Aortic Regurgitation: Causes and Treatments

What is Aortic Regurgitation?

Aortic valve regurgitation is a medical condition where the aortic valve doesn't close properly. This causes blood pumped from the heart's main pumping chamber (left ventricle) to leak back. This inefficient blood flow leads to fatigue and shortness of breath. Aortic valve regurgitation can develop suddenly or gradually over decades. Significant regurgitation requires surgery to repair or replace the aortic valve.

Causes and Diagnosis of Aortic Regurgitation

Causes of Aortic Regurgitation

The following conditions can damage the aortic valve and cause regurgitation:

• Congenital disease: Some are born with a bicuspid aortic valve (two leaflets instead of the normal three), or with fused leaflets;
• Endocarditis: An infection of the heart valves can damage the aortic valve;
• Rheumatic disease: A complication of streptococcal throat infection in childhood can damage the valve later;
• Trauma: Damage to the aortic valve from sternal trauma;
• Other rare diseases, such as Marfan syndrome;
• Aortic root dilation;

Symptoms and Diagnosis of Aortic Regurgitation

Aortic valve regurgitation often develops gradually, with the heart initially compensating. Symptoms may not appear for years. As it worsens, symptoms include:

• Heart murmur;
• Fatigue and weakness, especially with exertion;
• Shortness of breath after exercise or when lying down;
• Ankle swelling;
• Chest pain (angina) worsening with exertion;
• Irregular heartbeat (arrhythmia);
• Palpitations;

Diagnostic tests include:

• Electrocardiogram (ECG): Records the heart's electrical activity, detecting left ventricular hypertrophy and overload;
• Chest X-ray: Shows an enlarged heart shadow, often with ascending aortic dilation. Heart failure shows pulmonary congestion;
• Stress test: ECG recording during exercise (treadmill or cycling) to assess symptoms and hemodynamic response;
• Color Doppler Echocardiography: Identifies and assesses the severity of aortic valve regurgitation;
• Coronary angiography: Assesses coronary artery and overall heart condition;
• Magnetic Resonance Imaging (MRI): (Optional) Provides detailed images of the heart, including the aortic root;

Surgical Treatment of Aortic Regurgitation

When to Consider Aortic Valve Surgery?

Aortic valve surgery may be needed even without symptoms. Untreated, the heart's compensation can fail, leading to permanent weakening. Surgery should be performed in a high-volume center with experienced surgeons. Discuss risks and benefits with your doctor.

Aortic Valve Repair

Sometimes, the surgeon can repair the native valve, improving function without a prosthesis.

Aortic Valve Replacement

Often, the aortic valve needs replacing with a mechanical or biological prosthesis. Mechanical valves are durable but increase blood clot risk, requiring lifelong anticoagulants. Biological valves are often preferred for older patients (over 65/70), those with bleeding risks, or difficulty taking anticoagulants. They may be used in pregnancy to avoid fetal exposure to anticoagulants. Individual factors will be discussed pre-operatively.

EXPRESS QUOTE

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Minimally Invasive Aortic Valve Surgery

Aortic valve replacement usually requires open-heart surgery, general anesthesia, and a heart-lung machine. Minimally invasive techniques (mini-sternotomy) reduce pain, hospital stay, and complications. However, limited visibility makes it more complex than traditional surgery.

How to Prevent Aortic Regurgitation?

Prevention is often impossible, but these steps can help reduce risk:

• Proper sore throat treatment to reduce rheumatic disease risk;
• Good oral hygiene to reduce endocarditis risk;
• Active blood pressure monitoring;

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