Severe aortic regurgitation from systemic hypertension (without aortic dissection) requiring aortic valve replacement

Waller, Bruce F.; Zoltick, Jerel M.; Rosen, Jeffrey H; Katz, Nevin M.; Gomes, Mario N.; Fletcher, Ross D.; Wallace, Robert B.; Roberts, William C.

doi:10.1016/0002-9149(82)90527-6

Cited by 36 publications

(9 citation statements)

References 5 publications

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“…Waller and colleagues 5 in 1982 described 4 patients with severe AR from systemic hypertension (without aortic dissection) who underwent AVR, and they reviewed previously reported patients with systemic hypertension and pure AR. Of their 4 patients, the systemic arterial pressures Ϸ1 month postoperatively remained elevated in 2 of the 3 survivors.…”

Section: Discussionmentioning

confidence: 99%

Causes of Pure Aortic Regurgitation in Patients Having Isolated Aortic Valve Replacement at a Single US Tertiary Hospital (1993 to 2005)

et al. 2006

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Background— The causes of aortic regurgitation (AR) severe enough to warrant aortic valve replacement (AVR) have received little attention in the last 20 years. Methods and Results— We analyzed the causes of pure AR in 268 patients >20 years of age having isolated AVR at Baylor University Medical Center from 1993 to 2005 that was unassociated with mitral stenosis, mitral valve replacement, or a previous operation involving a cardiac valve or ascending aorta. In 122 patients (46%), the AR resulted from a problem with the aortic valve: congenital malformation unassociated with infective endocarditis, 66 patients (54%); infective endocarditis, 46 patients (38%; 15 with bicuspid valves); probable rheumatic heart disease, 8 patients (6%); and miscellaneous, 2 patients (2%). In the other 146 patients (54%), the AR was the consequence of a condition affecting the ascending aorta: dissection, 28 patients (19%); the Marfan syndrome or its forme fruste variety, 15 patients (10%); aortitis, 12 patients (8%), and in the remaining 91 patients (62%), the cause of the AR was not determined. This latter group was the oldest (mean age 66 years), 83 (91%) had hypertension, 26 (29%) had small calcific deposits in the valve cusps, and 46 (51%) had simultaneous coronary artery bypass grafting. Conclusions— The causes of pure AR severe enough to warrant isolated AVR are diverse. The most common category in this study was “cause unclear.”

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Section: Discussionmentioning

confidence: 99%

Causes of Pure Aortic Regurgitation in Patients Having Isolated Aortic Valve Replacement at a Single US Tertiary Hospital (1993 to 2005)

et al. 2006

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“…4,5 The aortic root diameter is strongly related to age, to body size, 1,6 and, less strongly, to blood pressure (BP). 7,8 However, only a small proportion of the variance of aortic root size can be explained by all of its known clinical and demographic variables. 8,9 The present study was undertaken to determine the heritability of echocardiographically derived aortic root diameter in the American Indian participants in the second Strong Heart Study (SHS) examination.…”

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confidence: 99%

Genetic Influences on Aortic Root Size in American Indians

Bella

MacCluer

Roman

et al. 2002

ATVB

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Abstract-Aortic root dilatation is a major pathophysiological mechanism for aortic regurgitation and predisposes the aortic root to dissection or rupture. However, only a small proportion of the variance of aortic root size can be explained by its known clinical and demographic correlates. The present study was undertaken to determine the heritability of echocardiographically derived aortic root diameter in the American Indian participants in the second Strong Heart Study examination. Echocardiograms were analyzed in 1373 SHS participants who had Ն1 family member in the cohort. Heritability calculations were performed by using variance component analysis as implemented in SOLAR, a computer analysis program. In a polygenic model, the variables entered and identified as covariates of larger aortic root diameter were older age, male sex, and center (PϽ0.001), which accounted for 35% of the overall variability of aortic root diameter. After simultaneous adjustment was made for these significant covariates, the proportion of phenotypic variance due to additive genetic contribution or residual heritability (h 2 ) was 0.51 (SEϭ0.08, PϽ0.001). Additionally, simultaneous adjustment for height, weight, and systolic and diastolic BPs yielded slightly lower residual h 2 of aortic root diameter (h 2 ϭ0.44, SEϭ0.08, PϽ0.001), which accounted for 26% of the overall variance of aortic root size. Because center effects were identified as significant covariates in the analyses, h 2 analyses were performed separately in Arizona, Oklahoma, and North/South Dakota centers, which confirmed that a significant proportion of the phenotypic variance of aortic root diameter is due to additive genetic contribution. Heredity explains a substantial proportion of the variability of aortic root size that is not accounted for by age, sex, body size, and blood pressure.

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“…Aortic root dilatation has been associated with myxoid degeneration ofthe aortic cusps. 4 However, the similar aetiology of the valve disease but different blood pressures seen here in those with AS and AS with AR suggests that the haemodynamic disturbances caused by the valve disease itself may be responsible for the blood pressure changes seen after AVR. In AS, patients with prior heart failure showed significant increases in systolic and reductions in diastolic pressure.…”

Section: Discussionmentioning

confidence: 69%

“…However, we have been misled by a patient with severe lone AS who had severe hypertension.2 Furthermore, the murmur of aortic regurgitation is found in a proportion of patients with diastolic hypertension3 and although this regurgitation was usually minor, progression necessitating aortic valve replacement (AVR) has been recorded. 4 Transient increases in blood pressure are well documented immediately following cardiac surgery and in patients with AS raised blood pressure has been reported in about 10% of cases in the immediate post-operative period.5 There are, however, few long-term data on the effects of AVR.6 '7 The association between hypertension and aortic valve disease is not widely recognized. This prompted us to examine the prevalence of hypertension in patients who underwent cardiac catheterization for severe aortic stenosis and/or regurgitation and to investigate blood pressure changes resulting from aortic valve replacement.…”

Section: Introductionmentioning

confidence: 99%

Hypertension in aortic valve disease and its response to valve replacement

Zezulka

Mackinnon

Beevers

1992

Postgraduate Medical Journal

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Summary:We have investigated the prevalence of hypertension and the response of blood pressure to operation in 87 patients with lone aortic valve disease who underwent aortic valve replacement.In patients with aortic stenosis alone 26% were hypertensive pre-operatively (age and sex adjusted blood pressure > 160 systolic and or > 95 mmHg diastolic) and 24% were hypertensive post-operatively. In those with aortic regurgitation alone, hypertension was present in 65% before and 57% after valve replacement using the same criterion. For combined stenosis and regurgitation, the prevalence was 54% and 62%, respectively.The post-operative increase in systolic pressure in patients with aortic stenosis occurred mainly in those with a history of left ventricular failure. In those with aortic regurgitation or combined stenosis with regurgitation, diastolic pressure rose after valve replacement resulting in a prevalence of diastolic hypertension of 44% and 35%, respectively. Blood pressure changes were not predicted by the type of valve inserted nor its size.Our data show that despite severe symptomatic aortic valve disease, systolic hypertension was common in aortic stenosis and diastolic hypertension was found in aortic regurgitation. This underlines the importance of blood pressure monitoring in patients following aortic valve replacement.

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Severe aortic regurgitation from systemic hypertension (without aortic dissection) requiring aortic valve replacement

Cited by 36 publications

References 5 publications

Causes of Pure Aortic Regurgitation in Patients Having Isolated Aortic Valve Replacement at a Single US Tertiary Hospital (1993 to 2005)

Causes of Pure Aortic Regurgitation in Patients Having Isolated Aortic Valve Replacement at a Single US Tertiary Hospital (1993 to 2005)

Genetic Influences on Aortic Root Size in American Indians

Hypertension in aortic valve disease and its response to valve replacement

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