Aortic Valve Insufficiency

Description of the Disease

Aortic valve insufficiency (aortic regurgitation) is a heart valve disorder in which the aortic valve does not close completely during each heartbeat, allowing blood to flow back from the aorta into the left ventricle. The heart consists of four chambers: two atria and two ventricles. Heart valves ensure that blood flows in only one direction. The aortic valve is located between the left ventricle and the aorta, the body’s largest artery. When this valve becomes incompetent, part of the blood pumped into the aorta returns to the left ventricle, increasing its workload.

Aortic valve insufficiency is more common in older men and accounts for approximately 10% of all valvular heart diseases.

Cause of the Disease

Any condition that damages the aortic valve may lead to aortic valve insufficiency. The most common cause is infective endocarditis. Individuals at the highest risk include people who inject drugs intravenously and those undergoing invasive medical or dental procedures. Other causes include congenital abnormalities of the aortic valve (such as a bicuspid aortic valve instead of the normal tricuspid valve), chest trauma, and age-related degeneration of the valve.

Symptoms

When the aortic valve does not close properly, some blood flows back into the left ventricle after each heartbeat. As a result, the left ventricle must pump a larger volume of blood, increasing its workload. Many patients remain symptom-free for years because the heart compensates for this extra demand. As the disease progresses, the left ventricle enlarges, its wall thickens, and its pumping function gradually deteriorates.

Common symptoms include:

• Fatigue and weakness.
• Progressive shortness of breath (dyspnea).
• Palpitations.
• Chest pain during physical exertion.

Diagnosis

Diagnosis is based on the patient’s symptoms, physical examination, and characteristic findings during cardiac auscultation. Additional investigations include chest X-ray and echocardiography, which is the primary imaging method used to assess the severity of aortic valve insufficiency.

Treatment

Mild aortic valve insufficiency may require only regular clinical follow-up. Although medications cannot eliminate the backward flow of blood, they can help control blood pressure and reduce the workload on the heart. Once symptoms develop or significant valve dysfunction is present, surgical treatment is often required. Depending on the individual case, the native valve may be repaired, or the aortic valve may be replaced with a prosthetic valve.

Source | Author Doctor Nikas Samuolis, reviewed by Prof. Virginijus Šapoka | Vilnius University | Faculty of Medicine | Head of the Department of Internal Medicine, Family Medicine, and Oncology