Aortic Valve Regurgitation

Aortic valve regurgitation (also known as aortic regurgitation) occurs when a backflow of blood that was just pumped out of the heart's main pumping chamber (left ventricle) has leaked back (regurgitation) through the aortic valve. This is due to the aortic valve not closing tightly.

This blood leakage may result in the heart being inefficient in pumping blood to the rest of your body. Patients with aortic valve regurgitation often experience fatigue and shortness of breath.

This condition can develop suddenly or gradually develop over many years. However, when aortic valve regurgitation becomes severe, surgery required to repair or replace the aortic valve.

As most cases of aortic valve regurgitation develops slowly, patients may have no signs or symptoms for a long period of time. However, when the condition worsens, some symptoms may appear, such as:

• Chest pain, fatigue and weakness, typically with an increase in activity level
• Irregular pulse
• Shortness of breath, especially with exertion or when you lie down
• Swollen ankles and feet
• Light-headedness or fainting
• Heart murmur
• Palpitations
  

Causes

Conditions which damage a valve can cause regurgitation. Some causes of aortic valve regurgitation are:

• Congenital heart valve disease
• Endocarditis
• Rheumatic fever
• Disease. Other rare conditions can enlarge the aortic valve and lead to regurgitation, including Marfan syndrome, a connective tissue disease
• Trauma to the aorta near the aortic valve
• Other conditions which enlarges the aortic valve (e.g Marfan syndrome)
  

Risks

Other risk factor of aortic valve regurgitation include:

• Aortic valve damage
• High blood pressure (hypertension)
• Age: In some cases, middle aged patients develop the condition due to natural deterioration of the valve.
  

The doctor will ask about the patient’s medical history and provide a physical exam which includes listening to the heart with a stethoscope. Aortic valve regurgitation generally produces a heart murmur, which can mean that blood is leaking backward through the aortic valve. Upon this first examination, the doctor will decide what tests are needed to make a diagnosis. Some of the diagnostic tests may include:

• Echocardiogram (Echo)
• Exercise tests
• Cardiac magnetic resonance imaging (MRI)
• Electrocardiogram (ECG)
• Chest X-ray 
• Cardiac catheterization (Coronary angiogram)

The tests will help the doctor diagnose aortic valve regurgitation, determine the severity of the condition, and decide if the patient’s aortic valve needs repair or replacement.

Treatment of aortic valve regurgitation depends on the severity of the blood leakage (regurgitation), symptoms arising from the condition,and the extent the heart function is affected.

• Observation: Cases with mild regurgitation may not need treatment. However, the patient will still require regular check-ups and monitoring by the doctor
• Valve repair: Aortic valve repair is a surgery whereby the surgeons will modify the original valve to bring it to its full functionality.
• Valve replacement:
  
• Mechanical or tissue valve replacement: Many severe cases of aortic valve regurgitation will require the aortic valve to be replaced with a mechanical valve or a tissue valve. Mechanical valves are made from durable metal, while tissue valves may come from a pig, cow or human donor. Before proceeding with the valve replacement surgery, the doctor will discuss with the patient which option is more suitable and the surgery risks involved.
• Minimally invasive procedures: Other less invasive surgical techniques include for Aortic valve replacement are also available. This treatment commonly requires open-heart surgery under general anaesthesia and the use of a heart-lung bypass machine.