Aortic Valve Regurgitation — Know It All!

Editorial

All you need to know about Aortic regurgitation.

Know your ailment well, so you can manage it better!!

Here we come with Aortic valve regurgitation today!

What is Aortic valve regurgitation?

Aortic valve regurgitation is also known as Aortic regurgitation.

Regurgitation of the aortic valve or aortic regurgitation is a condition that arises when the aortic valve of the heart doesn’t shut securely. The regurgitation of the aortic valve causes some of the blood pumped out of the main pumping chamber (left ventricle) of your heart to leak back into it.

The leakage can stop your heart from pumping blood to the rest of your body efficiently. You can feel fatigued and out of breath as a result.

Regurgitation of the aortic valve may occur rapidly or over decades. When aortic valve regurgitation becomes serious, surgery to restore or rebuild the aortic valve is often required.

What are the causes of Aortic valve regurgitation?

There are four valves in your heart which keep blood flowing in the right direction. The mitral valve, tricuspid valve, pulmonary valve and aortic valve contain these valves. During each heartbeat, each valve has flaps (cusps or leaflets) that open and shut once. The valves often do not open or shut correctly, interfering with the flow of blood into the heart, and possibly impairing the capacity to pump blood through the bloodstream.

The valve between the lower left heart cavity (left ventricle) and the main artery leading to the body (aorta) does not close correctly during aortic valve regurgitation, which allows any blood to flow backwards into the left ventricle. This forces further blood to be retained by the left ventricle, potentially allowing it to swell and thicken.

Initially, enlargement of the left ventricle benefits and with more force, it ensures enough blood supply. But these changes gradually weaken the left ventricle and the heart in general.

Regurgitation may be caused by any disease that damages a valve. Causes of regurgitation of aortic valves include:

Congenital heart valve disease.⠀

A valve can have only one cusp (unicuspid) or four cusps (quadricuspid) in some situations, but this is less common.

For any point in your life, these congenital cardiac defects place you at risk of developing aortic valve regurgitation. It raises the likelihood that you will have a bicuspid valve if you have a parent or relative with a bicuspid valve, although it may also happen if you may not have a personal history of developing a bicuspid aortic valve.

Age-related modifications to the heart.

Over time, calcium deposits will build upon the aortic valve, allowing the cusps of the aortic valve to rigidize. This will result in the narrowing of the aortic valve, although it can also not shut properly.

Endocarditis.

Endocarditis. Endocarditis, an infection within your heart that involves heart valves, can affect the aortic valve.

Rheumatic fever.

Rheumatic fever, a strep throat complication and once a widespread childhood condition in the United States, will affect the aortic valve. In developed countries, rheumatic fever is also common, but rare in the United States. Any older adults in the United States, although they may not have developed rheumatic heart disease, were prone to rheumatic fever as infants.

Other diseases. The aorta and aortic valve may be swollen by several unusual diseases and lead to regurgitation, including Marfan syndrome, a connective tissue disorder. Such autoimmune diseases can also lead to regurgitation of the aortic valve, such as lupus.

Trauma. Harm to the aorta near the aortic valve site, such as damage caused by injuries to the chest or a split in the aorta, will also allow blood to flow out into the valve.

What are the symptoms of Aortic valve regurgitation?

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What are the risk factors of Aortic valve regurgitation?

Risk factors of aortic valve regurgitation include:

  • Older age
  • Certain heart conditions present at birth (congenital heart disease)
  • History of infections that can affect the heart
  • Certain conditions that can affect the heart, such as Marfan syndrome
  • Other heart valve conditions, such as aortic valve stenosis
  • High blood pressure

What are the complications of Aortic valve regurgitation?

Aortic valve regurgitation can cause complications, including:

  • Heart failure
  • Infections that affect the heart, such as endocarditis
  • Heart rhythm abnormalities
  • Death

How is Aortic valve regurgitation diagnosed?

Echocardiography is better diagnosed with aortic regurgitation, since the murmur can be missed by physical examination in many cases. Echocardiography is also critical in assessing aetiology and predicting severity, being almost 100 percent sensitive and specific for the diagnosis of aortic regurgitation.

Using colour flow Doppler, the real regurgitant jet may be visualised directly; this is particularly important in patients with acute AR because there may be no valve abnormality revealed by physical inspection.

It is important to remember that the magnitude of echocardiography-assessed aortic regurgitation depends on the patient’s hemodynamic state at the time of the examination, most especially the afterload.

In most patients with aortic regurgitation, cardiac catheterization with aortography and hemodynamic tests is not required because of the precision of echocardiography. Aortic regurgitation can be observed during cardiac catheterization by inserting contrast into the aortic root and visualising the appearance of the contrast in the left ventricle.

Aortic root disease may also be assessed by catheterization. The degree of severity of aortic regurgitation during the procedure is affected by many factors. The amount of aortic regurgitation would be overestimated if the catheter is placed too close to the aortic valve. The amount of aortic regurgitation visualised is affected by the volume and rapidity of contrast injection into the aortic root. As stated earlier, the hemodynamic parameters also impact the intensity of aortic regurgitation at the time of measurement, again, mainly afterload.

The grading scale used during catheterization for aortic regurgitation is below. LVEDV and LVEDP can also be determined by cardiac catheterization, which can be useful for aortic regurgitation assessment. If aortic valve repair is planned, cardiac catheterization with coronary angiography is recommended, so the coronary arteries can be imaged. Coronary artery bypass grafting, or CABG, will be performed at the same time as valve repair if severe coronary atherosclerosis is present.

Structural anomalies, such as the bicuspid aortic valve or the prolapse of the AV, can be seen with respect to aetiology. It is also possible to detect vegetation on the aortic valve, which suggests endocarditis as the cause, while transesophageal echocardiography is more sensitive. Additionally, it is possible to calculate the scale of the aortic root and classify aortic dissections.

In echocardiography, the magnitude of aortic regurgitation can be measured using three parameters:

  • Plane Scale Regurgitant
  • Half-Time Pressure
  • Fraction Regurgitant

The ratio of the aortic regurgitation jet diameter just below the aortic valve leaflets to the size of the LV outflow diameter is represented by the regurgitant jet size. Ideally, because no regurgitant jet should be present, the ratio should be nil. The ratio below 24 is mild, 25 to 45 is moderate, 46 to 64 is fairly extreme, and 65 is more severe.

The pressure half-time index is the time it takes to decrease by 50 percent the original overall pressure gradient in diastole. This decrease in pressure is incremental in patients with moderate aortic regurgitation. A sudden decrease in pressure gradient occurs in the environment with extreme aortic regurgitation. A half-life of pressure greater than 500 ms is known to be mild aortic regurgitation, normal from 500 ms to 349 ms, moderate from 349 ms to 200 ms and extreme from less than 200 ms. In patients with substantially elevated LVEDP, the severity of aortic regurgitation measured using the pressure half-life is overestimated.

Perhaps a more simple way to measure aortic regurgitation magnitude is the regurgitant fraction. The regurgitant fraction is the proportion of the amount of the stroke that returns from the aorta during diastole to the left ventricle. For example, a regurgitant fraction of 33 percent will suggest that during diastole, one-third of the total volume of stroke returns to the LV retrograde through the aortic valve. A regurgitant fraction of less than 20 percent suggests mild aortic regurgitation, moderate aortic regurgitation of 20 to 35 percent, moderately severe aortic regurgitation of 36 to 50 percent, and severe aortic regurgitation of more than 50 percent.

The ECG is non-specific and can display left ventricular hypertrophy and left atrial enlargement in patients with aortic regurgitation. In acute aortic regurgitation, the only ECG abnormality may be sinus tachycardia due to an elevated sympathetic nervous tone. In aortic regurgitation, the chest radiograph is also nonspecific. In patients with chronic AR, cardiomegaly is present. Pulmonary edoema is almost uniformly present in acute AR. The mediastinum can appear swollen if the AR is due to an aortic dissection.

What is the treatment for Aortic valve regurgitation?

Aortic valve regurgitation care depends on the seriousness of the disease, whether you have signs and symptoms and whether your condition is getting worse.

Your doctor can control your condition with daily follow-up appointments if your symptoms are mild or you are not experiencing symptoms. Your doctor may prescribe that you make improvements to your healthier lifestyle and take drugs to relieve symptoms or minimise your risk of complications.

In order to stabilise or restore the diseased aortic valve, you can finally require surgery. Your doctor may prescribe surgery in some cases, even though you are not having symptoms. Doctors can perform aortic valve surgery at the same time as you have another heart operation. In certain circumstances, if the aorta is swollen, you can need a part of the aorta (aortic root) fixed or removed at the same time as aortic valve surgery.

Consider being diagnosed and treated at a surgical facility with a multidisciplinary team of cardiologists and other physicians and medical personnel qualified and specialised in the diagnosis and care of heart valve disease if you have aortic valve regurgitation. To assess the most effective medication for your illness, this team will consult closely with you.

Surgery is normally done by a cut (incision) in the chest to patch or replace an aortic valve. Physicians can perform minimally invasive cardiac surgery in some cases, which requires the use of smaller incisions than those used in open-heart surgery.

Choices for surgery include:

Aortic valve repair

Surgeons may perform many various forms of repair to repair an aortic valve, including removing valve flaps (cusps) that have fused, reshaped or removed excess valve tissue to allow the cusps to close securely, or patching holes in a valve.

Doctors may implant a plug or device to patch a failing replacement aortic valve using a catheter technique.

Aortic valve replacement

To treat aortic valve regurgitation, aortic valve replacement is also required. Your surgeon removes the weakened valve during aortic valve repair and replaces it with a mechanical valve or valve made of animal, pig or human heart tissue (biological tissue valve). It is also possible to use some kind of biological tissue valve substitute that uses your own pulmonary valve.

Over time, biological tissue valves degenerate and can potentially need to be replaced. In order to avoid blood clots, people with mechanical valves will continue to take blood-thinning drugs for life. Your doctor will discuss the advantages and risks of each form of valve with you and discuss which valve may be best for you.

A catheter operation can also be performed by doctors to instal a new valve into a failed biological tissue valve which is no longer operating properly. Some methods for treating aortic valve regurgitation using catheters to patch or restore aortic valves continue to be studied.

How to prevent from getting Aortic valve regurgitation:

Consult the doctor regularly for any cardiac problem so that he or she can track you and potentially detect aortic valve regurgitation or other heart condition before it progresses or when it is most readily treatable in the early stages. If a leaking aortic valve (aortic valve regurgitation) or a tight aortic valve (aortic valve stenosis) has been diagnosed, you will also need daily echocardiograms to make sure that the regurgitation of the aortic valve does not become serious.

Even, be mindful of factors that lead to the production of regurgitation of aortic valves, including:

Rheumatic fever

Rheumatic fever See a doctor if you have a serious sore throat. Rheumatic fever may result from untreated strep throat. Fortunately, with antibiotics, strep throat is easily handled.

High blood pressure

Low blood tension. Regularly monitor your blood pressure. To avoid aortic regurgitation, make sure it’s well regulated.

References:

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https://www.mayoclinic.org/diseases-conditions/aortic-valve-regurgitation/diagnosis-treatment/drc-20353135

https://emedicine.medscape.com/article/150490-differential

https://www.heart.org/en/health-topics/heart-valve-problems-and-disease/heart-valve-problems-and-causes/problem-aortic-valve-regurgitation

https://www.webmd.com/heart-disease/aortic-regurgitation#1

https://www.healio.com/cardiology/learn-the-heart/cardiology-review/topic-reviews/aortic-regurgitation