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