Definition

The left ventricle of the heart is a muscular chamber that pumps oxygen-rich blood from the heart to the entire body. The blood is pushed through the aortic valve into a major artery called the aorta. The valve closes tightly after each heart beat to keep blood flowing away from the heart and out to the body. In aortic insufficiency, the valve does not close tightly and blood leaks from the aorta back into the heart.

Most people with aortic insufficiency do not have any symptoms and may not need treatment. However, if you think you have aortic insufficiency, it is important to see your doctor because if your condition becomes severe, medical management and/or surgery may be needed.

	Aortic Valve Insufficiency
	© 2008 Nucleus Medical Art, Inc.

Causes

Aortic insufficiency can be caused by:

• A birth defect in which the aortic valve is bicuspid (two valves) instead of tricuspid (three valves)
• A hereditary disorder of the aortic valve
• Severe high blood pressure
• Bacterial infection of the aortic valve
• Injury to the aortic valve

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition. The following factors increase your chances of having aortic insufficiency. If you have any of these risk factors, tell your doctor:

• Gender: male
• Family history of aortic insufficiency

Symptoms

Aortic insufficiency may or may not have symptoms. If you experience any of these symptoms do not assume it is due to aortic insufficiency. These symptoms may be caused by other, less serious health conditions. If you experience any one of them, see your physician.

• Shortness of breath with activity
• Exercise intolerance
• Dizziness
• Chest pain
• Heart palpitations
• Heart arrhythmia (irregular heartbeat)
• Difficulty breathing when lying flat

Diagnosis

Your doctor will ask about your symptoms and medical history, and perform a physical exam. Tests may include the following:

• Chest x-ray —a test that uses radiation to take a picture of the chest.
• Echocardiogram —a test that uses high-frequency sound waves (ultrasound) to examine the size, shape, and motion of the heart and assess it’s valves in detail. This is usually done on the surface of the chest and is called a transthoracic echocardiogram. To look at the valve in more detail sometimes a transesophageal echocardiogram (TEE) is needed. With this procedure sedation is given and a small ultrasound probe is placed into the esophagus to take pictures of the heart.
• Electrocardiogram (ECG, EKG)—a test that records the heart’s activity by measuring electrical currents through the heart muscle.
• Cardiac catheterization —a tube-like instrument inserted into the heart through a vein or artery (usually in the arm or leg) to detect problems with the heart and its blood supply.

Treatment

Talk with your doctor about the best treatment plan for you. Treatment options include the following:

Surgery

If your aortic insufficiency is severe, your aortic valve can be surgically replaced with an artificial valve or, in rare cases, repaired without the need for a new replacement valve.

Medications

Medications can be used to manage the symptoms of aortic insufficiency. The type of medication used will depend on your symptoms. For example, diuretics can be used to treat high blood pressure and rid the body of excess fluids. Agents called calcium channel blockers, such as nifedipine, can reduce the leaking and in some cases delay the need for surgery. Other medications such as ACE-inhibitors and angiotensin receptor blockers may also work in this manner.

If you have less severe leaking of the valve, your physician may choose to follow you with repeat physical exams and a yearly echocardiogram.

Prevention

In most instances, aortic insufficiency cannot be prevented. If you are diagnosed with this condition, you will need to take antibiotics before undergoing dental or surgical procedures to prevent infection.

RESOURCES:

American Heart Association
http://www.americanheart.org/

National Heart, Lung, and Blood Institute
http://www.nhlbi.nih.gov/

CANADIAN RESOURCES:

Heart and Stroke Foundation of Canada
http://ww2.heartandstroke.ca/

University of Ottawa Heart Institute
http://www.ottawaheart.ca/UOHI/Welcome.do

References:

Aortic valve stenosis and insufficiency. American Heart Association website. Available at: http://www.americanheart.org/presenter.jhtml?identifier=11068 . Accessed November 29, 2006.

Coarctation of aorta. DynaMed website. Available at: http://dynamed102.epnet.com/Detail.aspx?id=115836 . Accessed November 27, 2006.

Congenital heart defects. National Heart, Lung, and Blood Institute website. Available at: http://www.nhlbi.nih.gov/health/dci/Diseases/chd/chd_what.html . Accessed November 27, 2006.

Congenital heart defects. Nemours Foundation website. Available at: http://www.kidshealth.org/parent/medical/heart/congenital_heart_defects.html . Accessed November 27, 2006.

Scognamiglio R, Rahimtoola SH, Fasoli G, Nistri S, Dalla Volta S. Nifedipine in asymptomatic patients with severe aortic regurgitation and normal left ventricular function. N Engl J Med. 1994;331:689.

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