic insufficiency depends on symptoms and left venticular function[1].
In asymptomatic patients with normal ejection fraction
- Rate of progression to symptoms or left ventricular dysfunction ≤ 6% per year
- Rate of progression to asymptomatic left ventricular dysfunction ≤ 3.5% per year
- Rate of sudden death ≤ 0.2% per year
In asymptomatic patients with decreased ejection fraction
- Rate of progression to symptoms ≥ 25% per year
In symptomatic patients
- Mortality rate ≥ 10% per year
Morbidity and Mortality
Mortality and morbidity in acute severe aortic insufficiency is high due to inability of ventricle to accommodate increased regurgitant volume. Increased left ventricular pressure leads to increase in left atrial and pulmonary pressure, thereby causing pulmonary edema. Decrease in ejection fraction also leads to reduced coronary perfusion resulting in myocardial ischemia and even sudden cardiac death. Early surgical intervention improves the prognosis in these patients.
Chronic aortic insufficiency has a comparatively slower and longer course when asymptomatic. However, the patients rapidly deteriorate once symptoms sets in. Therefore serial echocardiographic assessment of left ventricular function is warranted in asymptomatic patients for determining the need for surgery[1].
Patients with chronic severe aortic insufficiency who are managed conservatively[2]:
- Death from any cause - 4.7% per year
- Congestive heart failure - 6.2% per year
- Aortic valve surgery - 14.6% per year
Asymptomatic Patients:
- Mortality rate - 2.8% per year
Symptomatic patients:
- NYHA class I - 3.0% per year
- NYHA class II - 6.3% per year
- NYHA class III-IV - 24.6% per year
References
- ↑ 1.0 1.1 Bonow RO, Carabello BA, Chatterjee K, de Leon AC, Faxon DP, Freed MD, Gaasch WH, Lytle BW, Nishimura RA, O'Gara PT, O'Rourke RA, Otto CM, Shah PM, Shanewise JS (2008). "2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons". Circulation. 118 (15): e523–661. doi:10.1161/CIRCULATIONAHA.108.190748. PMID 18820172. Retrieved 2011-04-19. Unknown parameter
|month=ignored (help) - ↑ Dujardin KS, Enriquez-Sarano M, Schaff HV, Bailey KR, Seward JB, Tajik AJ (1999). "Mortality and morbidity of aortic regurgitation in clinical practice. A long-term follow-up study". Circulation. 99 (14): 1851–7. PMID 10199882. Retrieved 2011-04-19. Unknown parameter
|month=ignored (help)