Aortic regurgitation causes

Aortic insufficiency can be an acute illness or a chronic illness and the causes differ depending upon the acuity of the disease. In general, aortic insufficiency is due to abnormalities of the aortic valve itself or the aortic root. Aortic regurgitation secondary to dilation of the ascending aorta has overtaken the valvular aortic disease as the most common cause of aortic regurgitation.It can also occur after surgical valve placement.

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.

• Aortic dissection^[1]
• Bacterial endocarditis^[2]

• Bicuspid aortic valve^[3]
• Senile or degenerative calcific aortic valve disease^[3]
• Rheumatic heart disease^[4]
• After Valvular Surgery^[5]

The cause of Aortic Regurgitation by location can be classified as following:^[1]

• Bicuspid aortic valve^[3]
• Collagen vascular disease
• Senile or degenerative calcific aortic valve disease
• Endocarditis
• Myxomatous aortic valve
• Rheumatic fever^[6]
• Rheumatoid arthritis ^[7]
• Sinus of Valsalva Aneurysm
• Systemic Lupus Erythematosus
• Trauma^[8][9]
• Turner’s Syndrome
• Ventricular Septal Defect
• Weight loss medications
• Post Aortic Valve Surgery^[10]
• Quadricuspid Aortic Valve ^[11]

• Ankylosing spondylitis ^[12]
• Aortic dissection ^[13]
• Arteriosclerosis ^[14]
• Bechterew’s Disease ^[12]
• Behcet’s syndrome
• Cystic medial necrosis of the aorta
• Ehlers-Danlos Syndrome
• Giant cell arteritis
• Hypertension^[15]
• Idiopathic dilation of the ascending aorta
• Marfan syndrome^[9]
• Osteogenesis imperfecta
• Polymyalgia Rheumatica
• Pseudoxanthoma Elasticum
• Psoriatic arthritis
• Reiter’s syndrome
• Relapsing polychondritis
• Senile aortic ectasia and dilation
• Spondyloarthropathy
• Syphilitic aortitis
• Takayasu arteritis^[16]
• Trauma
• Ulcerative colitis
• Whipple’s disease

The causes of Acute Aortic Insufficiency include the following:^{[33][34][35][10]}

• Aortic valvuloplasty^[10]
• A type A aortic dissection may disrupt the integrity of the valve leaflets causing malcoaptation of the aortic leaflets.^[36]
• In bacterial endocarditis the infection can erode the valve and cause a leaflet to become flail, or a vegetation can prevent coaptation of the leaflets.
• Blunt chest trauma can disrupt the supporting apparatus of the aortic valve.
• Myxomatous aortic valve can degenerate, leading to insufficiency.
• Prosthetic valve dysfunction^[37]
• Rheumatic fever^[6]
• Rupture of a congenitally fenestrated cusp^[38]

The cause of Chronic Aortic Insufficiency include the following:^[1][39]

• Ankylosing spondylitis can be associated with inflammation of the aorta (aortitis).^[40] The inflammatory process can also involve the septum and cause conduction disease.
• A type A aortic dissection may disrupt the integrity of the valve leaflets causing malcoaptation of the aortic leaflets.
• Bechterew’s disease
• Rarely, in 5% of cases with Behcet disease there is an aortitis that involves the ascending aorta and in some cases the coronary arteries are involved.
• Bicuspid aortic valve is the most common congenital abnormality of the heart. It is the most common cause of isolated aortic insufficiency requiring surgical repair. Bicuspid aortic valve is also associated with inflammation of the aorta (an aortopathy) which may lead to dilation of the aorta and/or aortic dissection that can worsen the aortic insufficiency.^[41]
• Cystic medial necrosis of the aorta
• Ehlers-Danlos syndrome
• Giant cell arteritis may also be associated with an aortitis as well as coronary artery disease.^[42]
• Hypertension
• Marfan Syndrome
• Myxomatous aortic valve
• Polymyalgia rheumatica
• Pseudoxanthoma elasticum
• Reiter’s syndrome
• Rheumatic fever remains a cause of AS in the Middle East, Northern Africa and Asia as well as some immigrant populations in the United States. It is less prevalent in the US than it was in the 20th century. AR occurs as a result of fibrosis of the valve that is associated with thickening and retraction of the leaflets of the aortic valve. This retraction results in regurgitation in the center of the valve. At the same time, there may also be fusion of the aortic leaflets which results in concurrent aortic stenosis. It should be noted that rheumatic disease of the mitral valve is usually present in the same patient.
• Rheumatoid arthritis rarely causes symptomatic AR, but it can cause granulomatous nodules on the aortic leaflets which leads to clinical aortic regurgitation.^[43]
• Sinus of valsalva aneurysm
• Syphilis
• Systemic lupus erythematosus can cause AR by tow mechanisms. SLE can cause inflammation and fibrosis of the aortic leaflets leading to their damage and retraction.^[44] SLE can also be associated with the development of sterile verrucous vegetations on the valves called Libman-Sacks endocarditis.^[45][46]
• Takayasu arteritis can involve the aorta in an aortitis, the aortic valve itself, and the coronary arteries.^[47]
• Turner’s syndrome
• Ventricular septal defect^[48]
• Weight loss medications including fenfluramine and dexfenfluramine (a.k.a. Phen-Fen). These drugs have been associated with degeneration of the aortic valve.
• Whipple disease can involve the aortic valve.^[49]

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