Aortic Regurgitation

Aortic Regurgitation Definition

Aortic Regurgitation (AR) is a type of heart valve disorder that occurs when the aortic valve of the heart fails to close tightly. This condition is characterized by impaired closing of the aortic valve. The aortic valve lets the blood flow from the ventricle of the heart into the aorta as well as the body. The valve closes between heartbeats in order to prevent the blood from flowing backwards into the heart. When a person is affected by aortic regurgitation, some blood leaks back or regurgitates through aortic valve into left ventricle every time the heart beats. This prevents the body from getting enough blood, which makes it weak and fatigued.

The condition is also known as aortic valve regurgitation or aortic insufficiency (AI). AR can be mild, acute or chronic. Treatment procedures can range from being medicinal to surgical.

Aortic Regurgitation Causes

AR can be caused by a number of causes. It can develop over several decades or all of a sudden. Any condition which damages one’s aortic valve can give rise to regurgitation. The various factors which lead to aortic regurgitation are discussed below:

Congenital heart defects

An individual may be born with a unicuspid aortic valve which is an aortic valve that has only one leaflet, or a bicuspid aortic valve having two leaflets instead of the normal occurrence of three leaflets.

Endocarditis

Endocarditis may damage the aortic valve.

Deterioration of valve

AI may be caused by age-related wearing and tearing of the valve.

Rheumatic fever

Rheumatic fever can cause complications of the strep throat during early childhood, which may cause aortic regurgitation at an older age.

AR may arise from problems in a prosthetic aortic valve.

Other factors that are responsible for the development of AR include:

• Trauma
• Syphilis
• Reiter syndrome
• Aortic dissection
• Marfan syndrome
• High blood pressure
• Ankylosing spondylitis
• Relapsing polychondritis
• Systemic lupus erythematosus

Aortic Regurgitation Signs and Symptoms

AR develops gradually over years. Due to this reason, an individual with this condition may not experience any symptoms for a long time. The symptoms of this condition resemble those of a heart failure and include:

• Orthopnea
• Dyspnea, on exertion
• Paroxysmal nocturnal dyspnea

Angina pectoris and palpitations can also be seen. In acute cases of aortic regurgitation, there may be symptoms of circulatory shock and cyanosis. The other signs of AR include the following:

• Dizziness
• Heart murmur
• A tendency to faint
• Shortness of breath
• Weakness or fatigue
• Chest pressure or pain
• Irregular or rapid pulse
• Swelling of the abdominal area
• Swollen feet and ankles or edema
• Enlargement of the ventricle walls
• Arrhythmia or fast, slow, and uneven heartbeat
• Crushing, squeezing or tightness around the heart area

Aortic Regurgitation Prevalence

The condition cannot be prevented on many occasions. However, here are some steps that one can follow to protect his or her aortic valve from a possible damage.

• Preventing rheumatic fever
• Taking proper care of the heart
• Managing dental and oral hygiene

Aortic Regurgitation Risk Factors

The risk of development of AR is greater in individuals who have been affected by any of the following problems:

• Aortic valve damage
• Malformed aortic valve
• Hypertension or high blood pressure
• Widened aortic root caused by conditions such as syphilis, ankylosing spondylitis and Marfan syndrome

Aortic Regurgitation Diagnosis

A patient may be suspected of having AR if a heart murmur can be detected through a stethoscope during a routine checkup. The distinct heart murmur or other abnormal heart sounds are generated by leaking of blood through aortic valve. In that case, a doctor may ask questions about the personal and familial health history of the patient. A physical examination of the heart would then be conducted to understand the current status of the organ. A doctor or general practitioner may then refer the patient to a cardiologist. The cardiologist may perform various tests to diagnose whether the patient has AR. These include:

• Echocardiogram
• Doppler Echocardiogram
• Transesophageal Echocardiogram
• Transthoracic Echocardiography
• Electrocardiogram (ECG)
• Chest X-ray
• Cardiac catheterization
• Exercise tests
• Aortic angiography
• Heart MRI

Aortic Regurgitation Treatment

Depending on the severity of the illness, AR can be treated medically or surgically. Surgical treatment of asymptomatic patients is controversial. However, surgical treatment can be carried out if:

• The ejection fraction drops to 50% or lower
• There is severe dilatation of the left ventricle
• The patient responds abnormally to exercise testing

In both types of patients, use of surgical procedure before worsening ejection fraction or left ventricle dilation reduces the potentiality of abrupt death, and is linked with lower chances of peri-operative mortality. Surgery is also performed instantly in acute cases.

Medical Treatment

Medical treatment of Chronic AR is carried out by vasodilators if the cases are stable and asymptomatic. Medications such as ACE inhibitors, angiotensin II receptor antagonists, hydralazine and nifedipine, when used in small proportions, have demonstrated short term benefits in improving ejection fraction, left ventricular wall stress and mass. Usage of vasodilators is indicated in individuals having hypertension apart from aortic insufficiency. Other conservative methods of treatment for stable, asymptomatic cases include:

• Diuretics
• Calcium blockers
• Digoxin
• Low sodium diet
• Abstention from very strenuous activity

Surgical Treatment

AR is surgically treated by an open heart procedure, known as aortic valve replacement. For this process, patients are placed on a cardiopulmonary bypass. In severely acute cases of aortic insufficiency, all patients should undergo surgical procedure if no signs of absolute contraindications of surgery are present. Individuals having bacteremia with aortic endocarditis have a high mortality risk. Hence, they should not wait for medical therapy to take effect. They should immediately be treated by a valve replacement surgery with aortic valve homograft (if it is feasible). The valve may also be preserved by a valve repair surgery.

Aortic Regurgitation Complications

Certain complications may form through the development of AR. These are as follows:

• Heart failure
• Endocarditis
• Abnormal heart rhythms
• Infections within the heart

Aortic Regurgitation Follow-up

Patients having trivial or mild to moderate AR should visit the doctor for regular checkups and undergo a cardiac stress test and an echocardiography test every 1 or 2 years. In moderate to severe cases, echocardiography and cardiac stress test should be accompanied by an isotope perfusion imaging test after every 3 to 6 months. Blood pressure of the patient needs to be monitored to keep it from getting high.

Aortic Regurgitation Prognosis

AR can be cured through surgical repair. This can completely relieve the signs and symptoms of the condition, unless severe cardiac failure or other complications take root. Patients having congestive heart failure or angina due to aortic valve regurgitation do poorly without treatment.

Aortic Regurgitation Pictures

Here are some pictures that show the various signs of the disorder.

Picture 1 – Aortic Regurgitation

Picture 2 – Aortic Regurgitation Image

Aortic regurgitation is a serious condition of the heart valve, which if left untreated, can lead to major complications such as endocarditis and heart failure. A timely diagnosis followed by appropriate medical intervention goes a long way in ensuring the survival and health of an AR patient.