Aortic Regurgitation

What are the Aortic Regurgitation Causes?

More than 50% of cases of Aortic Regurgitation causes are due to a weakness in the main outflow tract of the heart leading to dilatation of the ring or “annulus” of the aortic valve. This “annuloaortic ectasia” forces the three aortic valve leaflets apart, producing leakage. Senile aortic calcification is where calcium deposits form as you get older on the valve. When this happens, it prevents both the opening and closing function to work properly.

In addition, the aorta can enlarge and become aneurysmal. The cause of aortic root enlargement is unknown in most instances, but it can also be associated with other conditions such as Marfan’s syndrome, old age, and aortic dissection (where the lining of the major artery in the body called the aorta tears apart). Other conditions producing Aortic Valve Regurgitation include rheumatic fever, infective endocarditis, and connective tissue disorders.

Bicuspid Aortic Valve Symptoms

In 10% – 15% of cases of Aortic Valve Regurgitation, the aortic valve is “bicuspid” leading to bicuspid valve surgery. A bicuspid valve is made up of two leaflets rather than three leaflets, with the turbulent flow of blood across this bicuspid valve leading to premature destruction of the valve leaflets. Bicuspid aortic valve symptoms are caused due to the presence of aortic wall weakness which can lead to aortic root aneurysm. In this condition, it is often the aorta rather than the aortic valve that is the problem which needs correcting, but in many cases bicuspid aortic valve repair can be performed to save it. Commonly, many people will not develop bicuspid aortic valve symptoms and problems until later in life, but the symptoms can start to show earlier.

Bicuspid aortic valve replacement will normally be recommended if the bicuspid aortic valve symptoms worsen and would involve the damaged valve being removed and replaced with a mechanical or biological tissue valve. Regular monitoring to review signs and symptoms, with an echocardiogram to diagnose a bicuspid valve, will determine if bicuspid aortic valve replacement is eventually needed. If bicuspid valve surgery is recommended as treatment, it will depend on a patient’s condition if bicuspid aortic valve repair or a replacement is needed.

What are the Aortic Regurgitation Symptoms?

Acute (sudden onset) Aortic Valve Regurgitation is a serious condition which produces sudden heart failure. Acute Aortic Valve Regurgitation often occurs as a result of infection of the valve, and if this happens, it is a surgical emergency. If it isn’t treated quickly, an aortic regurgitation murmur can have a high mortality rate. Fortunately, this is not very common and in most cases with the right expert medical attention, the consequences of acute aortic valve regurgitation can be resolved and surgical treatment can be planned. The most common Aortic Regurgitation symptoms that patients should look out for when it begins to worsen includes:

• Severe shortness of breath when exercising or lying down
• Feeling fatigued or weak – especially noticeable from increased activity
• Ankle and feet swelling
• Chest pain (angina) – discomfort or tightness in the chest
• Light-headedness or feeling faint
• An irregular pulse (arrhythmia) or heart murmur
• A rapid or fluttering heartbeat (palpitations)

Chronic Aortic Regurgitation (slow onset), is much better tolerated since a patient’s heart has time to accommodate to the gradually worsening leakage of the aortic valve. It does this by dilating and increasing in thickness over time. This then causes the heart to become inefficient and the volume overload resulting from this can lead to leakage of the mitral valve. Chronic Aortic Regurgitation symptoms are similar and include shortness of breath, swollen legs, and palpitations.

What Are the Risks & Complications Associated with Aortic Regurgitation?

Among the risks and complications of suffering from an Aortic Regurgitation murmur, it highlights the need to seek expert medical advice as soon as possible, especially if any symptoms begin to worsen. Our expert medical team have the experience and attention to care that patients seek so that the Aortic Regurgitation causes can be resolved in the right way.

Risk factors that increase the chances of suffering an aortic regurgitation murmur include:

• Any congenital heart disease that is present from birth
• A family history of aortic aneurysm or aortic valve regurgitation
• A history of infections that can affect heart health
• If you suffer from existing conditions such as Marfan Syndrome
• Any other heart valve conditions you may suffer from such as aortic valve stenosis
• Having high blood pressure
• Old age

If you have already been diagnosed with aortic valve regurgitation or suffer from aortic root enlargement, complications that can arise (but are not definite) can include heart failure, infections of the heart such as endocarditis, heart rhythm abnormalities and even death if left untreated. We are here to provide invaluable advice and aortic regurgitation treatments suitable for your condition. If you have any concerns then please get in touch.

What Aortic Regurgitation Treatment is Available?

Depending on the severity of your symptoms, medical therapy can be used to control the Aortic Regurgitation symptoms for many years. Drugs such as vasodilators, ACE inhibitors, and diuretics are commonly used to deal with Aortic Valve Regurgitation and in many cases if a patient shows no or only mild symptoms, regular monitoring will be recommended. If the condition worsens, then surgery will be the next step to treat the condition. The presence of aortic aneurysm should be excluded with either an echocardiogram or a CT scan. If there is evidence of heart enlargement, surgery will also be required.

Aortic Valve Regurgitation Surgery

In the presence of severe Aortic Regurgitation symptoms, expert advice will be needed to decide on the best course of surgical treatment. Any one of the following associated features indicates a patient may experience life enhancing benefits by undergoing aortic regurgitation treatment:

• The presence of symptoms despite undergoing the best medical therapy
• Severe dilatation of the left ventricle
• Reduced efficiency of contraction of the left ventricle
• Presence of aortic aneurysm

We perform all types of Aortic Valve Regurgitation Surgery in London at The Harley Street Clinic and The Wellington Hospital.

All patients with severe aortic valve regurgitation should be presented at an expert multidisciplinary team meeting and be considered for aortic valve repair. If this is not possible, the  aortic valve replacement will be performed. The team at The Keyhole Heart Clinic can make all of these assessments for you as we have one of the best team of individuals at hand to help and advise.

Aortic regurgitation associated with aortic aneurysm formation needs surgery as soon as possible. This is indicated once the diameter of the aorta becomes greater than 4.5 cm and earlier if the valve is bicuspid rather than tricuspid. In many cases, the aortic valve can be preserved by performing aortic valve sparing aortic root replacement (David Procedure).

Testimonial Aortic Valve Repair – TT 2020

“My husband had an aneurysm in his aortic artery… Basically a ticking time bomb.  To cut a long story short, I somehow found our saviour, Mr Birdi! He performed an eight hour operation and without causing major trauma [keyhole] to the chest. He also saved the healthy aortic valve, when other consultants had suggested replacing it. If you need a heart surgeon this is your guy!! This isn’t just a profession to him, he is so very, deeply passionate about his patients and what he believes in.  We have seen Mr Birdi more recently for check ups and he remains as vigilant and caring as ever. We simply cannot thank him enough.. From the bottom of our ❤️”

The David Procedure, named after the surgeon who conceived the operation, is where the patient’s aortic valve is not removed and reconnected to a replacement man made tube that is used to replace the enlarged aorta. We perform this procedure at The Keyhole Heart Clinic.

Ministernotomy AVR

The traditional approach to the aortic valve replacement is via a full breastbone break, demonstrated in the graphic. This is an intrusive option and thanks to advancements in medical procedure technology, can be avoided. Experienced surgeons, like our team here at The Keyhole Heart Clinic, can perform Aortic Valve Regurgitation surgery using a keyhole method. This means there will be significantly smaller breastbone incisions.

This allows for improved healing, greater bone stability, and much more subtle and aesthetically pleasing cosmetic results, as demonstrated by the small scar on the right of the graphic. Please do note however that the small breastbone incision still requires 12 weeks to heal fully.

Anterior Right Thoracotomy AVR

Anterior Right Thoracotomy AVR is an even more advanced Aortic Valve Regurgitation surgery procedure, that involves a small incision between the ribs on the right side of the chest. This means that no bones are divided; an approach that is very popular with patients since it heals in a few days rather than 3 months. Due to the procedure being very complex, it requires the experience and specialist skillset that our medical team can offer here at The Keyhole Heart Clinic.

Transcatheter Aortic Valve Implantation (TAVI)

TAVI is not suitable for patients with a dilated aortic valve ring or in those with aneurysm formation of the aorta pipe. This option is generally considered for patients who are classified as too ‘high risk’ for any standard valve replacement surgery. It involves a replacement valve being inserted into the aortic valve’s place without removing the existing damaged valve. The TAVI procedure is minimally invasive and typically has a shorter downtime for patients.

Speak to the Experts Here at The Keyhole Heart Clinic

With our over 15 years’ experience in keyhole surgery, we are best placed to provide the most advanced aortic regurgitation treatment options for those diagnosed with Aortic Valve Regurgitation. If you have any questions about Aortic Valve Regurgitation, or any of our keyhole surgeries, please feel free to get in contact with us, and a member of our medical team will be in touch as soon as possible.