Aortic Insufficiency

What is Aortic Insufficiency?

In aortic insufficiency (also called aortic regurgitation), blood flows back into the left ventricle during diastole. The ventricle becomes overloaded, dilated, and eventually hypertrophies. The excess fluid volume also overloads the left atrium and, eventually, the pulmonary system.

Aortic insufficiency by itself occurs most commonly among males. When associated with mitral valve disease, however, it's more common among females. This disorder also may be associated with Marfan syndrome, ankylosing spondylitis, syphilis, essential hypertension, and a ventricular septal defect, even after surgical closure.

Causes of Aortic Insufficiency

Aortic insufficiency results from rheumatic fever, syphilis, hypertension, endocarditis, or trauma. In some patients, it may be idiopathic.

Signs & Symptoms of Aortic Insufficiency

Signs and symptoms usually appear and may include:

• Rapid or irregular pulse
• Swollen ankles and feet
• Irregular, rapid, racing, pounding or fluttering pulse
• Fainting
• Palpitations

Diagnostic Tests

Cardiac catheterization shows reduction in arterial diastolic pressures, aortic insufficiency, other valvular abnormalities, and increased left ventricular enddiastolic pressure.

Chest X-rays - With an X-ray of your chest, your doctor can study the size and shape of your heart to determine whether your left ventricle is enlarged — a possible sign of damage to the aortic valve.

Echocardiography reveals left ventricular enlargement, dilation of the aortic annulus and left atrium, and thickening of the aortic valve. It also reveals a rapid, high-frequency fluttering of the anterior mitral leaflet that results from the impact of aortic insufficiency.

Electrocardiography shows sinus tachycardia, left ventricular hypertrophy, and left atrial hypertrophy in severe disease. ST-segment depressions and T-wave­inversions appear in leads I, aVL, V5, and V6 and indicate left ventricular strain.

Treatment

Valve replacement is the treatment of choice and should be performed before significant ventricular dysfunction occurs. This may not be possible, however, because signs and symptoms seldom occur until after myocardial dysfunction develops.

Digitalis glycosides, a low-sodium diet, diuretics, vasodilators, and especially angiotensin-converting enzyme inhibitors are used to treat patients with left­sided heart failure. In acute episodes, supplemental oxygen may be necessary.

Prevention Tips

• One possible way to prevent aortic insufficiency is to prevent rheumatic fever. You can do this by making sure you see your doctor when you have a sore throat. Untreated strep throat can develop into rheumatic fever.
• Notify your health care provider or dentist about any history of heart valve disease before treatment for any condition. Any dental work, including cleaning, and any invasive procedure can introduce bacteria into the bloodstream. This bacteria can infect a weakened valve, causing endocarditis.
• You might prevent aortic valve regurgitation from high blood pressure by taking care of your cardiovascular system. Getting your blood pressure under control is important because high blood pressure can lead to aortic valve damage and aortic valve regurgitation.