Aortic valve insufficiency
Aortic valve insufficiency (AVI) is also called aortic insufficiency or aortic regurgitation. This condition develops when the aortic valve is damaged. It’s more common in men than women.
The aortic valve is the final valve blood passes through when it exits the heart. It’s full of fresh oxygen and nutrients to be delivered to the rest of your body.
When the aortic valve doesn’t close all the way, some of the blood flows backward instead of out to the aorta and the body. This means the left ventricle never quite empties of blood before the next load of blood arrives from the left atrium.
As a result, the left ventricle must expand to accommodate the leftover blood and the new blood. The heart muscle also has to work extra hard to pump out the blood. The extra work strains the heart muscle and raises the blood pressure in the heart.
Despite all of the extra effort, the heart still cannot pump enough blood to keep the body well-oxygenated. This condition will make you feel tired and out of breath easily. Over time, it can take a serious toll on your heart and overall health.
Aortic valve insufficiency can be present without many noticeable symptoms for years. As the damage progresses, the symptoms can appear suddenly, including:
- chest pain or tightness that increases with exercise and subsides when you’re at rest
- heart palpitations
- shortness of breath
- difficulty breathing when lying down
- swollen ankles and feet
In the past, rheumatic fever was a common cause of damage to the heart valves. Today, we know of many other causes, including:
- congenital valve defects, which are defects you’re born with
- infections of the heart tissue
- high blood pressure
- genetic conditions such as Marfan’s syndrome, which affects the connective tissues
- untreated syphilis
- heart aneurysms
- ankylosing spondylitis, which is a form of inflammatory arthritis
Diagnostic tests for aortic insufficiency generally include:
- an office exam
- diagnostic imaging
- cardiac catheterization
During the office exam, your doctor will take a complete medical history. They’ll also listen to your heart, review your pulse and blood pressure, and look for indicators of heart valve problems, such as:
- an unusually forceful heartbeat
- visible pulsing of the neck artery
- a “water-hammer” pulse, which is a pounding pulse that’s typical of aortic insufficiency
- sounds of blood leaking from the aortic valve
After the initial exam, you may be referred for other diagnostic tests, including:
- a chest X-ray to spot enlargement of the left ventricle, which is typical of heart disease
- an electrocardiogram (EKG) to measure the electrical activity of the heart, including the rate and regularity of heartbeats
- an echocardiogram to view the condition of the heart chambers and heart valves
- cardiac catheterization to assess the pressure and flow of blood through the heart chambers.
These tests allow your doctor to confirm the diagnosis, determine the extent of damage, and decide on the most appropriate treatment.
If your condition is mild, your doctor may recommend regular heart monitoring and improving your health habits to reduce the load on your heart. Losing weight, exercising, and eating a healthy diet can reduce blood pressure and lower your chances of complications.
If you have advanced aortic disease, you may need surgery to repair or replace the aortic valve. Two types of aortic valve surgery are valve replacement and valve repair, or valvuloplasty. Your doctor may replace the aortic valve with a mechanical valve, or one from a pig, cow, or human cadaver.
Both surgeries may require open-heart surgery with a fairly lengthy recovery period. In some cases, the surgery can be performed endoscopically, or through a tube inserted into your body. This greatly reduces your recovery time.
Once your aortic valve is repaired, your prognosis is generally good. However, you’ll always need to guard against and respond quickly to any type of infections that could spread to your heart. People who have had their aortic valve repaired are more likely to need surgery if their hearts become infected than people who have their original heart valves.
Both dental disease and strep throat can cause heart infections. You should practice good oral hygiene and get immediate medical help for any dental problems or severe sore throats that arise.