ABSTRACT
Background: While the number of patients with aortic regurgitation (AR)
has been increasing in the aging society, its etiologies remain to be
fully elucidated. We examined the causes of AR in the elder patients by
analyzing transesophageal echocardiography (TEE) images.
Methods: We studied consecutive 132 patients with chronic moderate or
severe AR who underwent TEE for further evaluation of AR. After the
study subjects were divided into 2 groups by the age of 65 years, AR
etiology, which was confirmed based on the TEE findings, was
investigated in each group.
Results: The total number of
patients eligible for this study was 126 (mean age 67 ± 12 years),
consisting of the older group (n = 85, mean age 74 ± 5 years) and the
younger group (n = 41, mean age 52 ± 11 years). In the older group, cusp
bending was the most frequent cause of AR (48.2%), and right coronary
cusp (RCC) was the most common region to be affected (90.2%). On the
other hand, in the younger group, bicuspid aortic valve was the most
common etiology (36.5%), and cusp bending accounted for only 19.5% in
this group. Subsequently, all the study subjects were re-classified into
2 groups with or without cusp bending. Between these 2 groups, only age
showed a significant difference (p = 0.0017), and multivariate analysis
revealed that age was the only factor associated with cusp bending.
Conclusion: Cusp bending of RCC
was the most frequent etiology of AR in the elderly. Because AR caused
by cusp bending has a possibility to be mended by aortic plasty, it is
important to detect it especially in the older patients.
Keywords: valvular heart disease, aortic regurgitation, cusp bending