Aortic regurgitation, perioperative hemodynamic goals

Important essentials Anesthesiologist should know about Aortic regurgitation:

Etiology: 

• Rheumatic fever
• Infective endocarditis
• Ankylosing spondylitis
• Takayasu arteritis
• Marfan’s syndrome
• Degenerative aortic valve disease
• Syphilis etc.

Pathophysiology:

   

 Aortic regurgitation produces volume overload of the left ventricle. The effective forward SV is reduced because of backward flow of blood into the left ventricle during diastole. With chronic aortic regurgitation, the left ventricle progressively dilates and undergoes eccentric hypertrophy. Eventually, as ventricular function deteriorates, the ejection fraction declines. Acute aortic regurgitation typically presents as the sudden onset of pulmonary edema and hypotension, whereas chronic regurgitation usually presents insidiously as congestive heart failure.

Clinical Signs:

• Dyspnea on exertion, Orthopnea, Paroxysmal nocturnal dyspnea

• Palpitations

• Angina pectoris

• Cyanosis (in acute cases)

• Acute aortic regurgitation typically presents as the sudden onset of pulmonary edema and hypotension

• Chronic regurgitation usually presents insidiously as congestive heart failure.

• Diastolic pressures are often lower than 60 mm Hg, with pulse pressures often exceeding 100 mm Hg

• Early diastolic murmur (lower pitched and shorter than in chronic AR)

• An Austin-Flint murmur, which is caused by the regurgitant flow causing vibration of the mitral apparatus, is lower pitched and short in duration.

• Becker sign - Visible systolic pulsations of the retinal arterioles

• Corrigan pulse ("water-hammer" pulse) - Abrupt distention and quick collapse on palpation of the peripheral arterial pulse

• de Musset sign - Bobbing motion of the patient's head with each heartbeat

Perioperative Hemodynamic Goals:

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