Aortic valve regurgitation
Aortic valve regurgitation: A Comprehensive guide
Aortic valve regurgitation, sometimes called aortic insufficiency, is a condition in which the aortic valve does not close properly. The aortic valve normally ensures that blood flows in one direction—from the left ventricle into the aorta—and prevents backward leakage. When the valve becomes leaky, some blood flows back into the left ventricle with each heartbeat.
Over time, this backflow increases the workload of the heart, potentially leading to enlargement of the left ventricle, reduced pumping efficiency, and ultimately heart failure if left untreated.
Aortic regurgitation can develop suddenly (acute) due to infections, trauma, or aortic dissection, or gradually (chronic) due to valve degeneration, congenital abnormalities, or conditions such as rheumatic heart disease and high blood pressure.
Aortic valve regurgitation may remain asymptomatic for many years in mild cases. Symptoms usually develop as the condition progresses, when the heart can no longer compensate for the extra workload.
Common symptoms of aortic regurgitation include:
Shortness of breath (dyspnoea), especially during exertion or when lying flat.
Fatigue and weakness due to reduced blood flow to muscles and organs.
Palpitations—a noticeable awareness of the heartbeat, often irregular or forceful.
Swelling of ankles and feet (oedema) in advanced stages.
Chest pain or pressure (angina), particularly during exercise.
Lightheadedness or fainting (syncope) in severe cases.
Rapid, pounding heartbeat in the chest or neck due to increased stroke volume.
In acute aortic regurgitation, symptoms are usually sudden and severe, including:
Severe shortness of breath
Low blood pressure
Pulmonary oedema (fluid in lungs)
Shock (life-threatening emergency)
You should seek medical advice if you experience:
Unexplained shortness of breath, particularly if worsening.
Swelling in legs or feet not linked to other causes.
Palpitations or chest discomfort.
Dizziness, fainting, or reduced exercise tolerance.
Call emergency services immediately if you have:
Severe chest pain
Sudden onset breathlessness
Fainting episodes
Symptoms of heart failure (extreme fatigue, swelling, rapid weight gain, frothy sputum)
Even in the absence of symptoms, regular check-ups are important if you have:
A known heart murmur
Previous rheumatic fever
Congenital bicuspid aortic valve
Connective tissue disorders (e.g., Marfan syndrome)
Uncontrolled high blood pressure
A cardiologist will use a combination of history, physical examination, and imaging studies to diagnose aortic valve regurgitation.
1. Medical History & Examination:
Listening for a diastolic heart murmur with a stethoscope.
Checking for widened pulse pressure (large difference between systolic and diastolic BP).
Looking for signs of heart enlargement.
2. Echocardiogram (Echo):
Transthoracic echocardiogram (TTE): First-line test to assess severity and heart function.
Transoesophageal echocardiogram (TEE): Provides clearer images if needed.
3. Cardiac MRI / CT
Used when echo findings are unclear or to assess aortic size.
4. Cardiac Catheterisation
Sometimes required before surgery to evaluate coronary arteries.
The choice of treatment depends on severity, symptoms, and underlying cause.
1. Medical Management:
Blood pressure control with ACE inhibitors, ARBs, or calcium channel blockers.
Diuretics for fluid retention.
Beta-blockers in some cases, particularly Marfan syndrome.
Monitoring: Regular echocardiograms to track disease progression.
Medical therapy does not cure the condition but slows progression and eases symptoms.
2. Surgical Options:
Aortic Valve Repair (less common but preferred in suitable patients).
Aortic Valve Replacement (AVR):
Mechanical valves: durable but require lifelong anticoagulation (warfarin).
Biological (tissue) valves: less durable but no lifelong anticoagulation needed.
Transcatheter Aortic Valve Implantation (TAVI):
Primarily used for aortic stenosis but in select centres may be considered for regurgitation in high-risk surgical patients.
3. Management of Acute Aortic Regurgitation:
This is a medical emergency.
Requires urgent surgery.
Intravenous vasodilators and inotropes may be used temporarily to stabilise patients.
People with mild to moderate aortic regurgitation can often lead normal lives for years with careful monitoring.
Lifestyle recommendations include:
Lifestyle recommendations include:
Regular follow-up with echocardiograms.
Blood pressure control—maintain target BP.
Healthy diet: low salt, balanced nutrition.
Exercise: moderate, avoid extreme exertion unless cleared by a doctor.
Avoid smoking and excess alcohol.
Infective endocarditis prevention: good oral hygiene, prompt treatment of infections, sometimes antibiotic prophylaxis before certain procedures.
Pregnancy planning: Women with severe aortic regurgitation should discuss risks with a cardiologist before conceiving.
Mild regurgitation: Often stable for many years, may never require surgery.
Moderate to severe regurgitation: Risk of heart enlargement and heart failure increases.
With timely surgery: Excellent long-term survival, especially if performed before significant heart damage occurs.
Without treatment in severe cases: Risk of heart failure, arrhythmias, and sudden cardiac death increases.
Aortic valve regurgitation is sometimes called aortic insufficiency.
It can be acute (sudden, life-threatening) or chronic (gradual, often silent).
Many patients are asymptomatic for years before progression.
Echocardiogram is the gold standard test.
High blood pressure is a major risk factor.
Surgery is the only definitive treatment for severe regurgitation.
Mechanical valves last longer but require lifelong anticoagulation.
Biological valves avoid anticoagulation but may wear out faster.
Women with the condition should have pregnancy risk counselling.
Prognosis is excellent with timely diagnosis and treatment.
What is the severity of my aortic valve regurgitation?
Do I need surgery now, or can it be safely monitored?
How often should I have an echocardiogram?
What symptoms should I watch for that indicate progression?
What are the risks and benefits of mechanical vs biological valve replacement?
Am I a candidate for valve repair instead of replacement?
How will treatment affect my lifestyle and physical activity?
What medications do I need, and for how long?
Are there any precautions I should take regarding dental or surgical procedures?
What is my long-term outlook with and without surgery?
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