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Aortic Regurgitation : Definition, Causes, Symptoms, Diagnosis, Preventive and Treatment

Tuesday, August 14th 2012. | Disease, Heart Health

Aortic Regurgitation Definition

Aortic regurgitation is defined by an abnormality of the aortic valve at the exit of the left ventricle that separates the ascending thoracic aorta and no longer assumes the seal during diastole : the consequence is the reflux of blood from the aorta into the left ventricle.

The importance of aortic regurgitation and left ventricular function will be crucial in therapeutic choices available.

Aortic Regurgitation Symptoms

It is a dysfunction of the valves between the aorta and left ventricle.

Aortic insufficiency is responsible for a leak during diastole, and an amount of blood depends on the importance of the leak, regurgitates from the aorta into the left ventricle.

Downstream, the left ventricle is the subject of work overload because at each systole, it must eject more blood volume regurgitated. It fits with a progressive dilatation of its cavity and hypertrophy of its walls that allow the maintenance of a satisfactory cardiac output.

Aortic regurgitation is called “decompensated” and the person affected has no symptoms.

The aortic insufficiency may be acute if the volumes of blood are rejected in a large left ventricle have not had time to adjust: an urgent surgical indication may be asked.

Later alteration of the myocardial fibers will ensure that the heart fails and are working as clinical signs appear:  aortic insufficiency is called decompensated.

Upstream increase in stroke volume during systole leads to a dilation of the ascending aorta. Usually moderate this expansion becomes important when the same tissue of the aorta are the subject of a specific pathology.

Aortic Regurgitation

Aortic Regurgitation (img thanks to empowher.com)

Aortic Regurgitation Causes

Aortic regurgitation can originate from either abnormalities of the valves or problems on the walls of the aorta.

On the valves:

  • Rheumatic fever responsible for less than a third of aortic insufficiency was the main cause before. The evolution is often prolonged over several years, even decades after the initial inflammatory process. 
  • Bacterial endocarditis, the most common cause of acute aortic insufficiency. It occurs on valves sound or preexisting lesions (bicuspid, rheumatic damage) and causes of vegetation, genuine growths, ulceration and valvular perforations, destruction of the free edge and abscesses of the aortic annulus. These lesions are responsible for leaks and decaying very important. 
  • The congenital bicuspid: more often it is complicated to adulthood stenosis than aortic regurgitation, but valvular leakage can occur around the age of 30 to 40 years. On the walls of the aorta: - Aneurysms of the ascending aorta (or disease-annuloaortic ectasia) common cause of aortic insufficiency (17%), often voluminous without specific cause (idiopathic) or due to Marfan syndrome, disease Ehlers-Danlos syndrome. Evolution is often accelerated and severe, due to aortic complications (rupture of aneurysms, aortic dissection), especially in Marfan’s disease   - Aortic dissection is a possible complication of hypertension, cystic necrosis of the media, some inflammation of the aorta, and may be the occasion of chest trauma with sudden deceleration. - isolated valvular dysplasia with inflammation secondary to syphilis, ankylosing spondylitis, a disease of Takayasu aortitis or other inflammatory such as rheumatoid arthritis, lupus erythematosus, Behcet’s disease, giant cell arteritis.

Aortic Regurgitation Sign

The clinical signs and echocardiography are the basis of the diagnosis and monitoring of aortic regurgitation.

Long and often without symptoms discovery is done by finding a quiet heart murmur during a medical consultation.  Shortness of breath, chest pain of angina or discomfort with possible slight loss of consciousness are the first signs.

The presence pulmonary symptoms of heart failure and left or right sometimes angina reflects an emergency. This is the amount of leakage which is responsible for the level and severity of symptoms.

The symptoms are always a sign of severity, and we should not expect them to consider the transaction occurred, hence the importance of a regular cardiac monitoring. The degree of dilatation of the aorta and its rate of progression, assessed by ultrasound , are also important elements of supervision. They can lead to considering surgery in a symptomatic patients, and this regardless of the severity of valvular regurgitation.

Aortic Regurgitation Diagnosis

If the chest radiograph and ECG give some information about the impact of aortic regurgitation, cardiac echo Doppler remains the gold standard enabling 

  • To confirm the diagnosis, 
  • To assess the severity of the valvular and the importance of the leak, 
  • To appreciate its impact on the left ventricle 
  • The search for other associated valvular disease,   
  • To measure the diameter of the ascending aorta.

It is based on the information that will be specified monitoring frequency and that will put a possible indication for surgery.

In case of surgery, a measure of pressure in the heart chambers, a visualization of these cavities (cardiac catheterization) are performed; examined coronary (coronary angiography) is often performed after 50 years in search of associated coronary lesions.

Aortic Regurgitation Treatment

The first medical treatment may be surgical cases of cardiac decompensation.

In the absence of signs of decompensation it is not necessary to require medical treatment. The treatment is then that of congestive heart failure and is adapted depending on the severity of clinical signs. Surgical treatment is to replace an aortic valve prosthesis under extracorporeal circulation. There are two types of prosthesis: 

  • The disc mechanical prostheses have long durability but require anticoagulation therapy for life. 
  • The biological prostheses, xenografts of animal origin, or homografts of human origin, does not require anticoagulant treatment but degenerate over time, often with a new intervention from the 8th to the 10th year.

The indication is formal at the onset of symptoms (angina, shortness of breath) as the spontaneous evolution would be pejorative . It is urgent at the stage of heart failure. In the absence of symptoms echocardiographic criteria may confirm the indication for surgery.

The Bentall procedure is a prosthetic replacement of the ascending aorta, associated with a prosthetic valve, or the conservation of the native aortic valve. L ‘postoperative course was good in the forms made at an early stage and in worse forms made late, ie in the presence of heart failure, a significant left ventricular dilatation or degradation of its contractility.

Aortic Regurgitation Preventive

Aortic regurgitation is valve damage most at risk of bacterial endocarditis, severe infectious complication.

Preventive methods: 

  • Do not allow “drag” an unexplained fever: a medical opinion and realization of blood cultures are needed. 
  • To regularly monitor dental status by his dentist to search for microbial deposits and keep teeth in good condition. 
  • In case of dental care, preventing the dentist that you are carrying a risk of valvular endocarditis. It will set in motion a course of antibiotics.    
  • Some surgical or endoscopic some of the digestive, urinary tract or the airways, skin acts also require some treatment with antibiotics. Again, it is important to remember that one is carrying a heart valve. In aortic regurgitation “offset”, there is no specific scheme, but, in view of a possible surgical treatment of the disease, it is recommended not to gain weight. Stage heart failure, salt-free diet is essential.Physical activity authorized must be evaluated with the cardiologist, and it depends on the degree of aortic insufficiency, its impact on the heart and its etiology. Competition is usually cons-indicated, as in most cardiac diseases, but efforts are often practiced endurance possible.
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