Overview
Aortic valve regurgitation, also known as aortic regurgitation, is a condition in which the aortic valve of the heart does not seal tightly. As a result, a portion of the blood pushed from the heart’s primary pumping chamber (left ventricle) escapes backward.
The leaking may hinder the heart’s ability to adequately pump blood to the rest of the body. Consequently, you may experience weariness and shortness of breath.
Regurgitation of the aortic valve can develop suddenly or over decades. When aortic valve regurgitation reaches a high level, surgery is frequently necessary to repair or replace the aortic valve.
Symptoms
Aortic regurgitation can persist for an extended period of time without noticeable symptoms. They may manifest quickly or develop gradually. Among the symptoms are:
- Chest discomfort that worsens with exercise
- Fatigue
- Problems breathing
- Inflammation of the ankles
- Rapid pulse rate
Pathophysiology
Incompetent closure of the aortic valve can be caused by intrinsic leaflet or cusp disease, aortic disease, or trauma. Diastolic reflux through the aortic valve can cause volume overflow in the left ventricle. A combination of an increase in systolic stroke volume and a decrease in diastolic aortic pressure results in an increase in pulse pressure. The clinical symptoms of Aortic Regurgitation are induced by the forward and reverse flow of blood across the aortic valve, which results in an elevated stroke volume.
AR severity is dependent on the area of the diastolic regurgitant valve, the diastolic pressure gradient between the aorta and left ventricle, and the duration of diastole.
Depending on whether AR is acute or chronic, its pathogenesis differs. In acute AR, the LV is unable to dilate in response to volume load, whereas in chronic AR, the LV may undergo a sequence of adaptive (and maladaptive) alterations.
Acute aortic regurgitation
Significantly severe acute AR increases the blood volume in the LV during diastole. The LV does not have enough time to dilate in reaction to the abrupt volume rise. Consequently, LV end-diastolic pressure rises rapidly, creating an increase in pulmonary venous pressure and modifying the dynamics of coronary blood flow. As pulmonary circuit pressure increases, the patient gets dyspnea and pulmonary edema. In extreme circumstances, heart failure may develop and perhaps progress to cardiogenic shock. Myocardial ischemia can result from decreased myocardial perfusion.
Consider surgical intervention as soon as possible (particularly if AR is due to aortic dissection, in which case surgery should be performed immediately).
Chronic aortic regurgitation
Chronic AR induces a cumulative volume overload of the left ventricle, which results in a series of compensatory alterations, including LV enlargement and eccentric hypertrophy. The addition of sarcomeres in series (leading in longer myocardial fibers) and the reorganization of myocardial fibers contribute to LV dilatation. In turn, the LV grows larger and more flexible, with a greater capacity to provide a large stroke volume that can compensate for the volume of regurgitation. LV dilatation necessitates the resultant hypertrophy to handle the increased wall strain and stress (Laplace law).
During the early stages of chronic AR, the left ventricular (LV) ejection fraction (EF) is normal or even elevated (due to the increased preload and the Frank-Starling mechanism). Patients may have no symptoms throughout this time. As AR advances, LV expansion exceeds the preload reserve on the Frank-Starling curve, causing the EF to decrease to normal and ultimately subnormal levels. The increase in LV end-systolic volume is indicative of increasing myocardial dysfunction.
Eventually, the LV reaches its maximum diameter and diastolic pressure begins to rise, resulting in symptoms (dyspnea) that may be exacerbated by activity. In addition to inducing subendocardial and myocardial ischemia, necrosis, and apoptosis, a rise in LV end-diastolic pressure may also reduce coronary perfusion gradients. The LV transitions progressively from an ellipse to a spherical structure.
Causes
This issue can be caused by any ailment that inhibits the aortic valve from shutting entirely. When the valve does not seal completely, some blood returns with each heartbeat.
When a substantial amount of blood returns to the body, the heart must work harder to pump out sufficient blood to meet the body’s needs. The left lower chamber of the heart dilates and the heart beats with great force (bounding pulse). Over time, the heart’s ability to deliver sufficient blood to the body declines.
Rheumatic fever was the leading cause of aortic regurgitation in the past. The use of antibiotics to treat strep infections has decreased the incidence of rheumatic fever. Therefore, aortic regurgitation is typically caused by other factors. These consist of:
- Ankylosing spondylitis
- Dissections of the aorta
- Congenital (existing at birth) valve defects, including bicuspid valve
- Endocarditis (infection of the heart valves)
- Elevated blood pressure
- Marfan syndrome
- Reiter syndrome (also known as reactive arthritis)
- Syphilis
- Systemic lupus erythematosus
- Injuries to the chest
- Aortic insufficiency is most prevalent among men aged 30 to 60.
Risk factors
These factors increase your likelihood of developing aortic valve regurgitation:
- Older age
- Certain congenital cardiac diseases (congenital heart disease)
- An illness history that can harm the heart
- Certain heart-affecting diseases, such as Marfan syndrome
- Other disorders affecting the heart valves, such as aortic valve stenosis
- Elevated blood pressure
Complications
- Heart failure is the most serious potential complication of aortic valve regurgitation. Heart failure occurs when the heart muscle weakens and is unable to pump blood effectively throughout the body.
- Heart failure can afterwards cause difficulties in other organs.
- Aortic regurgitation can also increase the risk of endocarditis, an infection of the heart’s inner lining.
Diagnosis
Your doctor may be able to diagnose aortic regurgitation by listening to your heart using a stethoscope, even in the absence of symptoms.
If your doctor detects a whooshing sound between heartbeats, you may have valve issues. The whooshing sound indicates that blood is flowing abnormally through the valve.
If your doctor suspects that you have aortic regurgitation, he or she may order one or more of the following tests:
- Echocardiogram: By directing sound waves at your heart, a movie of its beating is created. This imaging technique can detect aortic regurgitation and assess its severity in impeding healthy blood flow.
- Chest X-ray: This typically reveals whether or not the heart is enlarged, possibly due to aortic regurgitation. A chest X-ray can also reveal if your lungs have been harmed by blood pooling in the heart.
- During a cardiac catheterization, your physician inserts a catheter through an artery and into your heart. Your physician may use a special dye and an X-ray “movie” to examine the valves and chambers of your heart in greater detail.
Treatment
- Mild regurgitation may not necessitate medical treatment. It may suffice to simply monitor it routinely during your regular examinations.
- If you have high blood pressure, you may take medicine and alter your lifestyle in order to control it.
- Aortic valve replacement may be the best option in more severe instances.
- Transcatheter aortic valve replacement is a relatively modern alternative to conventional open surgery for aortic valve replacement (TAVR).
- TAVR does not involve the chest being opened. Instead, your physician uses a catheter to reach the aortic valve via an artery.
- Your doctor replaces the faulty valve with a replacement valve. Once the new valve is in place, the doctor removes the catheter, and your heart resumes normal function.
Prevention
Regularly visit your doctor if you have a cardiac condition so he or she can monitor you. If you have a parent, sibling, or sibling with bicuspid aortic valve, you should undergo an echocardiography to evaluate for aortic valve regurgitation. It may be easier to treat aortic valve regurgitation or another heart problem if it is detected before it occurs or in its early stages.
Also, prevent circumstances that can increase your risk of aortic valve regurgitation by taking the following measures:
- Rheumatic disease. See a doctor if you have a severe sore throat. Strep throat can develop to rheumatic fever if left untreated. Antibiotics can quickly treat strep throat.
- Elevated blood pressure Regularly check your blood pressure. Ensure that it is effectively managed to prevent aortic regurgitation.
