AORTIC INSUFFICIENCY AND REGURGITATION

AORTIC INSUFFICIENCY/AORTIC REGURGITATION(AR)

Aortic insufficiency is a heart valve disease in which the aortic valve weakens or balloons, preventing the valve from closing tightly. This leads to the backward flow of blood from the aorta (the largest blood vessel) into the left ventricle (the left lower chamber of the heart).

Causes of Aortic Regurgitation(AR)

• Bacterial or fungal infection of the valve may cause perforations (holes) in the cusps. Holes in valve leaflets most often cause acute valve regurgitation. Aortic dissection, caused by bleeding into the wall of the aorta, can expand the aortic valve and cause it to leak. 

•  A chest injury can also cause the aortic valve to leak. Chronic valve regurgitation is most often caused when the aorta near the valve slowly expands. The most common cause is high blood pressure. Other causes include Marfan syndrome, some rheumatoid diseases, rheumatic fever, and abnormalities of the valve that you were born with.
• Common causes include being born with a defective aortic valve, wear and tear from aging, infection of the lining of the heart(endocarditis), and rheumatic fever. Enlargement of the aorta, associated with high blood pressure and hardening of the arteries (atherosclerosis), can also cause aortic valve regurgitation. On rare occasions, radiation treatments to the chest can damage the aortic valve.
• Endocarditis is the most common cause of aortic valve regurgitation that develops suddenly. Mild endocarditis does not usually cause sudden (acute) aortic valve regurgitation but may result in longstanding aortic valve regurgitation. Other conditions that cause acute regurgitation include trauma to the heart valve or aorta and aortic dissection, the separation of the inner layer of the aorta from the middle layer.
• Rheumatic fever is a condition which sometimes follows an infection with a bacterium called the streptococcus. You body makes antibodies to the bacterium to clear the infection. But in some people the antibodies also 'attack' various parts of the body, in particular the heart valves. Inflammation of a valve may develop which can cause permanent damage and lead to thickening and scarring years later. This may prevent the valve from closing properly.
• If the root of the aorta becomes abnormally wide, the cusps of the valve cannot meet and the valve becomes leaky. The tissue at the base of the aorta can be affected by various conditions such as: Marfan's syndrome, ankylosing spondylitis, rheumatoid arthritis, Reiter's syndrome, relapsing polychondritis, syphilis.
• Rarer conditions that cause aortic valve regurgitation include a disorder of the body's connective tissues (Marfan's syndrome), a type of arthritis (ankylosing spondylitis), some autoimmune diseases, and syphilis.

Symptoms

• Bounding pulse
• Chest pain, angina type (rare)
  • Under the chest bone; pain may move to other areas of the body
  • Crushing, squeezing, pressure, tightness
  • Pain increases with exercise, and goes away with rest
• Fainting
• Fatigue, excessive tiredness
• Irregular, rapid, racing, pounding, or fluttering pulse
• Palpitations
• Shortness of breath with activity or when lying down
• Weakness, particularly with activity

Note: Aortic insufficiency commonly shows no symptoms for many years. Symptoms may then occur gradually or suddenly.

Signs and tests

The doctor may hear a heart murmur when listening to the chest with a stethoscope. Palpation (examination by hand) may reveal a very forceful beating of the heart.

Diastolic blood pressure may be low. There may be signs of fluid in the lungs.

Aortic insufficiency may be seen on:

• Aortic angiography
• Doppler ultrasound
• Echocardiogram - ultrasound examination of the heart
• Left heart catheterization
• Transesophageal echocardiogram (TEE)

An ECG or chest x-ray may show swelling of the left lower heart chamber.

Lab tests cannot diagnose aortic insufficiency, but they may be used to rule out other disorders or causes.

Treatment

If there are no symptoms or if symptoms are mild, you may only need to get an echocardiogram from time to time and be monitored by a doctor.

If the blood pressure is high, then treatment with certain blood pressure medications may help slow the worsening of aortic regurgitation.

ACE inhibitor drugs and diuretics (water pills) may be prescribed for more moderate or severe symptoms.

In the past, most patients with heart valve problems were given antibiotics before dental work or an invasive procedure, such as colonoscopy. The antibiotics were given to prevent an infection of the damaged heart. However, antibiotics are now used much less often before dental work and other procedures.

Moderate activity restriction may be recommended. People with severe symptoms should avoid strenuous activity.

Surgery to repair or replace the aortic valve corrects aortic insufficiency. The decision to have aortic valve replacement depends on your symptoms and the condition and function of the heart.

Surgery to repair the aorta may be required if the condition is caused by disorders of the aorta.

 

Complications

• Left-sided heart failure
• Pulmonary edema
• Endocarditis

Expectations (prognosis)

Aortic insufficiency is curable with surgical repair. This can completely relieve symptoms unless severe heart failure is present or other complications develop. Without treatment, patients with angina or congestive heart failure do poorly.

Prevention

Treat strep infections promptly to prevent rheumatic fever, which can lead to aortic insufficiency. Aortic insufficiency caused by other conditions often cannot be prevented but some of the complications can be.

Follow the doctors's treatment recommendations for conditions that may cause valve disease. Notify the doctor if you have a family history of congenital heart diseases.

Blood pressure control is particularly important if you are at risk for aortic regurgitation.

Please Note;

Call your doctor if:

• You have symptoms of aortic insufficiency
• You have aortic insufficiency and symptoms worsen or new symptoms develop, especially chest pain, difficulty breathing, or edema (swelling)