Aortic insufficiency risk factors


 * Associate Editors-In-Chief:, , Mohammed A. Sbeih, M.D. [mailto:msbeih@perfuse.org]

Overview
In the past, the most common risk factor for aortic valvular disease has been rheumatic fever, fibrosis then leads to retraction of the cusps and prevents their apposition during diastole.

In the modern era, a more common risk factor for acquired aortic regurgitation is degenerative disease of the aorta and aortic valve in which case there is calcification and fibrosis of the cusps. Infective endocarditis also considered an important risk factor and cause of aortic insufficiency.

Congenital conditions such as congenital bicuspid aortic valve or a ventricular septal defect can also result in aortic insufficiency. Patients with bicuspid aortic valve are at increased risk of developing aortic dissection.

Risk factors
Some of the risk factors for aortic insufficiency due to aortic root disease include:
 * Age-related degeneration of aortic root.
 * Hypertension
 * Aortic dissection
 * Cystic medial necrosis of the aorta
 * Giant cell arteritis
 * Syphilitic aortitis
 * Behçet's syndrome
 * Ankylosing spondylitis
 * Psoriatic arthritis
 * Reiter's syndrome
 * Ulcerative colitis
 * Osteogenesis imperfecta
 * Relapsing polychondritis

Risk factors for acute aortic insufficiency include:

 * Rheumatic Fever
 * Bacterial Endocarditis
 * Aortic dissection
 * Traumatic aortic rupture following blunt chest trauma
 * After aortic balloon valvotomy
 * Myxomatous aortic valve

Risk factors for chronic aortic insufficiency include:

 * After aortic balloon valvotomy
 * Bicuspid aortic valve
 * Aortic Dissection
 * Hypertension
 * Rheumatic Fever
 * Bacterial Endocarditis
 * Arteriosclerosis
 * Myxomatous aortic valve
 * Cystic medianecrosis of aorta
 * Pseudoxanthoma Elasticum
 * Ehlers-Danlos Syndrome
 * Marfan Syndrome
 * Bechterew's Disease
 * Rheumatoid Arthritis
 * Ankylosing Spondylitis
 * Reiter's Syndrome
 * Systemic Lupus Erythematosus
 * Polymyalgia Rheumatica
 * Turner's Syndrome
 * Ventricular Septal Defect
 * Sinus of Valsalva Aneurysm
 * Syphilis
 * Weight loss medications

Precautions
People with aortic insufficiency of any aetiology are at risk for the development of infection of their damaged valve, i.e. infective endocarditis. To lessen the chance of developing that serious complication, people with AI are usually advised to take antibiotic prophylaxis around the time of certain dental/medical/surgical procedures. Routine upper and lower GI endoscopy (i.e. gastroscopy and colonoscopy), with or without biopsy, are not usually considered indications for antibiotic prophylaxis.

Not withstanding the foregoing, the American Heart Association has recently changed its recommendations regarding antibiotic prophylaxis for endocarditis. Specifically, as of 2007, it is recommended that such prophylaxis be limited only to:
 * Those with prosthetic heart valves.
 * Those with previous episode(s) of endocarditis.
 * Those with certain types of congenital heart disease.