Aetiology, Aorta and LV Flashcards
Definition of organic AR?
- Primary anatomical problem with the valve struture
Definition of functional AR?
- 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
What are the main causes of AR?
- Cuspal abnormalities
- Annular/root dilatation
- Annular/root distortion
- Loss of commissural support
Causes of AR: Causes of Cuspal Abnormalities
- Infective endocarditis
- Rheumatic
- Congenital
- AV prolapse
Causes of AR: Causes of Annular/Root dilatation
- Dissection
- Aortopathies
- Connective Tissue Disorders
Causes of AR: Causes of Annular/Root Distortion
- Autoimmune
2. Aortitis
Causes of AR: Causes of Loss of Commissural Support
- Dissection
- VSD
- Trauma
During what part of the cardiac cycle is QAV diagnosed?
Diagnosed in diastole when leaflets are closed
Most common type of QAV?
4 equal cusps
How does infective endocarditis lead to AR?
- Destroys valve leaflets/causes leaflet perforation
2. Leaflet vegetation can interfere with coaptation
How does RHD lead to AR?
- Inflammatory process
- Cusps infiltrated with fibrous tissue; unable to close normally
- Often associated with some degree of commissural fusion and AS (often associated MS too)
How does QAV lead to AR?
- QAV is rare but valve doesn’t function normally
2. AR commonly seen with QAV
How does aortic dissection lead to AR?
- Mobile intimal flap
2. Loss of annular support leading to AR
How does VSD cause AR?
- Membranous VSD = loss of commissural support
2. RCC effectively sucked into VSD leading to AR
How does Connective Tissue Disease cause AR?
- Loss of elastic tissue
- Medial degeneration
- Aortic dilatation
- AR
Common type of connective tissue disease?
Marfan Syndrome: characterized by long fingers, especially thumb
Echo characteristics of Marfan Syndrome?
- Dilatation of aortic root and ascending aorta
- Mitral valve prolapse
- Dilatation of main PA
How to properly measure aortic arch and descending aorta?
- Suprasternal window
- End diastole: onset of QRS complex
- Arch measured leading edge to leading edge
- Descending aorta measured inner edge to inner edge
- Measured perpendicular to vessel
Define effacement of the aorta?
- Defined as gradual increase in aortic diameter from sinuses of Valsalva to ascending aorta
- ST junction is absent
Status of left ventricle in mild AR?
LV size expected to be close to normal
Status of left ventricle in moderate AR?
LV size could be normal or dilated
Status of left ventricle in severe AR?
- LV dilatation is expected
- Exception for acute severe AR where LV has not had time to dilate
Functional Classification of Aortic Regurgitation: What defines type I dysfunction?
- Type I dysfunction = aortic cusp motion is normal and AR occurs due to dilatation or cusp perforation
- Subcategorised a - d
Functional Classification of Aortic Regurgitation: What defines type Ia dysfunction?
- Normal cusp motion
- Dilatation of STJ and ascending aorta causing AR (aneurysm of ascending aorta)
- Central AR jet
Functional Classification of Aortic Regurgitation: What defines type Ib dysfunction?
- Normal cusp motion
- Dilatation of sinuses of Valsalva and STJ causing AR (aneurysm of aortic root)
- Central AR jet
Functional Classification of Aortic Regurgitation: What defines type Ic dysfunction?
- Normal cusp motion
- Isolated dilatation of the ventriculoarterial junction (VAJ)
- Central AR jet
Functional Classification of Aortic Regurgitation: What defines type Id dysfunction?
- Normal cusp motion
- Cusp perforation causing AR in the absence of lesion/dilatation
- Eccentric AR jet
Functional Classification of Aortic Regurgitation: What defines type II dysfunction?
- Leaflet prolapse as a result of excessive cusp tissue or commissural disruption
- Eccentric AR jet
Functional Classification of Aortic Regurgitation: What defines type III dysfunction?
- Leaflet restriction
- Occurs as a result of calcification, thickening and fibrosis of the aortic leaflets
