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4D Imaging of the Aortic Valve: Aortic Regurgitation

Aortic regurgitation results from abnormalities of the valve cusps or aortic root preventing close apposition of the free margins of the valve leaflets. Chronic regurgitation results in left ventricular volume overload and progressive dilatation of the left ventricle. Symptoms are of heart failure and angina.

Valvular causes of aortic regurgitation include congenitally malformed valve leaflets, infectious endocarditis, and connective tissue disorders. Aortic root causes of aortic regurgitation include cystic medial necrosis, Marfan's syndrome, aortic dissection, inflammatory diseases and severe hypertension.

Color doppler echocardiography, and recently MRI, are used to detect the regurgitant jet across the aortic valve. The aortic valve may show calcifications, thickening, congenital deformity, vegetations, rupture, or prolapse. The normal valve area is 3-4 cm2 in adults. The aortic root may be dilated, have calcifications or evidence of dissection. If the aortic root is dilated, evaluation of valve morphology is important for determining if valve replacement is necessary when surgery is performed.

Treatment for aortic regurgitation due to aortic dissection requires surgery. Infective endocarditis requires antibiotics and may require surgery. Systemic hypertension is treated as it exacerbates regurgitation. Valve replacement surgery is performed in symptomatic patients with left ventricular dysfunction.

Source: Zoghbi WA, Afridi I. Aortic Regurgitation. In: Current Diagnosis and Treatment in Cardiology, 2nd edition. The McGraw-Hill Companies.