Chronic regurgitation leads to left ventricular dilatation with an increase in end-systolic, end-diastolic, and stroke volumes. Haemodynamics are explained in more detail below:
- Regurgitant jet in diastole - there is dilatation and hypertrophy of the left ventricle as a result of the filling with regurgitant blood in addition to that received from the left atrium. The ventricular dilatation and hypertrophy are both more marked than that seen in chronic mitral regurgitation. In some cases these ventricular changes may be extreme (cor bovinum), although the thickness of the ventricular wall remains normal.
- Increased stroke volume in systole - this is because only a proportion is effective forward flow to the periphery. The remainder returns to the ventricle during systole.
- The duration of systole is normal with the increased stroke volume ejected more rapidly. this causes a fast rate of rise of arterial pressure and often an ejection murmur.