Aortic Valve Regurgitation

What is Aortic Regurgitation?

Over time, this leaky aortic valve can strain the heart and may cause symptoms such as tiredness, breathlessness or chest pain. Severe cases often need valve repair or replacement.

The first sign of its presence may only be a heart murmur.

It does this by dilating and increasing in thickness over time. This then causes the heart to become inefficient, and the resulting volume overload from this can lead to leakage of the mitral valve.  

Acute aortic valve regurgitation often occurs as a result of a heart valve infection and is considered 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. 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.

Diagnosis

If you develop any symptoms, the doctor will review your health history, give you a physical exam and listen with a stethoscope for heart murmurs or lung congestion.

When your heart valve leaks, doctors use a heart ultrasound (echocardiogram) to measure the amount of blood flowing backwards. There are three levels of valve leakage: mild, moderate and severe.

Aortic Regurgitation Causes

Causes of aortic regurgitation include: 

• Congenital heart problems (10% – 15% of cases): Heart valve disease present at birth, like a bicuspid aortic valve (where the valve is made up of two flaps instead of three)

• Degenerative aortic calcification: Calcium deposits form on the valve as you get older. 

• Aortic root enlargement/aneurysm: The aorta can enlarge for unknown reasons, or due to conditions such as:
  – Annuloaortic ectasia
  – Marfan’s syndrome
  – Old age
  – Aortic dissection (where the lining of the major artery in the body, called the aorta,  tears apart)
  – Syphilitic aortitis

• Rheumatic fever: Damage from rheumatic fever that causes rheumatic heart disease, where the heart valve becomes irregular

• Infective endocarditis

• Connective tissue disorders

• Anorectic drug use 

• Trauma (chest injury, deceleration injury) 

• Jet lesions from subaortic stenosis

• Long-standing hypertension (high blood pressure)

The most common causes of acute aortic regurgitation are:

• Bacterial endocarditis

• Aortic dissection

• Blunt chest trauma

Less common causes:

• Non-bacterial endocarditis

• Aortic laceration

• Complications of invasive procedures (like valvuloplasty and balloon dilatation)

Aortic Valve Regurgitation Symptoms

The most common symptoms of aortic regurgitation include:

• Severe shortness of breath when exercising or lying down

• Feeling fatigued or weak – especially noticeable from increased physical activity

• Ankle and foot swelling

• Chest pain (angina) – discomfort or tightness in the chest 

• Light-headedness or feeling faint

• Irregular pulse (arrhythmia) or heart murmur

• Rapid or fluttering heartbeat (palpitations)

Seek expert medical advice as soon as possible, especially if any worsening symptoms occur.

Risk Factors & Complications of Aortic Regurgitation

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

• Any congenital heart or aortic disease that is present from birth (like a bicuspid valve)

• 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 aortic valve disease you may suffer from, such as aortic valve stenosis 

• Having high blood pressure

• Old age

• Some forms of arthritis, including rheumatoid arthritis and ankylosing spondylitis

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.

Aortic Regurgitation Treatment in London

Depending on the severity of your symptoms, medical therapy can be an effective treatment used to control the symptoms for many years. If the condition worsens, surgery will be the next step in treating the condition. 

Medication

In many cases, if a patient shows no or only mild aortic regurgitation symptoms, regular monitoring will be recommended, paired with medication such as: 

• Vasodilators

• ACE inhibitors

• Diuretics

Keyhole Aortic Regurgitation Surgery Treatment Options

Here at The Keyhole Heart Clinic, we are happy to offer keyhole surgery to treat aortic valve regurgitation, meaning quicker healing and less intrusive methods.

We perform all types of aortic regurgitation surgery in London at The Harley Street Clinic and The Wellington Hospital.

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 surgical treatment for aortic regurgitation:

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

Ministernotomy AVR

The traditional approach to aortic valve replacement is via a full breastbone break, as demonstrated in the graphic. This is an intrusive option, and thanks to advancements in medical procedure technology, it can be avoided.

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 aorta valve ring or those with aneurysm formation of the aorta. 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.

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The Keyhole Heart Clinic: Minimally Invasive Aortic Treatments

With over 20 years of experience in keyhole surgery, we provide the most advanced aortic regurgitation treatment options for those diagnosed with aortic valve regurgitation.

Renowned cardiologist Mr. Inderpaul Birdi leads our clinic and specialises in keyhole cardiac procedures, which use smaller incisions than traditional surgery. These include:

• Keyhole coronary bypass surgery
• Keyhole tricuspid valve replacement
• Keyhole aortic valve replacement
• Keyhole atrial fibrillation ablation
• Keyhole atrial septal defect closure

We also offer heart screening services.

If you have any questions about Aortic Valve Regurgitation or any of our keyhole surgeries, please feel free to get in contact with us. A member of our medical team will be in touch as soon as possible.