Aortic Valve Regurgitation Or Incompetence
Aortic valve regurgitation occurs during left ventricular relaxation when the diseased valve cannot hold blood from leaking back to the left ventricle.
In normal hearts, during left ventricular relaxation blood flows back from the left atrium to the left ventricle via the mitral valve. But with aortic incompetence, blood leaks through the aortic valve resulting in an increase in the blood volume and pressure in the left ventricle. To adapt itself to this higher volume of blood, the left ventricle gradually enlarges and its wall becomes thickened (hypertrophied). Sometimes the heart fails to adapt completely to the new situation, resulting in failure of the heart pump and lung congestion (fluid accumulation).
Causes of Aortic Valve regurgitation
In developing countries where antibiotics are not properly used, still rheumatic fever and syphilis are the most common causes. Both diseases are now rare in USA and Europe.
In developed countries, causes are different namely aortic dissection, degeneration of the aortic valve due to a defect in the binding (connective) tissues as well as aortic aneurysm and infection of the valve tissue with bacteria.
Birth defect is another cause of aortic valve regurgitation, where the valve is formed of 3 leaflets (cusps) instead of 2. This occurs in around 1% of newborns.
Symptoms and methods of Diagnosis
In early cases where the disease is still mild, the symptoms are usually absent. As the disease progress in severity and heart failure develops, the patient will start to experience easy fatigue and shortness of breath with exertion as well as when lying flat in bed. Chest pain is another symptom which occur in 4 % of patients and can be explained by the fact that thickened (hypertrophied) muscle needs more blood.
During examination , your doctor will notice a special pulse characteristic of Aortic valve regurgitation . This pulse is known by physicians as water hammer pulse. When listening to your heart with a stethoscope, a characteristic heart murmur is heard. When suspecting aortic regurgitation, your doctor will order further tests such as ECG and more importantly an echocardiogram. Echocardiogram will show the diseased valve, the heart function as well as other valves of the heart. if you are a male in the 40′s or a female in the 50′s , coronary angiography will be ordered if surgery is decided to be the solution to your problem.
Treatment Of Aortic valve Regurgitation
If you are diagnosed with the disease, you will receive antibiotic before some dental and surgical procedures, to avoid infection of the damaged valve leaflets.
In mild aortic regurgitation, treatment will be focused in preventing and treating heart failure symptoms using diuretics , ACE inhibitors and digoxin. Follow up with echocardiography is essential to monitor the severity of the regurgitation and the heart size and function.
In severe cases, surgery will be the only option and is carried out to replace the damaged valve with either a tissue or mechanical valve. Mechanical valves will require life long therapy with an oral anticoagulant (blood thinner)
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Yasser Elnahas
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