Table 1

Causes of acute aortic regurgitation

MechanismAetiologyDetailsReferences
Ascending aortic dissection (type A dissection)Idiopathic/hypertensionMost common cause of acute secondary AR.2 13
Congenital bicuspid aortic valveRisk of dissection at a given diameter not higher than tri-leaflet, but lifetime risk of dissection nine times higher due to aortic dilation. Risk of severe AR with dissection is higher.14 15 48
Inherited aortopathy (Marfan, Loeys-Dietz, vascular EDS, etc)High risk of dissection, consider in patients with dissection <45 years.14
FTAADFamily history important at presentation.14
Aortic vasculitisBehçet’s, GPA, Takayasu’sMay involve leaflets (primary AR) and/or aortic wall (secondary AR).16–19
Endocarditis, NTBELeaflet destruction or obstructionEndocarditis is most common cause of acute primary AR.2 3 49
Paravalvular abscessMay rupture from aorta to LV, RV, RA or LA depending on site around annulus.4
TraumaBlunt chest trauma, deceleration injuryOften MVC or fall resulting in leaflet rupture or aortic dissection.5 6 50
IatrogenicCatheter traumaProlapse, perforation, or laceration of leaflet.10 51
Transcatheter valvuloplastyLeaflet stuck open after valvuloplasty.9
Transvalvular axial flow LV assist deviceResulting from leaflet injury, persistent after device removal.11 12
Mitral valve surgerySecondary to surgical trauma.52
Fenestration ruptureCongenital or myxomatous degenerationRupture of fibrous cord, often leading to valve prolapse and eccentric AR jet. Incidence higher in males, RCC frequently involved.7 8 53
  • AR, aortic regurgitation; EDS, Ehlers-Danlos syndrome; FTAAD, familial thoracic aortic aneurysm and dissection; GPA, granulomatosis with polyangiitis; LA, left atrium; LV, left ventricle; MVC, motor vehicle collision; NTBE, non-bacterial thrombotic endocarditis; RA, right atrium; RCC, right coronary cusp; RV, right ventricle.