CARDIOVASCULAR JOURNAL OF AFRICA • Kenya Cardiac Society July 2023 7 AFRICA Submission ID: 1 SPECTRUM OF CAUSES OF ISOLATED (PURE) AORTIC REGURGITATION AT A SOUTH AFRICAN PUBLIC SECTOR TERTIARY CARE INSTITUTION M MASIKATI, W BASERA, T PENNEL, M NTSEKHE 1. DEPARTMENT OF MEDICINE, UNIVERSITY OF CAPE TOWN AND GROOTE SCHUUR HOSPITAL, CAPE TOWN, SOUTH AFRICA. 2. DEPARTMENT OF MEDICINE, DIVISION OF CARDIOLOGY, UNIVERSITY OF CAPE TOWN AND GROOTE SCHUUR HOSPITAL, CAPE TOWN, SOUTH AFRICA 3. DEPARTMENT OF SURGERY, CHRIS BARNARD DIVISION OF CARDIOTHORACIC SURGERY, UNIVERSITY OF CAPE TOWN, SOUTH AFRICA. 4. SCHOOL OF PUBLIC HEALTH & FAMILY MEDICINE, UNIVERSITY OF CAPE TOWN, SOUTH AFRICA. Background Aortic Regurgitation (AR) is due to primary abnormalities of the aortic valve or peri-valvular apparatus and structures such as the aortic root and the ascending aorta. The etiology and mechanisms of AR is relatively well described in Europe and North America, little information exists about their spectrum and frequency in a South African context. The aims of this study were to determine the spectrum of disorders that cause isolated AR and their proportion, the predominant mechanisms of isolated AR and the accuracy of pre-op determination of etiology by clinical and imaging evaluation. Methods This is a retrospective review of 141 hospital records of patients who had aortic valve replacement (AVR) for isolated AR from Jan 2003 to June 2018 at Groote Schuur Hospital (GSH). For this study the etiology and pathological mechanism was confirmed by macroscopic examination at surgery and pathological examination of the explanted valve was confirmed by preoperative clinical and echocardiographic findings or pathological examination where available. In the absence of histology, clinical,echocardiographic, and macroscopic examination were used to determine etiology. Results Rheumatic heart disease 32.6% (46/141) was the most common disease causing AR in our study.The mean age of the cohort was 43 years (29-57) with a male predominance of 63.1% (89/141). Preoperative evaluation with clinical and echocardiographic assessment was able to accurately identify the mechanisms of 95.7% (135/141) the patients.Five predominant categories of mechanisms were found. Conclusion In a SA cohort, we show that AR in our setting is a disease of young patients, the majority of which is caused by RHD. Other important causes in our setting included IE, HPT, aortitis and bicuspid valves. These findings evaluating the spectrum of causes of isolated AR in an urban African environment are in contrast to those in the global north where isolated AR is predominantly degenerative valve disease, BAV or of unknown etiology. With many of the patients referred in the north being older patients (55-70). Variable Total Aortic Root Aortic Bicuspid Aortic Degenerative Valve (N=141) Dilatation (N=38) Dissection (N=14) Valve (N=2) Disease (N=6) Demographics Sex Male 89 (63.1) 23 (60.5) 8 (57.1) 0 4 (66.7) Female 52 (36.9) 15 (39.5) 6 (42.9) 2 (100) 2 (33.3) Age (years) 43.1 (±14) 45.0 (±15) 44.9 (±13) 44.0 (±17) 43.1 (±19) Medical history Hypertension 61 (43.3) 20 (52.6) 8 (57.1)L 1 (50.0) 2 (33.3) Diabetes mellitus 2 (1.4) 0 0 0 1 (16.7) Dyslipidaemia 13 (9.2) 5 (13.2) 2 (14.3) 1 (50.0) 1 (16.7) Coronary Heart Disease 6 (4.3) 3 (7.9) 0 1 (50.0) 0 CKD 7 (5.0) 2 (5.3) 0 0 1 (16.7) COPD 8 (5.7) 4 (10.5) 0 0 1 (16.7) HIV positive 21 (16.9) 5 (15.6) 1 (8.3) 1 (50.0) 0 On HAART 13 (61.9) 3 (60.0) 1 (100) 1 (100) - CD4 count 344 (259-545) 173 (96-357) 490 (490) 239 (239) - Syphilis reactive 12 (8.5) 4 (10.5) 1 (7.1) 0 1 (16.7) Clinical presentation NYHA I 15 (10.8) 5 (13.9) 2 (14.3) 0 0 II 45 (32.4) 14 (38.9) 5 (35.7) 2 (100) 2 (33.3) III 65 (46.8) 15 (41.7) 7 (50.0) 0 1 (16.7) IV 14 (10.1) 2 (5.6) 0 0 3 (50.0) Heart failure 104 (73.8) 25 (65.8) 9 (64.3) 1 (50.0) 6 (100) Pulmonary Oedema 33 (23.4) 6 (15.8) 3 (21.4) 0 4 (66.7) Aortic valve morphology Bicuspid 11 (7.9) 2 (5.4) 1 (7.7) 1 (50.0) 1 (16.7) Tricuspid 128 (92.1) 35 (94.6) 12 (92.3) 1 (50.0) 5 (83.3) Presence of minimal/functional MR 97 (71.9) 29 (80.6) 6 (50.0) 1 (50.0) 5 (83.3) Presence of mild AS 12 (8.8) 4 (11.1) 1 (8.3) 0 1 (16.7) AoVPG <35 mmHg 91 (64.5) 23 (60.5) 4 (28.6) 2 (100) 4 (66.7) Grading of AR Mild 2 (1.4) 0 1 (7.1) 0 0 Moderate 18 (12.8) 8 (21.1) 1 (7.1) 1 (50.0) 2 (33.3) Severe 121 (85.8) 30 (79.0) 12 (85.7) 1 (50.0) 4 (66.7) Surgical Intervention Mechanical prosthesis 88 (68.2) 21 (58.3) 6 (46.2) 1 (50.0) 2 (40.0) Bioprosthesis 24 (18.6) 5 (13.9) 1 (7.7) 1 (50.0) 2 (40.0) David’s procedure 17 (13.2) 10 (27.8) 6 (46.2) 0 1 (20.0) Demographics,comorbidities, clinical presentation, echocardiographic findings and causes of AR
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