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Week 2: Aortic Regurgitation > Aetiology, Aorta and LV > Flashcards

Aetiology, Aorta and LV Flashcards

1
Q

Definition of organic AR?

A
  • Primary anatomical problem with the valve struture
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2
Q

Definition of functional AR?

A
  • Occurs secondary to causes other than primary valve problem
  • I.e. AV normal and usually another cause for AR e.g. dilatation of aortic root
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3
Q

What are the main causes of AR?

A
  1. Cuspal abnormalities
  2. Annular/root dilatation
  3. Annular/root distortion
  4. Loss of commissural support
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4
Q

Causes of AR: Causes of Cuspal Abnormalities

A
  1. Infective endocarditis
  2. Rheumatic
  3. Congenital
  4. AV prolapse
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5
Q

Causes of AR: Causes of Annular/Root dilatation

A
  1. Dissection
  2. Aortopathies
  3. Connective Tissue Disorders
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6
Q

Causes of AR: Causes of Annular/Root Distortion

A
  1. Autoimmune

2. Aortitis

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7
Q

Causes of AR: Causes of Loss of Commissural Support

A
  1. Dissection
  2. VSD
  3. Trauma
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8
Q

During what part of the cardiac cycle is QAV diagnosed?

A

Diagnosed in diastole when leaflets are closed

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9
Q

Most common type of QAV?

A

4 equal cusps

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10
Q

How does infective endocarditis lead to AR?

A
  1. Destroys valve leaflets/causes leaflet perforation

2. Leaflet vegetation can interfere with coaptation

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11
Q

How does RHD lead to AR?

A
  1. Inflammatory process
  2. Cusps infiltrated with fibrous tissue; unable to close normally
  3. Often associated with some degree of commissural fusion and AS (often associated MS too)
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12
Q

How does QAV lead to AR?

A
  1. QAV is rare but valve doesn’t function normally

2. AR commonly seen with QAV

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13
Q

How does aortic dissection lead to AR?

A
  1. Mobile intimal flap

2. Loss of annular support leading to AR

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14
Q

How does VSD cause AR?

A
  1. Membranous VSD = loss of commissural support

2. RCC effectively sucked into VSD leading to AR

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15
Q

How does Connective Tissue Disease cause AR?

A
  1. Loss of elastic tissue
  2. Medial degeneration
  3. Aortic dilatation
  4. AR
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16
Q

Common type of connective tissue disease?

A

Marfan Syndrome: characterized by long fingers, especially thumb

17
Q

Echo characteristics of Marfan Syndrome?

A
  1. Dilatation of aortic root and ascending aorta
  2. Mitral valve prolapse
  3. Dilatation of main PA
18
Q

How to properly measure aortic arch and descending aorta?

A
  1. Suprasternal window
  2. End diastole: onset of QRS complex
  3. Arch measured leading edge to leading edge
  4. Descending aorta measured inner edge to inner edge
  5. Measured perpendicular to vessel
19
Q

Define effacement of the aorta?

A
  • Defined as gradual increase in aortic diameter from sinuses of Valsalva to ascending aorta
  • ST junction is absent
20
Q

Status of left ventricle in mild AR?

A

LV size expected to be close to normal

21
Q

Status of left ventricle in moderate AR?

A

LV size could be normal or dilated

22
Q

Status of left ventricle in severe AR?

A
  • LV dilatation is expected

- Exception for acute severe AR where LV has not had time to dilate

23
Q

Functional Classification of Aortic Regurgitation: What defines type I dysfunction?

A
  • Type I dysfunction = aortic cusp motion is normal and AR occurs due to dilatation or cusp perforation
  • Subcategorised a - d
24
Q

Functional Classification of Aortic Regurgitation: What defines type Ia dysfunction?

A
  • Normal cusp motion
  • Dilatation of STJ and ascending aorta causing AR (aneurysm of ascending aorta)
  • Central AR jet
25
Q

Functional Classification of Aortic Regurgitation: What defines type Ib dysfunction?

A
  • Normal cusp motion
  • Dilatation of sinuses of Valsalva and STJ causing AR (aneurysm of aortic root)
  • Central AR jet
26
Q

Functional Classification of Aortic Regurgitation: What defines type Ic dysfunction?

A
  • Normal cusp motion
  • Isolated dilatation of the ventriculoarterial junction (VAJ)
  • Central AR jet
27
Q

Functional Classification of Aortic Regurgitation: What defines type Id dysfunction?

A
  • Normal cusp motion
  • Cusp perforation causing AR in the absence of lesion/dilatation
  • Eccentric AR jet
28
Q

Functional Classification of Aortic Regurgitation: What defines type II dysfunction?

A
  • Leaflet prolapse as a result of excessive cusp tissue or commissural disruption
  • Eccentric AR jet
29
Q

Functional Classification of Aortic Regurgitation: What defines type III dysfunction?

A
  • Leaflet restriction

- Occurs as a result of calcification, thickening and fibrosis of the aortic leaflets

Week 2: Aortic Regurgitation (3 decks)

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