Aortic Insufficiency vs. Aortic Regurgitation

[tobagotwo]

Betty (BVDR) and I have been having some fun with each other about the theoretical interchangeability of the terms AI and AR, lately.

Eventually, curiosity claimed me. I spent some time going through sites that refer to aortic insufficiency yesterday, looking to find a consensus in the resources.

One of the entanglements is that Aortic Insufficiency is frequently restated as Aortic Valve Insufficiency (the valve), versus Insufficiency of the Aorta (the blood vessel). That alone is enough to engender confusion, and is probably responsible for some of the cross-definitions.

That aside, what I found, once you remove the duplicate (i.e. word-for-word copied) definitions is that the descriptions fall into three general categories:

1) Referring to insufficiency as being fully synonymous with regurgitation

2) Referring to insufficiency as being the overall diagnosis for a host of individual problems, including AS, AR, MR, and even mitral prolapse.

3) Referring to insufficiency as a separate result of a cause or set of causes

The pattern seems to be that (1) and (2) appear with about equal frequency, and (3) less than the other two. It could be argued that (2) and (3) are quite similar, inthat the causations (e.g. AR, AS, MR) are not equated directly as actually being AI, unlike (1).

So, it's basically a standoff. The term is now used loosely throughout the echotechnology specialty, almost to the point of slang, and a strict definition is probably no longer defensible. Casual usage is the bane of accuracy.

Still, my preference would remain to keep to as strict a definition as is reasonable. It seems a shame to blur the meaning of a perfectly good word for convenience's sake. In every practical sense, medically and mechanically, AI is a result, and AR a causation for it. Even the individual meanings of the words as nonmedical terms promote the logic that insufficiency is a lack of something (blood), and regurgitation is the process of something returning from where it's supposed to be back to where it came from with an unfortunate result. Those just aren't synonymous meanings. The first is a state of being, the second is an action.

One disparate thought (I am positive that someone will correct me if I'm wrong on this): in British parlance, insufficiency is frequently used as a synonym for incompetency or failure, terms preferred in the US. Inthat the valve leaks, it is incompetent, and could thus be termed insufficient - at least, if you're British or Australian...

As such, Betty, I'll honor the use of AI and AS synonymously, and I won't try to "correct" it anymore, as even the current medical sources are split on the subject.

But I still intend to use it the right way...

 

[Mary]

I knew you couldn't leave it alone.

 

[tommy]

I used to challenge my cardio becuse the diagnosis on my receipt always had the "AI" box checked. I was always told that it was th closest "box" and not to worry about it. So much for medical "science".

 

[bvdr]

OK, Bob.

You can expect my PMs to you to become less frequent now. You can use whatever terminology that you like: I'll know what you mean.

I remember back in college when there were "true" and "false" exams. I always preferred the ones you could mark false and then had to qualify your answer or change the statement to make it true. So often I just couldn't casually check something and go on because I so often could think of an exception. I think I've softened a little with age but I still love intellectual volleys.

 

[strawberry]

I had the same confusion with "myxomatous mitral valve" vs mvp. Some websites call them synonyms but they're not. Myxo valves is a deteriorating valve that can cause mvp but mvp generally is not caused by myxo. In fact my valve is myxomatous with no frank mvp but it's buckling and stretching. I just say MVP to the dentist cause it's less confusing. Or I throw in the AI. Or is it AR. No, I think it's AI. Doesn't AI play for the Seventy-Sixers?

 

[tobagotwo]

I agree with you strawberry. Again, it seems like cause and effect are being made synonymous for convenience.

As expressed in this study by Kohn, et al: http://jtcs.ctsnetjournals.org/cgi/content/full/107/1/143

Myxomatous degeneration of the mitral valve producing the so-called floppy mitral valve is the most common abnormality of human heart valves and is a major cause of mitral regurgitation in North America. 1-3 The leaflets and chordae tendineae stretch as a result of deposition of myxomatous material in the valve leaflets and chordae resulting in mitral valve prolapse, especially of the posterior leaflet. 4 Mitral valve prolapse is very common in women 20 to 30 years old, but increases in men with age, often requiring operation for severe mitral regurgitation. 1-3 This report summarizes experience at the Brigham and Women's Hospital, from 1981 to 1993, on mitral valve reparative procedures in patients with isolated mitral regurgitation from myxomatous degeneration.

The MVP is a result that can be caused by myxomatous tissue infiltration, and it seems like it should not be synonymous with it. Note that MVP is not exclusively associated with myxomatous tissue.

Interestingly, though women have MVP more often, and present with it earlier in their lives, their bodies seem to come to terms with it. It is most often men who are diagnosed with it later in life who require surgery.

Best wishes,

 

[bvdr]

Strawberry, it does get confusing doesn't it. I have rheumatic heart disease and my mitral valve was stenotic and had moderate regurgitation. In addition to that the pathology report listed the tissue as being myxomatous degenerative. So I guess it is possible that even without the rheumatic fever I may have ended up with valve problems.

I think you are right just referring to your valve as MVP to your dentists though. It will get you your needed antibiotics and that is what you are after anyway

 

[strawberry]

Betty,

Yeah, although when I referred to it as mvp, he goes well did he do an echo and use the new criteria? I said yes, and threw in the AI to boot. It's ironic cause for years I had to argue with dentists that I didn't need an antibiotic due to my repaired pda. Sheeesh.