When aortic valve insufficiency aortic valve is designated in the left ventricle. Part of the aortic blood can flow back during the relaxation phase of the chamber, which, depending on the degree of severity, has long-term effects on the heart and the entire cardiovascular system.
What is aortic regurgitation?
Lighter forms of aortic valve insufficiency, in which the blood return makes up less than 20 percent of the blood squeezed out of the left ventricle, are almost asymptomatic and go unnoticed by those affected.
A leak in the aortic valve , which acts as a valve between the left ventricle and the aorta , the main artery of the body, is known as aortic regurgitation or, better, aortic regurgitation . During the systolic contraction phase of the heart chamber, the aortic valve opens and clears the way for the oxygenated blood from the pulmonary circulation.
According to growtheology, the aortic valve is designed as a so-called pocket valve with three pockets that fill with blood after the end of the pressure phase and virtually close the aorta so that no blood can flow back from the aorta into the left chamber during the relaxation phase of the chambers (diastole). If the aortic valve does not close completely and more than 15% of the blood pumped into the aorta flows back, aortic valve regurgitation is present.
The most common cause of aortic valve insufficiency is a direct bacterial infection of the valve tissue ( endocarditis ) or a previous streptococcal infection, which can trigger rheumatic fever and spread to the heart valves. Once the infection has been overcome, scarring can occur on the pockets of the aortic valve, which can then no longer close tightly.
The venereal disease syphilis used to present a serious problem , as it can also spread to the heart valve tissue and cause valve insufficiency. Despite the possibility of treatment with antibiotics , the disease is on the rise again. In rarer cases, certain gene mutations also play a role, such as in Marfan’s syndrome . The gene mutations, which occur spontaneously in up to 40 percent of cases, in this case not inherited, lead to disorders in the structure of the connective tissue .
In some cases, an aortic valve misalignment plays a role. It can happen that only two pockets instead of three are formed in the aortic valve, which is not noticeable at first, but favors later insufficiency. Further factors are an overstretching of the aortic root or the ascending branch of the aorta or an aortic dissection in which the inner wall of the aorta loosens and blood penetrates into the intermediate area of the aortic walls.
Symptoms, ailments & signs
Lighter forms of aortic valve insufficiency, in which the blood return makes up less than 20 percent of the blood squeezed out of the left ventricle, are almost asymptomatic and go unnoticed by those affected. In more severe forms of insufficiency, there is initially a high amplitude of blood pressure with, as a rule, very low diastolic pressure.
The next signs of a possible aortic valve insufficiency are noticeable physical loss of performance with increasing difficulty in breathing and cardiac arrhythmias, which can trigger occasional fainting attacks. If the insufficiency has persisted for a longer period of time, back pressure gradually sets in in the lungs and veins.
This leads to fluid retention in the body tissues and especially in the legs. Further symptoms are a so-called water hammer pulse, a rapid, strongly noticeable pulse that is based on very high blood pressure amplitudes of sometimes over 100 mmHg. In most cases, extrasystoles are also noticeable. In the case of untreated aortic valve insufficiency, an unconscious nod of the head to the rhythm of the pulse may occur.
Diagnosis & course
There are a number of diagnostic options for determining aortic valve insufficiency. The first method of choice is auscultation, because the insufficiency is noticeable by a typical diastolic sound (Austin-Flint sound). It is a rumbling noise that is clearly audible from about mid-diastole to the onset of systole.
Further diagnostic options are EKG , ultrasound , phonocardiography, X-rays and cardiac catheter examinations . If left untreated, the insufficiency can gradually lead to an expansion (dilation) of the left ventricle and a thickening of the outer heart muscle (eccentric hypertrophy) .
These physiological compensatory measures result in an increased oxygen requirement of the heart muscle and a decrease in performance, so that heart failure occurs. If left untreated, the course of the disease can lead to loss of physical performance and gradual changes in the left ventricle and heart muscles to life-threatening conditions.
Complications that arise as a result of untreated aortic valve insufficiency are based on an insufficient supply of the entire body with oxygen-rich, arterial blood. This also includes the central nervous system. Due to the leakage of the aortic valve, part of the blood that was pumped from the left ventricle into the aorta during systole flows back during diastole.
As a result, it mixes with blood, which also flows from the left atrium into the left ventricle during this phase. The accompanying complications depend very much on the degree of leakage or the amount of blood backflow. If the reflux is less than 20 percent of the originally squeezed volume, there are hardly any symptoms or complications.
In the case of higher-grade insufficiencies, complications such as loss of performance, shortness of breath , brief fainting spells after exercise, and often cardiac arrhythmias in the form of frequent extrasystoles or atrial fibrillation arise. If the aortic valve regurgitation persists for a longer period of time, there are additional complications. The left ventricle can expand and because the heart wants to compensate for the shortage of supply, the ventricular muscles of the left ventricle gradually thicken.
The compensatory measure ultimately leads to heart failure, which in turn can cause further complications such as water retention in the lower extremities and severe loss of performance, as well as congestion in the veins. The life-threatening conditions that arise in the further course of the disease can largely be avoided through early treatment.
When should you go to the doctor?
In the worst case, the aortic valve insufficiency can lead to the death of the patient and must therefore under no circumstances be left untreated. The symptoms cannot be felt directly in the heart, but are usually expressed through other restrictions in everyday life. Usually these are not particularly characteristic of the disease.
However, if you have heart problems or if you feel weak, a doctor should always be consulted. A medical examination is particularly necessary if you experience difficulty breathing. If the person concerned is also suffering from loss of consciousness and an increased heart rate, these symptoms can also indicate aortic valve insufficiency and should be examined.
Heart problems often lead to accumulations of water in different regions of the body. If the patient should therefore notice these accumulations, a doctor must also be consulted so that there is no consequential damage or death of the patient. In many cases, an unconscious nod of the head also indicates aortic valve insufficiency. Even if you are generally tired, exhausted and have reduced resilience, which occurs for no particular reason, a medical examination is definitely required.
Treatment & Therapy
With asymptomatic low blood return of less than 20 percent of the pumped blood, no treatment is necessary, but regular control is necessary in order to be able to initiate measures in good time if necessary. If an incipient dilatation of the left ventricle and a thickening of the wall muscles become apparent, surgical repair or surgical replacement of the aortic valve is necessary.
A number of options are available for this. Open heart surgery can be performed or, in certain cases, even minimally invasive via catheters. Basically – depending on the initial situation – there are options to change the leaky heart valve surgically so that it can perform its function again or that it is replaced by an artificial heart valve made of plastic or biological tissue.
Outlook & forecast
The aortic valve insufficiency can be classified as good with today’s medical possibilities. Some patients do not need any further therapy measures for their entire life, as they are able to lead an adequate life with the aortic valve insufficiency.
You experience restrictions or prohibitions, but the warning notices often move outside the comfort zone and thus do not lead to any real impairment. In addition to regular check-ups, it is possible that the sick perceive themselves to be very healthy and have adapted their lifestyle to the circumstances.
Patients in need of medical care also have good prospects of recovery. In a surgical procedure, the heart valve is corrected so that the heart is then fully functional again. The procedure is now very routine and can be completed within a few hours. After a few days, the patient is usually discharged from the hospital. After an appropriate rest period, he can participate in normal life again as usual and manage his everyday life independently.
Nevertheless, despite the positive outlook, the risks and side effects of an operation under general anesthesia must of course be taken into account. Good wound care is also essential on the healing path. After the operation, the patient has the task of incorporating precautionary measures and health-endangering restrictions into his everyday life. Sports activities must be adapted and extreme situations must be avoided in order not to cause overexertion.
There are no known preventive measures that could effectively prevent aortic regurgitation. Only the treatment of essential high blood pressure can also be considered a preventive measure, because the high blood pressure favors the development of insufficiency.
However, if an aortic valve insufficiency has been found that does not affect the person affected, a regular check of the wall thickness and volume of the left ventricle is recommended as a preventive measure, so that an operative measure can be carried out in good time before irreparable secondary damage occurs.
Follow-up care options are severely limited in the case of aortic valve insufficiency. In most cases, the patient is primarily dependent on treatment by a doctor so that there is no reduced life expectancy or a sudden stop of the heart. The earlier the aortic valve insufficiency is recognized, the higher the probability of a positive course of the disease.
In most cases, aortic valve regurgitation requires the patient to undergo surgery. Only then can the valve be repaired or replaced so that the heart can work again. The operation usually proceeds without complications and allows the person affected to live a symptom-free life.
After the surgery, the patient should rest and not engage in strenuous or physical activity. In general, unnecessary strain on the body or other stressful situations should be avoided in order not to strain the heart unnecessarily.
A healthy lifestyle can have a positive effect on the further course of the disease, whereby the person affected should pay particular attention to a healthy diet. A doctor should also be consulted immediately at the first signs of aortic valve regurgitation.
You can do that yourself
A necessary adjustment of behavior in everyday life to aortic valve insufficiency depends on the severity of the insufficiency. The degree of severity can reach levels I (mild) to IV (severe). The assignment of the insufficiency to one of the four degrees of severity depends on the proportionate amount of blood backflow into the left ventricle during the relaxation phase of the ventricles ( diastole ).
While stages III and IV usually require reconstructive interventions or the replacement of the heart valve to improve survivability and improve living conditions, significant improvements in well-being can be achieved in the lighter forms by adapting behavior and taking self-help measures. It is not known whether this can also influence the course of the disease. It almost goes without saying that the self-help measures also include severe restrictions on tobacco and alcohol consumption .
The most important part, however, is exercise and active sports. Sports that do not require uncontrollable top performance are best suited. Therefore, sports such as swimming, hiking, Nordic walking and kayaking as well as golfing on flat terrain are well suited. Most ball sports such as tennis, soccer and handball are not considered self-help measures.
It is also important to have a balanced diet to strengthen the immune system and avoid stressful situations that are too frequent . Relaxation techniques such as yoga , meditation, and autogenic training are recommended.