What Is Aortic Insufficiency (Aortic Regurgitation)
Aortic insufficiency occurs when your aortic valve fails to close properly once the blood enters the aorta. This causes blood to flow the wrong way back into the heart.
When the left ventricle doesn’t fully empty and some blood remains, it forces the ventricle to hold more blood than normal as the next heartbeat pulls in more oxygenated blood from the left atrium. The heart has to do extra work to hold this additional blood. This can lead to enlargement of the left ventricle, weakening the heart and leading to heart failure.
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Causes of Aortic Insufficiency
The most common causes for aortic insufficiency are:
- deterioration of the heart valve over time,
- dilation of the aorta (aortic root aneurysm),
- infections,
- high blood pressure,
- trauma, or
- congenital heart defects.
In patients with a congenital defect, you may not know about the condition until later in life when you experience symptoms.
For patients without a congenital cause for the disease, aortic insufficiency often gets worse with age as your heart valves wear out over time.
Risk Factors for Aortic Insufficiency
Similar to aortic stenosis, the most common risk factors for developing aortic insufficiency include:
- Old age,
- Frequent infections,
- Rheumatic fever,
- Prolonged high blood pressure,
- Chronic kidney disease, and
- Radiation therapy in the chest area.
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Symptoms of Aortic Insufficiency
Some of the most common symptoms you may experience with aortic insufficiency include:
- Shortness of breath with high levels of exertion or while lying on your back;
- Feeling fatigued or weak during period of increased activity;
- Heart palpitation, irregular heartbeats, or heart murmurs;
- Swelling in the ankles and feet; and/or
- Chest pain or tightness, particularly during or after physical activity.
If you experience these symptoms, you should schedule an appointment with a cardiologist immediately.
He or she will use echocardiography to identify and diagnose aortic insufficiency. Your doctor can then recommend the appropriate treatment plan based on how severe your condition is.
Some patients experience symptoms of the disease suddenly (called acute aortic regurgitation), while others experience an extended deterioration that eventually leads to aortic regurgitation (chronic valvular insufficiency).
Acute Aortic Regurgitation
Trauma can cause acute insufficiency by damaging the aortic valve. An infection, such as endocarditis, can also damage the heart causing acute aortic regurgitation or complications following a valve replacement.
Chronic Aortic Regurgitation
Chronic aortic regurgitation occurs slowly over time as the aortic valve wears out and eventually cannot close entirely. Patients that experience chronic regurgitation often won’t experience any symptoms for many years and may not get a diagnosis until much later in life when you do begin to experience symptoms.
Treatment Options for Aortic Insufficiency
For patients with mild aortic regurgitation, we may recommend reducing the level of physical exertion and exercise or limiting specific exercises that could increase the risk of complications. Instead we may recommend focusing on safe exercises that allow you to remain active and not increase your risk of complications.
For moderate to severe aortic insufficiency, we will usually perform open heart surgery to either repair the damaged aortic valve or replace it entirely. Surgical repair is an option in situations where the damage is minimal or easy to correct, or for patients that are younger and in good overall health.
For patients that cannot have the valve repaired, replacement of the valve with a prosthetic is an option, and some patients may be good candidates for the less invasive transcatheter aortic valve replacement (TAVR) surgery. We may also perform a Ross procedure to replace your aortic valve with your pulmonary valve. However, you must be 60 and younger and have a well-functioning pulmonary valve to qualify for this option.
Preventing Aortic Valve Disease
If you develop aortic valve disease because of a congenital heart defect, you cannot prevent the disease. However if you don’t have a congenital heart defect, there are some steps you can take to reduce the risk of developing aortic valve disease.
Take antibiotics when you have strep throat to prevent rheumatic fever. Strep throat can be easily tested at your doctor’s office and antibiotics can usually treat this disease quickly and effectively. This will help you avoid complications that can lead to rheumatic fever and heart damage.
Reduce your risk of heart disease by:
- keeping your blood pressure under control,
- managing diabetes appropriately,
- maintaining healthy cholesterol levels (and having your cholesterol checked regularly), and
- maintaining a healthy body weight to avoid obesity.
Take care of your teeth and gums. There is increasing evidence that having healthy teeth and gums and avoiding gingivitis can reduce the risk of endocarditis, which is an infection in heart tissue that could damage the aortic valve.
Brushing and flossing daily and seeing your dentist every six months for a cleaning and checkup can reduce your risk of developing gum disease.
