Aortic regurgitation: examination, investigations and aortic root management
THE CONTEXT
Assessment of aortic regurgitation includes auscultation and imaging of ventricular and aortic changes; aortic root dilatation can determine the required operation.
Management continuation
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When systemic hypertension accompanies aortic regurgitation, non-rate-limiting vasodilators such as nifedipine are used to control systolic blood pressure.
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When aortic root dilatation causes aortic regurgitation, as may occur in Marfan syndrome, aortic root replacement is usually necessary.
Examination and structural findings
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The early diastolic murmur is best heard at the left sternal border, with the patient leaning forward and holding the breath in expiration.
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An accompanying ejection systolic murmur can produce a to-and-fro murmur.
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Pulse pressure is increased in the illustration, and the aortic arch and left ventricle may become dilated. Doppler echocardiography demonstrates the regurgitant jet.
Investigations
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The electrocardiogram is initially normal but may later show left ventricular hypertrophy and T-wave inversion.
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Chest radiography may show cardiac dilatation, possible aortic dilatation and features of left heart failure.
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Echocardiography may show a dilated, hyperdynamic left ventricle and a fluttering anterior mitral leaflet; Doppler detects reflux.
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Cardiac catheterisation may demonstrate a dilated left ventricle, aortic regurgitation and a dilated aortic root. It is not always required.