Aortic valve regurgitation
The aortic valve, which is located on the left side of the heart, is one of four valves that open to keep blood flowing forward and prevent it from flowing backward. When the valve’s leaflets don’t close properly, some of that blood is regurgitated and leaks back from the aorta into the left ventricle. This condition is called aortic valve regurgitation, aortic regurgitation (AR) or aortic insufficiency (AI).
Definition & Facts
During a normal cardiac cycle, whenever the left ventricle begins to contract, the squeezing action forces the aortic valve to open. After the aortic valve opens, blood flows forward out of the left ventricle into the aorta. The aorta and its associated arteries then send the blood forward to the rest of the body. At the end of its contraction, the ventricle relaxes, which causes the aortic valve to close. This sequence is repeated continuously, and blood flows without restrictions.
AR occurs when disease, dysfunction or distortion prevents the aortic valve from snapping shut when the left ventricle relaxes. When the valve does not completely close, some blood is leaked back into the left ventricle. As a result, the left side of the heart cannot function properly. This causes the aorta to be insufficiently supplied with blood, which is referred to as aortic insufficiency (AI).
AR may be acute. This happens when the condition develops quickly, is severe and lasts a short time. It can also be chronic, which means it develops progressively, is debilitating and lasts a long time. AR occurs in all age groups; but it is unusual to see AR in people younger than the age of 50.
Symptoms & Complaints
- Difficulty breathing
- Chest pain when exerting oneself
- Fainting, fatigue, or tiredness
- swelling of legs and feet
- Severe heart failure symptoms such as difficulty breathing when lying flat, nighttime breathing difficulties, nighttime chest pain, abdominal discomfort, pounding heart, irregular heartbeat and an uncomfortable awareness of the heart beating. All of these heart failure symptoms are more obvious when the individual is lying on their left side.
AR is primarily caused by disease of the aortic valve leaflets or an enlargement of the aortic root. This is the part of the aorta that is attached to the fibrous rings that hold and support the valve leaflets and the cardiac muscle.
Any damage to the aortic valve can potentially cause aortic valve regurgitation. AR can be brought about by calcium deposits in the aortic valve, congenital heart disease, rheumatic heart disease, rheumatoid arthritis, hypertension, lupus, drug-induced cardiovascular diseases, and a separation of the aorta.
Infections of the heart that may be associated with aortic valve regurgitation include endocarditis. This condition itself may be caused by bacterial infection, viral infection, or fungal infection. Blunt force trauma from automobile accidents and other events may also cause injury to the valves, leading to aortic valve regurgitation. Examples of congenital heart defects include a bicuspid aortic valve, in which a person is born with two rather than three leaflets.
Diagnosis & Tests
There are a few tests that physicians may perform to help them diagnose and evaluate AR. Some of the tests include:
- Echocardiogram: This test uses sound waves (echoes), which create a picture of the beating heart. The physician is then able to see the size of the four chambers and how well the heart and valves are functioning.
- Electrocardiogram: This test is also known as an ECG or EKG. This test helps the physician to see and measure the electrical activity within the heart.
- Cardiac catheterization: This test allows the physician to insert a thin tube into a blood vessel and thread it up to the heart. Through this and with the use of a dye and X-rays, the physician is able to see where the aortic valve is leaking and if there is any blockage.
- Chest X-ray: This test lets the physician see the size and shape of the heart and aorta.
- Magnetic resonance imaging: Allows the physician to see the size and shape of the heart and aorta in greater detail than a chest X-ray.
- Exercise stress test: Helps the physician determine the level of tolerance or exertion that causes breathing difficulties or chest discomfort.
- Pulse oximetry: Sensors are placed on an adult’s fingers and the hand of infants and children to measure the blood oxygen levels
Treatment & Therapy
The treatments for AR are case-by-case and based on the specific symptoms and diagnostic test results for an individual. They may include:
- Monitoring with advisement to adopt a healthy lifestyle. A diet low in fat and low in cholesterol may be advised.
- Medications for hypertension such as diuretics, ACE inhibitors, and beta blockers
- Surgeries such as aortic valve repairs or replacement. Replacement valves may come from pigs or cows or from another tissue in the patient's body. They may also be mechanical. In addition to open-heart surgery, surgery may also be performed via laparoscopy which is less invasive though more complicated.
Prevention & Prophylaxis
Regular visits to a physician for any heart condition could treat AR before it develops or while it is in its early stages. Other prevention measures include getting infections treated and keeping hypertension under control via healthy diet and regular exercise. Exercise can include activities like strength training and aerobic training.