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2.1
Congenital Aortic Insufficiency
Primary Valve Deficiency

Presentation

[…] if the condition was present at the time of inpatient admission. [icd.codes]

On Admission POA Help "Present On Admission" is defined as present at the time the order for inpatient admission occurs — conditions that develop during an outpatient encounter, including emergency department, observation, or outpatient surgery, are [icd10data.com]

Stenosis - when the valve doesn't open enough and blocks blood flow Valve problems can be present at birth or caused by infections, heart attacks, or heart disease or damage. [icdlist.com]

It is vital that patients with quadricuspid aortic valve who present with progressive aortic regurgitation undergo valve replacement or repair at appropriate time. Here, we present two cases of quadricuspid aortic valve. [cardiothoracicsurgery.biomedcentral.com]

Cardiomegaly is present in patients with chronic AR. In acute AR, pulmonary edema is almost universally present. If the AR is due to an aortic dissection, the mediastinum may appear widened. [healio.com]

Entire Body System

  • Fatigue

    Mitral stenosis — limits blood flowing into the left ventricle of the heart, and can cause symptoms such as fatigue and shortness of breath. [sutterhealth.org]

    See your doctor if you have fatigue, shortness of breath, and swollen ankles and feet, which are common symptoms of heart failure. Causes Your heart has four valves that keep blood flowing in the correct direction. [mayoclinic.org]

    Symptoms can include fatigue, fainting, shortness of breath, palpitations (sensation of the heart beating), and swelling of the feet, legs, or abdomen. [uabmedicine.org]

    Symptoms of BAV, caused by an aortic valve that leaks or does not open completely, include: Trouble breathing Chest pain or pressure Fatigue Heart racing Light-headedness Fainting Less than five percent of people with BAV will develop complications from [nm.org]

  • Asymptomatic

    Timing of AVR in asymptomatic patients weighs risks of surgery against risk of disease progression. [clinicaladvisor.com]

    History Part I: Pattern Recognition One method of classifying patients with AR is to assign them to one of three categories: asymptomatic patients with normal LV function; asymptomatic patients with depressed systolic function; and symptomatic patients [thecardiologyadvisor.com]

    The asymptomatic patient who has moderate to severe aortic regurgitation may not have symptoms for many years. In seven studies, 1 – 7 490 asymptomatic patients with moderate to severe aortic regurgitation were followed for a mean of 6.4 years. [aafp.org]

    The other three patients were asymptomatic at last follow-up at age 8, 10 and 20 years, respectively. CONCLUSIONS: Supportive management is recommended until it becomes necessary to intervene surgically when regurgitation becomes severe. [ncbi.nlm.nih.gov]

    The second patient is a 20-year-old asymptomatic boy who has been closely followed up and has not received any surgical treatment. [cardiothoracicsurgery.biomedcentral.com]

  • Congestive Heart Failure

    If not repaired or placed, a severely regurgitant valve can lead to congestive heart failure. Symptoms of congestive heart failure include swollen ankles and feet, fatigue, chest pain and shortness of breath. [sutterhealth.org]

    heart failure contractility coronary artery curve decrease diagnosis diastolic digitalis diuretics drug dyspnea ectopic effect ejection electrocardiogram fibers fibrillation filling findings first fluid function gallop heart disease heart sound Hemodynamic [books.google.com]

    Once they occur, the aortic regurgitation symptoms are mostly from congestive heart failure. Left heart failure results in symptoms related to low cardiac output. [healio.com]

    Surgery can cure aortic insufficiency and relieve symptoms, unless you develop heart failure or other complications. People with angina or congestive heart failure due to aortic regurgitation do poorly without treatment. [medlineplus.gov]

    Auscultation of breath sounds may reveal fine crackles (rales) if pulmonary congestion is present from left-sided heart failure. [medical-dictionary.thefreedictionary.com]

  • Surgical Procedure

    Many of these children will require repeat balloon dilation or surgical valve replacement procedures. The outcomes of open-heart surgical procedures for severe aortic valvar stenosis have been excellent. [cincinnatichildrens.org]

    Dental procedures (including a professional dental cleaning) and certain surgical procedures may introduce bacteria into the blood ( click here for more information on dental prophylaxis). [cormedicalgroup.com]

    Additionally, the remaining surgical procedures were likely limited to simple blade commissurotomy since the mode of failure of these surgical patients was recurrent stenosis (a complication typically seen with inadequate resection of the valve nodular [annalscts.com]

    Treatment of Aortic Valve Regurgitation is based on the condition of the heart, the overall health condition of the individual, and the signs and symptoms presented (whether they are mild, moderate, or severe): Surgical procedures to either repair or [dovemed.com]

    The patient with known bicuspid aortic valve requires antibiotic prophylaxis for invasive dental or noncardiac surgical procedures. [chd-uk.co.uk]

  • Short Stature

    Typical features of Turner syndrome (eg, short stature in females with webbed neck and broad chest) or Williams syndrome (eg, elfin facies, mild retardation) may suggest the possibility of bicuspid aortic valve. Cardiac examination TREATMENT. [chd-uk.co.uk]

Gastrointestinal

  • Regurgitation

    OBJECTIVES AND BACKGROUND: Congenital aortic regurgitation is rare as an isolated lesion. [ncbi.nlm.nih.gov]

    This may be a result of long-term aortic regurgitation. [cardiothoracicsurgery.biomedcentral.com]

    Convert to ICD-10-CM : 746.4 converts directly to: 2015/16 ICD-10-CM Q23.1 Congenital insufficiency of aortic valve Approximate Synonyms Aortic valve regurgitation, congenital Aortic valve, bicuspid Bicuspid aortic valve Congenital aortic valve regurgitation [icd9data.com]

    A regurgitant fraction of less than 20% indicates mild aortic regurgitation, from 20% to 35% moderate aortic regurgitation, from 36% to 50% moderately severe aortic regurgitation, and greater than 50% severe aortic regurgitation. [healio.com]

    Overview Aortic valve regurgitation — or aortic regurgitation — is a condition that occurs when your heart's aortic valve doesn't close tightly. [mayoclinic.org]

Cardiovascular

  • Heart Disease

    […] defect (Medical Encyclopedia) [ Read More ] Heart Valve Diseases Also called: Valvular heart disease Your heart has four valves. [icdlist.com]

    Ariane Marelli to bring you a new edition of Clinical Recognition of Congenital Heart Disease. [books.google.com]

    […] where rheumatic heart disease is rare, aortic regurgitation may be due to bicuspid aortic valve disease or senile degenerative calcific aortic valve disease which may present in the fourth to sixth decade. [wikidoc.org]

    Cedars-Sinai is pioneering the use of minimally invasive techniques to treat heart disease, as well as noninvasive approaches to managing heart conditions. [cedars-sinai.edu]

    Our arrhythmia team uses EKGs to evaluate problems including: Arrhythmias : Heartbeats that are too fast, too slow, or erratic Congenital heart disease : Birth defects in the heart Coronary artery disease : Problems with blood flow to the heart muscle [stanfordhealthcare.org]

  • Heart Murmur

    The main sign of heart valve disease is an unusual heartbeat sound called a heart murmur. Your doctor can hear a heart murmur with a stethoscope. But many people have heart murmurs without having a problem. [icdlist.com]

    At CHOP's Cardiac Center, we usually diagnose aortic regurgitation after a primary care doctor detects a heart murmur and refers a child to us. [chop.edu]

    An early indicator of BAV is a heart murmur, which is an abnormal sound caused by the turbulent flow of blood over a diseased heart valve. [nm.org]

    […] beating) Shortness of breath with activity or when lying down Swelling of the feet, legs or abdomen Uneven, rapid, racing, pounding or fluttering pulse Weakness, more often with activity Signs may include: A heart murmur when the healthcare provider [wexnermedical.osu.edu]

    Most commonly, however, late-developing DSVAS is recognized because of a heart murmur before symptoms are recognized. [pted.org]

  • Left Ventricular Dysfunction

    The need for surgical treatment is indicated by the appearance of a diastolic thrill, left ventricular strain on the electrocardiogram or other evidence of left ventricular dysfunction on the echocardiogram or exercise stress testing by treadmill or radionuclide [ncbi.nlm.nih.gov]

    left ventricular dysfunction is less than 6 percent per year. [aafp.org]

    AVR should be elected after there is evidence of left ventricular dysfunction or the onset of symptoms. [thecardiologyadvisor.com]

    Asymptomatic patients should also be operated on when left ventricular function begins to deteriorate, since the likelihood of developing irreversible myocardial dysfunction is high if intervention is delayed. [patient.info]

  • Diastolic Murmur

    Finally, a third murmur, known as an Austin Flint murmur, may be detected. This is a soft, rumbling, low-pitched, late diastolic murmur which is heard best at the apex. [med.ucla.edu]

    Auscultation reveals an S3 and a high-pitched, decrescendo early diastolic murmur. Another characteristic diagnostic finding is widened pulse pressure. [amboss.com]

    A high pulmonary artery pressure may cause a diastolic pulmonary regurgitation murmur (Graham Steel). Like the diastolic murmur of AR, this murmur is high-pitched along the left sternal border. [clinicaladvisor.com]

    Presentation See also the separate Heart Auscultation, Heart Murmurs in Children and Pulse Examination articles. AR is diagnosed by the presence of a characteristic diastolic murmur, exaggerated arterial pulsations and low diastolic pressure. [patient.info]

    Physical exam features include a high-frequency, decrescendo diastolic murmur; in some, an Austin-Flint murmur is heard. [thecardiologyadvisor.com]

  • Water Hammer Pulse

    They’ll also listen to your heart, review your pulse and blood pressure, and look for indicators of heart valve problems, such as: an unusually forceful heartbeat visible pulsing of the neck artery a “water-hammer” pulse, which is a pounding pulse that [healthline.com]

    High pulse pressure Water hammer pulse of peripheral arteries characterized by rapid upstroke and downstroke Pulsing of carotid arteries with rapid upstroke and downstroke Visible capillary pulse ( Quincke sign ) Nodding of the head with each pulse Point [amboss.com]

    The classical Corrigan or 'water hammer' pulse is rarely felt these days, as such marked disease is surgically corrected. [patient.info]

    (Watson water hammer pulse), bobbing uvula (Mueller sign), a pistol shot sound heard over the femoral artery during compression (Traube’s sign), systolic and diastolic murmurs over the femoral artery with compression (Duroziez sign), pulsations of the [thecardiologyadvisor.com]

    The increased pulse pressure and rapid aortic runoff result in many of the peripheral signs of severe aortic regurgitation, including the visible carotid pulse and suprasternal pulsations as well as the collapsing quality of the pulse (“water-hammer” [aafp.org]

Neurologic

  • Irritability

    Fecal transplant is used to treat gut infections and is now being studied as a treatment for obesity, urinary tract infections, irritable bowel syndrome and more. [nytimes.com]

Workup

Hypertrophy

  • Left Ventricular Hypertrophy

    This gradient may progressively increase without any significant changes to left ventricular function because of compensatory left ventricular hypertrophy, appreciated clinically by the pressure loaded apex beat 1,2. [radiopaedia.org]

    ECG typically indicates left ventricular hypertrophy. [en.wikipedia.org]

    ventricular hypertrophy and left atrial enlargement. [healio.com]

    Chest x-ray revealed cardiomegaly to left and inferior and an electrocardiogram indicated left ventricular hypertrophy. [cardiothoracicsurgery.biomedcentral.com]

    The CXR may demonstrate left ventricular hypertrophy and a dilated aorta, as well as pulmonary edema. Cardiac MRI can be used to accurately measure regurgitant volumes, as noted above. [thecardiologyadvisor.com]

Treatment

Many children with congenital heart defects don't need treatment, but others do. Treatment can include medicines, catheter procedures, surgery, and heart transplants. [icdlist.com]

Our renowned surgeons and faculty continue to push the frontiers of surgical science through innovative treatment and leading-edge research, changing lives and the future of surgical treatment, each and every day. [surgery.yale.edu]

Children with mild aortic stenosis rarely require treatment. However, it is important to note that aortic stenosis may be progressive, and that children with mild disease may eventually require treatment later in life. [cincinnatichildrens.org]

12/10/2018 Depending on the severity of your aortic regurgitation, your cardiologist may recommend: Medications Surgical treatments Non-surgical, less invasive treatments To learn about the various treatment options for aortic regurgitation, keep reading [secondscount.org]

Treatments include medications to control symptoms, and valve repair or replacement. [sutterhealth.org]

Prognosis

Prognosis [ 2 ] Patients with acute severe AR have a poor prognosis without intervention, due to their haemodynamic instability. Patients with chronic severe AR and symptoms also have a poor long-term prognosis. [patient.info]

Prognosis and Patient Counseling. Prognosis The long-term prognosis of chronic AR depends on the severity of the regurgitation and the presence of left ventricular dysfunction. [clinicaladvisor.com]

Once your aortic valve is repaired, your prognosis is generally good. However, you’ll always need to guard against and respond quickly to any type of infections that could spread to your heart. [healthline.com]

[…] squatting and handgrip Austin Flint murmur In more severe stages, possibly a harsh, crescendo-decrescendo mid- systolic murm u r that resembles the ejection murmur heard in aortic stenosis Screening tests (optional) References: [4] [5] [1] [2] Treatment Prognosis [amboss.com]

Outlook (Prognosis) Surgery can cure aortic insufficiency and relieve symptoms, unless you develop heart failure or other complications. People with angina or congestive heart failure due to aortic regurgitation do poorly without treatment. [mountsinai.org]

Etiology

Regarding etiology, structural abnormalities, such as a bicuspid aortic valve or prolapse of the AV may be seen. [healio.com]

Classification and etiology There are numerous other predisposing factors and causes of aortic stenosis. [radiopaedia.org]

Etiology Acute AR Infective endocarditis Aortic dissection ( ascending aorta ) Chest trauma Chronic AR Congenital bicuspid valve : most common cause of AR in young adults and in developed countries Rheumatic heart disease : most common cause of AR in [amboss.com]

Even in the absence of symptoms, the etiology of aortic regurgitation needs to be considered in deciding if and when to operate. [aafp.org]

(Etiology) Aortic Valve Regurgitation is caused due to a variety of factors, chiefly: Being born with a congenital heart condition High blood pressure may damage the heart or dilate the aorta, and also thicken the arteries Rheumatic fever Injury/trauma [dovemed.com]

Epidemiology

"The worldwide epidemiology of acute rheumatic fever and rheumatic heart disease". Clinical Epidemiology. 3 : 67–84. doi : 10.2147/CLEP.S12977. PMC 3046187. PMID 21386976. ↑ Bekeredjian, R.; Grayburn, PA. (2005). [wikidoc.org]

Epidemiology [ 2 ] Rheumatic heart disease is the most common cause of AR throughout the world. In developed countries, congenital and degenerative valve abnormalities are the most common cause and the peak age of presentation is 40-60 years. [patient.info]

Epidemiology Frequency United States An estimated 5 million Americans have at least one form of heart valve disease. In 2000, 1 million Americans were affected by congenital heart disease. This is a 3-fold increase from 300,000 in 1980. [emedicine.medscape.com]

Pathophysiology

Grasp the full scope of the pathophysiology of CHD with well-organized, expert guidance. Quickly search the contents online, download images in JPG or PPT format, and view 70 echocardiogram videos at expertconsult.com. [books.google.com]

Anomalous coronary artery arising from the opposite sinus: descriptive features and pathophysiologic mechanisms, as documented by intravascular ultrasonography. J Invasive Cardiol 2003; 15: 507–14. [link.springer.com]

[…] most common cause of AR in developing countries Distortion or dilation of the ascending aorta and aortic root Connective tissue disorders (e.g., Marfan syndrome, Ehlers-Danlos syndrome) Tertiary syphilis See also heart valve disease References: [1] [2] Pathophysiology [amboss.com]

Pathophysiologically, the left ventricle must continue to eject a large stroke volume to keep forward stroke volume normal. [aafp.org]

Pathophysiology – Aortic Regurgitation The abnormal backflow of blood that occurs leads to pathologic changes that are highly dependent on aortic regurgitation severity and pace of disease development. [healio.com]

Prevention

At surgery, the fibrous band was stretching the non-coronary cusp so that it prevented coaptation of the aortic valve. The situation was termed by us as the 'kite anomaly'. [ncbi.nlm.nih.gov]

There are valves that prevent the blood from flowing the wrong way. [dovemed.com]

It is usually caused by rheumatic fever, and is rare in the United States, where antibiotics are used to prevent serious infections. Treatments include medications to control symptoms, and valve repair or replacement. [sutterhealth.org]

Make sure it's well-controlled to prevent aortic regurgitation. Aug. 02, 2017 [mayoclinic.org]

Causes Any condition that prevents the aortic valve from closing completely can cause this problem. When the valve does not close all the way, some blood comes back each time the heart beats. [mountsinai.org]

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