Aortic Regurgitation

Aortic regurgitation is sometimes called leaky aortic valve. In aortic regurgitation the aortic valve does not close properly. Therefore, blood leaks back (regurgitates) into the left ventricle from the aorta.

In some cases, aortic regurgitation occurs at the same time as aortic stenosis.

Causes of aortic regurgitation

The main causes include the following:

Rheumatic fever

Rheumatic fever is a condition that sometimes occurs during an infection with a bacterium called the streptococcus. Your body makes antibodies to the bacterium to clear the infection. However, in some people the antibodies also attack various parts of the body, in particular the heart valves. Inflammation of a valve may develop which can cause permanent damage and lead to thickening and scarring years later.

Congenital causes

Various heart problems present at birth may include aortic regurgitation.

Abnormal widening of the base of the aorta

If the root of the aorta becomes abnormally wide, the cusps of the valve cannot meet and the valve becomes leaky. The tissue at the base of the aorta can be affected by various conditions such as:  ankylosing spondylitis, rheumatoid arthritis, syphilis.

Endocarditis

This is an infection of the valve.

Symptoms of aortic regurgitation

  • If the leak is small there are likely to be no symptoms.
  • If the backflow of blood becomes worse the left ventricle has to work harder with each heartbeat to pump the extra blood back into the aorta. The wall of the ventricle may then enlarge and may also become thickened (hypertrophied). Symptoms can then include:
    • Dizziness.
    • Chest pain (angina) on exertion. This occurs because of reduced blood flow to the coronary arteries.
    • Forceful heartbeats which may be felt as palpitations.
  • If the backflow of blood is severe the left ventricle may not function properly and heart failure may develop. This causes shortness of breath, tiredness, and fluid retention in various tissues of the body. See separate leaflet called Heart Failure.

Complications of aortic regurgitation

  • Heart failure may become severe and life-threatening.
  • Endocarditis is an uncommon complication. This is an infection of the valve. Unless promptly treated, endocarditis can cause serious illness.

How is aortic regurgitation diagnosed?

  • A doctor may hear a heart murmur or other abnormal noises when listening with a stethoscope. There are typical murmurs and noises which occur with aortic regurgitation. Sometimes this is detected on a routine examination.
  • An electrocardiogram (ECG) can show that the left ventricle is thickened or enlarged.
  • An echocardiogram (ultrasound scan of the heart) can confirm the diagnosis.

Treatments for aortic regurgitation

If the backflow of blood is mild and there are no symptoms then treatment may not be needed. If symptoms or complications develop, various medicines may be advised to ease the symptoms. Surgery may be advised if symptoms become worse.

Valve replacement surgery

This may be with a mechanical or a tissue (are tissue valves used in Pakistan) valve. Mechanical valves are made of materials which are not likely to react with the body, such as titanium.  Surgical treatment has greatly improved the outlook in most people with more severe regurgitation. Surgery to replace the valve has a very good success rate. The outlook is good if the valve is treated before the heart becomes badly damaged.

Antibiotics to prevent endocarditis

People at risk of endocarditis only need to take antibiotics if they actually have an infection at the time that dental or surgical procedures are undertaken.

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