Aortic Valve Insufficiency

Definition

The aortic valve separates the left ventricle of the heart (the heart's largest pumping chamber) from the aorta, the large artery that carries oxygen-rich blood out of the left ventricle to the rest of the body. In aortic valve insufficiency, the aortic valve becomes leaky, causing blood to flow backwards into the left ventricle.

Description

Aortic valve insufficiency occurs when this valve cannot properly close after blood that is leaving the heart's left ventricle enters the aorta. With each contraction of the heart more and more blood flows back into the left ventricle, causing the ventricle to become overfilled. This larger-than-normal amount of blood that collects in the left ventricle puts pressure on the walls of the heart, causing the heart muscle to increase in thickness (hypertrophy). If this thickening continues, the heart can be permanently damaged.

Aortic valve insufficiency is also know as aortic valve regurgitation because of the abnormal reversed flow of blood leaking through the poorly functioning valve.

Causes and symptoms

The faulty working of the aortic valve can be caused by a birth defect; by abnormal widening of the aorta (which can be caused by very high blood pressure and a variety of other less common conditions); by various diseases that cause large amounts of swelling (inflammation) in different areas of the body, like rheumatic fever ; and, although rarely, by the sexually transmitted disease, syphilis.

About 75% of people with aortic valve insufficiency are men. Rheumatic (inflammatory) diseases have been the main cause of this condition in both men and women.

Aortic valve insufficiency can remain unnoticed for 10 to 15 years. In cases of severe insufficiency a person may notice a variety of symptoms, including an uncomfortable pounding of the heart when lying down, a very rapid or hard heart beat (palpitations), shortness of breath, chest pain, and if untreated for very long times, swelling of the liver, ankles, and belly.

Diagnosis

A poorly functioning or insufficient aortic valve can be identified when a doctor listens to the heart during a physical examination. A chest x ray, an electrocardiogram (ECG, an electrical printout of the heart beats), as well as an echocardiogram (a test that uses sound waves to create an image of the heart and its valves), can further evaluate or confirm the condition.

Treatment

Aortic insufficiency is usually corrected by having the defective valve surgically replaced. However, such an operation is done in severe cases. Before the condition worsens, certain drugs can be used to help manage this condition.

Drugs that remove water from the body, drugs that lower blood pressure, and drugs that help the heart beat more effectively can each be used for this condition. Reducing the amount of salt in the diet also helps lower the amount of fluid the body holds and can help the heart to work more efficiently as well.

In cases of a severely malfunctioning valve that has been untreated for a long time, surgery is the treatment of choice, especially if the heart is not functioning normally. Human heart valves can be replaced with man-made valves or with valves taken from pig hearts.

Prognosis

Although drug treatment can help put off the need for surgical valve replacement, it is important to replace the faulty valve before the heart muscle itself is damaged beyond recovery.

Resources

PERIODICALS

Condos Jr., William R. "Decade-old Heart Drug May Have a New Use." San Diego Business Journal 18 (21 July 1997): 24.

ORGANIZATIONS

American Heart Association. 7320 Greenville Ave. Dallas, TX 75231. (214) 373-6300. 〈http://www.americanheart.org〉.

National Heart, Lung and Blood Institute. P.O. Box 30105, Bethesda, MD 20824-0105. (301) 251-1222. 〈http://www.nhlbi.nih.gov〉.

KEY TERMS

Rheumatic fever— A disease believed to be caused by a bacterium named group A streptococcus. This bacterium causes a sore "strep throat" and can also result in fever. Infection by this bacterium can also damage the heart and its valves, but how this takes place is not clearly understood.