Sunil Kalmath VIII Term Mandya Institute of Medical Sciences

Aortic

regurgitation is a valvular dysfunction in which there is backward return from the aorta into the left ventricle during diastole. Prevalence of RHD in India- 0.68/1000 school children AR usually asso. with mitral valve disease.

  

Backward leak from aorta into left ventricle during diastole Increased volume in left ventricle End diastolic size related to the degree of leak Forward flow impaired Compensated by: 1. peripheral vasodilatation 2. inc ejection from left ventricle Peripheral pulse pressure wide - due to increased systolic ejection fraction -lowered diastolic pressure Slowing of heart rate increases diastolic period and so increased volume of regurgitant blood

If left ventricular myocardium failing left ventricular diastolic pressure increase Left atrial pressure increase Pulmonary congestion Significant increase in left ventricular pressure Dilatation of left ventricle Stress on mitral valve papillary muscle complex Inadequate apposition of mitral valve leaflets Appearance of mitral regurgitation

       

More common in boys Main symptom palpitation- large stroke volume, dyspnea, fatigue Wide pulse pressure Severe AR- Diastolic pressure zero CORRIGANS SIGN- prominent carotid pulsation Dancing peripheral pulses Variable abdominal aorta pulsations WATER HAMMER PULSE- hold middle of forearm and raise it- Sharply rising and falling pulse is detected DE MUSSETS SIGN- nodding of head seen with each systole- Due to sudden carotid filling in severe AR.

HILLS SIGN- exaggerated systolic pressure b/w brachial and femoral artery > 20 mm HG

PISTOL SHOT sounds when stethoscope on artery DUROZIEZ SIGNProximal occlusion- systolic murmur Distal occlusion- diastolic murmur this dual combination of sounds is called duroziez sign

x Quincke sign- pressure on tip of fingernail, fingertip transillumination or glass slide on lip x Lighthouse sign- flushing and blanching of forehead x Landolfis sign- pupillary constriction and dilation x Beckers sign- retinal vessel pulsation x Rosenbachs sign- liver pulsation x Gerhardts sign- splenic pulsation

Cardiac enlargement

Apexdownward and outward Second heart sound audible or masked by murmur

Conducted thrill to carotidscarotid shudder

Forcible or heaving apex

First heart sound soft

Systolic thrill over precordium

high pitched

Decrescendo

Diastolic murmur MURMURStarting with aortic component of S2 Lt sternal border Heard at Radiates to apex Accentuated on leaning forward and breath held in expiration

Mid diastolic murmur with presystolic accentuation Seen in severe AR only Causesx AR jet impinging on AML forcing it down thus decreasing mitral orifice x Turbulence when AR jet meets mitral inflow jet x AML fluttering due to AR jet x LV endocardial vibrations due to AR jet

ECGDeep S waves v1

CXRlt ventricular cardiomegaly

ECHOinc flow across aortic valve

Tall R waves

dilated ascending aorta

regurgitant stream through valve during diastole

Deep Q wavesleft chest leads

Tall T waves diastolic overloading of left ventricle

Exercise stress test

Radionuclide angiography

MRI

LV/RV stroke volume ratio > 2 indicates severe AR

Can accurately measure severity of AR by measuring Regurgitant volume, Regurgitant fraction and Regurgitant area

Used when echo is suboptimal

CT
NORMAL AR

 Patent

ductus artewriosus Arterio venous fistula Ventricular septal defect Ruptured sinus of valsalva Anemia Thyrotoxicosis

If regurgitation trivial or mild, treatment usually not necessary. Monitor patient with regular follow up Surgery For CHF or Angina Consider before surgery: 1. Rheumatic myocarditis 2. Suggestive progressive deterioration 3. Adherence to life long anti coagulants

repair1. Annuloplasty 2.Valvoplasty

Valve

replacement1.Biological replacement porcine valves donor valves 2. Prosthetic valves

Valve

   

Aortic valve replaced with patient's pulmonary valve. The pulmonary valve replaced with one from a donated organ. Valves grow with the child, and Anti coagulants aren't required.

textbook of pediatrics Nelsons textbook of pediatrics www.heartpearls.com Childrens hospital of Philadelphia resource page www.medicalmnemonics4u.blogspot.co m
O.P.Ghai

THANK YOU