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Aortic Regurgitation

Aortic Regurgitation

Alternate Names

  • aortic insufficiency
  • Aortic valve insufficiency

Definition

Aortic regurgitation is a condition in which blood flows backwards into the left side of the heart through the aortic valve. The aortic valve is a flap-like opening located between the left side of the heart and the aorta. The aorta is the main artery carrying blood from the heart.

What is going on in the body?

The heart is divided into two halves, right and left. Each side has a pumping chamber, called a ventricle. The left ventricle receives blood from the lungs. During a heartbeat, the left heart chamber squeezes, generating enough pressure to open the aortic valve. Blood from the left side is then pumped into the aorta and out into the body for general circulation.
As the left heart chamber empties, the aortic valve closes. In a normal heart, the valve seals shut, and no blood is allowed to flow back into the left side. But when the aortic valve is abnormal, blood does flow backwards. In this instance, blood is now flowing into the left heart chamber from two directions. The first source is from the lungs, which is normal. The second source is from the backflow of blood across the leaky aortic valve.
When the heart receives this excess amount of blood, the left side must work harder. This excess work can stress the left side of the heart and cause it to enlarge. This damage can happen slowly over time, or can get worse rather quickly.

Risks

What are the causes and risks of the condition?

There are many causes of aortic regurgitation. Some of the more common ones include:
  • ankylosing spondylitis, a spinal disorder
  • aortic dissection, a tear in the aorta that allows blood to flow between the inner and outer layers
  • congenital heart defects that are present at birth
  • high blood pressure
  • infective endocarditis, an infection in the valves or lining of the heart
  • Marfan syndrome, an inherited disease that weakens body tissues
  • Reiter syndrome, (also called Reactive Arthritis), an arthritic disorder that affects adult males
  • rheumatic fever, a disease that can cause arthritis and heart problems
  • rheumatoid arthritis, which also causes joint pain and swelling
  • syphilis, a sexually transmitted disease (STD)
  • systemic lupus erythematosus (SLE), an autoimmune disorder in which the person creates antibodies against his or her own tissues

Prevention

What can be done to prevent the condition?

Some cases of aortic insufficiency can be prevented by treating underlying disorders. For example, effective treatment of autoimmune disorders may prevent some damage to the aortic valve. High blood pressure can be managed with lifestyle changes and medicines. Following safer sex guidelines can prevents some STDs.

Diagnosed

How is the condition diagnosed?

Diagnosis of aortic regurgitation begins with a history and physical exam. Aortic regurgitation usually causes a heart murmur that can be heard with a stethoscope. The healthcare provider also may do one or more of these tests:
  • cardiac catheterization
  • chest X-ray
  • echocardiogram with or without color Doppler studies
  • electrocardiogram (ECG)

Long Term Effects

What are the long-term effects of the condition?

Aortic regurgitation may worsen if a person has a heart infection or aortic dissection. The function of the left heart chamber may deteriorate quickly within a few weeks or months. Chronic regurgitation usually progresses slowly. It can cause severe congestive heart failure (CHF).

Other Risks

What are the risks to others?

Aortic regurgitation is not contagious and poses no risk to others.

Treatments

What are the treatments for the condition?

Medicines to improve the pumping action of the heart may be given to reduce the severity of the regurgitation. This treatment may allow surgery to be postponed or avoided in people who have no symptoms. Heart valve surgery may be needed for some people when there are signs that the left heart chamber is not working well.

Side Effects

What are the side effects of the treatments?

Medicines used to treat aortic regurgitation can cause a variety of side effects. Surgery can be complicated by bleeding, infection, or allergic reaction to anesthesia.

After Treatment

What happens after treatment for the condition?

If a person does not have symptoms and the left heart chamber works well, he or she may remain on medicine for a long time. Successful replacement of the valve restores normal blood flow. The long-term outcome is usually very good. Artificial valves wear out over a period of years. Their function is monitored, and the valves are replaced as necessary.
Some artificial valves require that the person take:
  • antibiotics before and after surgeries or dental work to avoid serious heart infections
  • blood-thinning drugs to avoid blood clots, such as deep venous thrombosis

Monitor

How is the condition monitored?

An individual with aortic regurgitation needs to make regular visits ti the healthcare provider. The provider may order electrocardiograms and echocardiograms periodically to detect any signs of deterioration. Any new or worsening symptoms should be reported to the provider.

Sources

Merck Manual, 1999

Current Medical Diagnosis and Treatment, 1996

Harrison's Principles of Internal Medicine, 1991

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