Aortic Valve Regurgitation

The aortic valve is located in the heart (between the left ventricle and aorta) and is responsible for allowing blood to flow from the left ventricle into the aorta. The left ventricle is the main pumping chamber in the heart, and the aorta (the largest artery) is responsible for sending oxygenated blood throughout the body. 

When the left ventricle squeezes blood into the aorta, the aortic valve normally closes to prevent blood from flowing back into the left ventricle. When the aortic valve doesn't close efficiently, it can allow blood to leak backwards into the heart – a condition known as aortic regurgitation or aortic insufficiency. 

Naturally, blood leaking back into the heart means less is going out to the body – so it needs to works harder to provide an adequate supply of oxygenated blood. Common symptoms of aortic regurgitation include shortness of breath, decreased endurance during exercise, and swelling in the extremities. 

Aortic regurgitation can be caused by congenital malformations (birth defects), infection, aortic aneurysms, or acquired diseases such as rheumatic heart disease. 

Left untreated, this condition can weaken the heart because it has to work harder to pump the adequate amount of blood forward to the body.


Causes of Aortic Valve Regurgitation

Aortic valve regurgitation can develop suddenly or over a prolonged period of time and has a variety of causes:
  • Aortic aneurysm
  • Congenital malformation (e.g., bicuspid aortic valve)
  • Infection (endocarditis)
  • Rheumatic fever
  • Trauma

Risk Factors

Risk factors for developing aortic valve regurgitation include the following:

Aortic valve damage: Certain conditions, such as endocarditis or rheumatic fever, can cause damage to the aortic valve leaflets, rendering it incompetent.

Congenital malformation: Congenital malformations of the aortic valve, such as a unicuspid or bicuspid aortic valve, where the valve consists of only one or two leaflets rather than the usual three, predisposes to aortic valve regurgitation.

Aortic aneurismal disease: Connective tissue disorders (e.g., Marfans syndrome), or other disease processes can cause the aorta surrounding the aortic valve to dilate, thereby pulling the leaflets away from each other such that they do not close properly.


Symptoms

Symptoms stemming from aortic valve regurgitation include:
  • Fatigue and weakness, especially on exertion
  • Shortness of breath (dyspnea) during exertion or when you are lying flat
  • Chest pain (angina) and any discomfort or tightness in the chest, especially if it increases during activity
  • Near fainting (presyncope) or fainting (syncope) spells
  • Swelling (edema) of the ankles and feet


Diagnostic Tests

Tests used for diagnosing aortic valve regurgitation include an electrocardiogram (ECG), chest X-ray, echocardiogram, and cardiac catheterization.

Electrocardiogram (ECG): An ECG measures the electrical impulses of the heart. Abnormal electrical conduction patterns indicating enlargement of the left ventricular cavity can be a sign of significant aortic regurgitation. The extra volume of blood that leaks backwards into the left ventricle leads to dilation of this chamber.

Chest X-ray: A chest X-ray can reveal a left ventricle that has enlarged in response to significant aortic regurgitation.

Echocardiogram: Echocardiography provides excellent functional images of the heart, including all four of its valves. It is the primary imaging study used to diagnose aortic valve disease, including regurgitation.

Cardiac catheterization: A cardiac catheterization, or coronary angiogram, is performed by threading a thin catheter into the heart via an artery in your leg or arm and injecting dye directly into the coronary arteries. These studies map out the coronary anatomy and detect narrowing within the arteries. For patients with aortic valve regurgitation, this study is generally used to rule out significant coronary artery disease prior to surgical repair.



Treatment

Aortic valve replacement: Severe aortic regurgitation is often treated with aortic valve replacement surgery in which the diseased native valve is removed and replaced with a prosthetic valve. Our internationally renowned cardiac surgeons at Yale have integrated the most innovative techniques into their practice and are experts at aortic valve replacement. In appropriate patients, we offer minimally invasive techniques, which allow our patients to experience reduced recovery times and less postoperative discomfort.

Aortic root replacement: When aortic valve regurgitation is caused by dilation of the aorta, an aortic root replacement may be necessary. In this operation, the aortic valve and the segment of aorta surrounding it are replaced with a composite prosthetic valve and Dacron tube. In some cases, when the aortic valve structure is otherwise normal, simply replacing a portion of the ascending aorta and sparing the valve can correct the insufficiency.

We understand that the thought of undergoing open heart surgery can feel overwhelming. Our surgeons will review your surgical plan with you, in detail, so that you know what to expect before, during, and after your operation. You can rest assured that you will be cared for by top surgeons internationally renowned for their technical skill and clinical judgment.


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Yale Cardiac Surgery
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New Haven, CT 06511

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