AORTIC VALVE REPAIR

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ETIOLOGY

INDICATION FOR SURGERY

TECHNIQUES

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ETIOLOGY OF AORTIC REGURGITATION (AR)

AR is the diastolic reflux of blood from the aorta into the left ventricle due to failure of coaptation of the aortic valve leaflets at the onset of diastole

Aetiology:
1. Primary Disease of the Aortic Leaflets:  causing valve leaflet distortion and interfere with coaptation

• Aortic leaflets calcific degeneration.
• Myxomatous Degeneration.
• Infective Endocarditis (IE).
• Rheumatic disease.
• Bicuspid aortic valve.
• Anorectic medications: fenfluramine and phentermine.

2. Disease of the Aortic Root causing Dilatation: causing improper leaflet coaptation

• Aortic Dissection
• Trauma
• Chronic systemic Hypertension
• Aortitis:
  • Syphilis
  • Viral Syndromes
  • Systemic Arteritides:
    • Giant Cell Arteritis.
    • Takayasu Arteritis.
• Connective Tissue Disorders:
  • Marfan's Syndrome
  • Reiter's Disease.
  • Ehlers-Danlos Syndrome.
  • Osteogenesis Imperfecta.
  • Rheumatoid Arthritis

Infective Endocarditis of the Aortic valve with cusp vegetation

Senile degenerative calcified aortic stenosis
Calcification penetrates the cusps and the commirssures are not fused

Degenerative aortic valve mixed disease (excised) with cusp calcification

Rheumatic aortic stenosis

Rheumatic aortic valve mixed disease (excised) with fish-mouth narrow rigid orifice 

Impacts of annulo-aortic ectasia:
a Aortic regurgitation
b acute dissection typeA
​ c aortic rupture