What is aortic regurgitation? An overview
Aortic regurgitation consists of a reflux of blood through the aortic valve that occurs as a result of left ventricular relaxation
Aortic regurgitation is caused by deterioration of the aortic valve and the surrounding aortic root; the aorta is the blood vessel that carries blood from the heart to the rest of the body.
The deterioration occurs in patients with a bicuspid aortic valve, but could be caused by a bacterial infection of the valve or rheumatic fever.
Aortic regurgitation is usually asymptomatic unless heart failure develops
The diagnosis will be made on a clinical basis, which will be confirmed by an electrocardiogram, which is necessary to assess its severity.
The damaged heart valve must be monitored periodically so that it can be replaced or surgically repaired once the leakage is significant and the heart shows signs of failure.
The aortic valve is the opening between the left ventricle and the ascending aorta; the aortic valve opens when the left ventricle contracts to pump blood into the aorta.
If the aortic valve does not close completely, there will be a regurgitation of blood from the aorta into the left ventricle when the latter relaxes to fill with blood from the left atrium.
The reflux of blood, called regurgitation, will increase the volume and pressure in the left ventricle; consequently, the workload of the heart muscle will increase.
Compensation will occur due to the muscle walls of the ventricles thickening, and there will be hypertrophy of the muscle; the volume of the ventricular chambers will increase as they dilate.
The heart, despite the compensation, will not be able to meet the body’s demand for blood, and as a result, heart failure will occur with accumulation of fluid in the lungs.
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Causes of aortic regurgitation
Aortic valve regurgitation will be acute if it occurs suddenly, chronic if it occurs gradually.
The most common causes of acute aortic regurgitation include: bacterial infection of the valve and thus infective endocarditis and aortic dissection.
The most common causes of chronic aortic regurgitation will include: spontaneous valve or ascending aorta injury, especially in the presence of a congenital defect in which the aortic valve is bicuspid, and rheumatic fever.
1% of newborns have a bicuspid aortic valve, but this will not cause discomfort until adulthood.
Symptoms of aortic regurgitation
In mild aortic regurgitation, there will be no symptoms other than a heart murmur, which can be auscultated with the stethoscope when the left ventricle relaxes.
If you have severe aortic regurgitation, you will have symptoms if heart failure develops.
The heart failure will cause dyspnoea should they exert themselves; there will be shortness of breath, sleep apnoea.
It may also occur that aortic regurgitation causes angina pectoris, a consequence of insufficient blood supply to the heart.
The pulse may be momentarily vigorous and then disappear, as blood is regurgitated through the aortic valve, causing a sudden reduction in blood pressure.
Diagnosis of aortic regurgitation
The diagnosis will be based on the objective test, examples of which are heart murmurs and pulse collapse; this will be confirmed by an echocardiogram.
The latter will show the severity of the regurgitation and the probable involvement of the myocardium.
If the echocardiogram does not detect aortic dilatation, computed tomography or magnetic resonance imaging may be useful to detect aortic dissections.
Chest X-ray and electrocardiogram will show signs of cardiac dilatation
Before proceeding with surgery, coronary angiography should be performed, as 20% of subjects with aortic regurgitation usually also have coronary artery disease.
First-degree relatives of individuals with a bicuspid valve will need to be screened, as about 30% have it.
Pharmacological treatment will not be effective in slowing the progression of heart failure and will therefore not reduce the likelihood of needing valve repair or replacement.
An echocardiogram should be performed periodically to determine the time of dilatation of the left ventricle and to decide on the type of intervention.
The damaged valve will have to be repaired or replaced with an artificial valve before the left ventricle is irreversibly damaged.
Those who have undergone valve replacement surgery will receive antibiotic prophylaxis prior to any surgical, medical or dental procedures to reduce the risk of contracting heart valve infections.
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