Aortic regurgitation, also known as aortic insufficiency, is a condition characterized by the leakage of blood backward through the aortic valve into the left ventricle of the heart during diastole, the relaxation phase of the cardiac cycle. This leakage occurs when the aortic valve does not close properly, allowing blood to flow backward from the aorta into the left ventricle instead of being pumped forward into the body.
Causes and Types
Aortic regurgitation can be classified into two main types based on its cause:- 1. Acute aortic regurgitation:This occurs suddenly and is often due to an acute event that affects the structure or function of the aortic valve, such as:
- – Infective endocarditis: Infection of the aortic valve, often resulting from bacteria entering the bloodstream and adhering to the valve surface.
- Aortic dissection: Tear in the inner layer of the aorta, which allows blood to flow between the layers of the aortic wall and disrupts the function of the aortic valve.
- Trauma or injury to the aorta or aortic valve.
- 2. Chronic aortic regurgitationThis occurs gradually over time and is typically due to chronic conditions that affect the structure or function of the aortic valve, such as:
- Bicuspid aortic valve: A congenital heart defect in which the aortic valve has two cusps (leaflets) instead of the normal three, which can lead to premature degeneration and dysfunction of the valve.
- Rheumatic heart disease: Damage to the aortic valve due to rheumatic fever, an inflammatory condition caused by untreated streptococcal infections.
- Aortic valve prolapse: Bulging or stretching of the aortic valve leaflets into the left ventricle during diastole, often associated with connective tissue disorders.
- Degenerative changes in the aortic valve leaflets, such as calcification or fibrosis.
Symptoms
The symptoms of aortic regurgitation can vary depending on the severity of the condition and whether it develops gradually or suddenly. Common symptoms may include:- Fatigue
- Shortness of breath, especially with exertion or when lying flat (orthopnea)
- Palpitations or irregular heartbeats
- Chest discomfort or pain, particularly with exertion
- Dizziness or lightheadedness
- Fainting (syncope)
- Swelling of the ankles, feet, or abdomen (edema)
Diagnosis
Diagnosis of aortic regurgitation may involve a combination of medical history, physical examination, laboratory tests (including blood tests and cardiac biomarkers), imaging tests (such as echocardiography, transesophageal echocardiography [TEE], cardiac MRI, or cardiac CT scan), and cardiac catheterization.Treatment
Treatment for aortic regurgitation aims to relieve symptoms, improve heart function, and reduce the risk of complications. Treatment options may include:- Medications: Medications to manage symptoms (such as diuretics for fluid retention), improve heart function (such as ACE inhibitors or beta-blockers), and prevent complications (such as anticoagulants to reduce the risk of blood clots).
- Surgery: Surgical interventions may be necessary to repair or replace the aortic valve in cases of severe or symptomatic aortic regurgitation. Surgical options may include aortic valve repair (which preserves the patient’s own valve tissue) or aortic valve replacement (which involves replacing the diseased valve with a mechanical or bioprosthetic valve).
- Transcatheter interventions: Minimally invasive procedures, such as transcatheter aortic valve repair (e.g., using the TAVR/TAVI procedure) or transcatheter aortic valve replacement, may be options for select patients who are not candidates for traditional surgery.