HVD-Aortic Regurgitation

The aortic valve allows blood to flow from the heart’s left ventricle up into the aorta and on to the rest of the body. Aortic regurgitation (also called aortic insufficiency or aortic incompetence) occurs when the valve does not close properly. If the valve does not close all the way because it is weakened or widened, blood leaks backward, and the left ventricle overfills with each heartbeat. Aortic valve regurgitation is graded from mild to severe based on the amount of backflow. In time, the left ventricle is forced to pump more blood than normal, and it gradually enlarges. Untreated valve disease can lead to congestive heart failure, cardiomyopathy, arrhythmia, or blood clots.

What Causes Aortic Valve Regurgitation?

Aortic valve regurgitation can be caused by a congenital valve deformity (e.g., having only two leaflets instead of three), an infection (e.g., rheumatic fever or infective endocarditis), aortic root disease (e.g., Marfan syndrome), or another disease process taking place in the body, such as severe high blood pressure. It is most common in men aged 30 to 60.

Symptoms

Symptoms depend on the patient and the type and severity of the regurgitation. Some patients experience no symptoms. In other cases, valve disease may take its toll over many years. Symptoms may not develop until the left ventricle has been affected, and they include:

• fatigue (especially during physical activity)
• shortness of breath
• fluid retention or edema (e.g., in the ankles)
• abnormal arrhythmias (including a fast or fluttering pulse)
• angina pectoris or chest pain that worsens during exercise

These symptoms are likely to occur or worsen during exercise or physical exertion.

Diagnosis

Heart valve disease is diagnosed by listening to the heart with a stethoscope; diseased heart valves make distinct clicking sounds or murmurs. Other diagnostic tests that are used to determine the underlying cause, complexity, and severity of heart valve disease include a chest x-ray, blood tests, an echocardiogramelectrocardiography (ECG) or Holter monitoring, exercise stress testing, electrophysiology (EP) studies, cardiac catheterization, and diagnostic imaging scans, such as computed tomography (CT), magnetic resonance imaging (MRI), or positron emission tomography (PET). A careful and complete diagnostic workup will help determine the timing and composition of the treatment plan.

Treatment

Treatment for aortic valve regurgitation depends on its type and severity. Asymptomatic patients may not need treatment. In some cases, careful monitoring is all that is needed.

Medicine cannot cure the valve, but some types of medicine (digitalis, diuretics, anticoagulants, beta blockers, calcium channel blockers, and ACE inhibitors) may ease the pain or symptoms, reduce the workload on the left ventricle, or regulate an associated arrhythmia.

If symptoms worsen, become difficult to manage, or if medicine no longer relieves symptoms, an intervention or open heart surgery may be needed. The aortic valve can be repaired or replaced. Repair may involve reinforcing the valve or reconstructing its anatomy to restore normal function. Replacement is used to treat an aortic valve that cannot be repaired. It involves removing the defective heart valve and replacing it with a prosthetic valve. Prosthetic valves can be mechanical (made from materials such as plastic, carbon, or metal) or biological (made from human or animal tissue). Mechanical valves carry the risk of developing a blood clot on the new valve, so patients with mechanical heart valves must take blood-thinning medicine for the rest of their lives to prevent this complication.

Preventative Antibiotics and Heart Valve Disease

Patients with heart valve disease who have an abnormal heart or who’ve had heart surgery risk developing endocarditis. The American Heart Association no longer recommends taking routine antibiotics before certain dental or surgical procedures except for people at the highest risk for bad outcomes if they do develop endocarditis.


Resources

Texas Heart Institute www.texasheartinstitute.com/HIC/Topics/Cond/valvedis.cfm
Texas Heart Institute www.texasheartinstitute.com/HIC/Topics/Cond/vaortic.cfm
Mayo Clinic www.mayoclinic.org/heart-valve-disease/index.html
American Heart Association www.americanheart.org/presenter.jhtml?identifier=4448