February 23, 2023 Author : José Roquette The aortic valve is one of the heart four valves. It separates the left ventricle from the aorta; It opens when the ventricles contract (ventricular systole) so that blood flows from the left ventricle to the aorta; It closes in ventricular diastole to prevent blood from flowing back from the aorta into the left ventricle. What is aortic regurgitation or insufficiency? In aortic regurgitation or insufficiency, there is reflux of blood from the aorta to the left ventricle , that is, in the direction opposite to normal one. This happens because the aortic valve does not close well in ventricular diastole. When this happens, there is an overload of the left ventricle , because in ventricular diastole it receives blood simultaneously from: The left auricle, as is normal; The aorta (regurgitation). The greater volume of blood in the ventricles and the greater pressure it exerts on their walls require a greater effort of ventricles to contract. To compensate, the walls of the ventricles increase in thickness and the chambers of the ventricles increase in volume . In the area where the blood impacts the ventricle, the normal myocardium can suffer fibrosis and no long contractile capacity, which over time can lead to the development of heart failure . What are the causes of aortic regurgitation? Aortic valve insufficiency or regurgitation may be due to: Lesions or defects of the valve itself, sometimes congenital, for example a bicuspid valve; Dilation of the initial portion of the aorta artery (aortic root) surrounding the valve, pulling the valve outwards and creating central regurgitation due to the non-coaptation of the valve leaflets; Infectious and non-infectious diseases, for example rheumatic fever, syphilis, infective endocarditis. Symptoms and diagnosis Aortic regurgitation can be: Acute , when it occurs suddenly. Its severity is variable. It may cause no symptoms or more often give rise to severe symptoms of heart failure and cardiogenic shock. Chronic , when it develops over time. In this case, aortic insufficiency may not have symptoms for a long time. When symptoms begin, they are progressive, including: Difficulty breathing (dyspnea), usually during the night, particularly associated with exercise or physical exertion; Chest pain. The diagnosis can be accidental, for example following an auscultation performed in a routine consultation in which a murmur is identified that results from the failure to completely close the aortic valve. If there is a suspicion of aortic insufficiency, other tests should be carried out: Electrocardiogram and echocardiogram In some cases, a cardiac CT-scan or a cardiac computed tomography; Cardiac catheterization, essential for the treatment as this is sometimes associated with coronary disease. Treatment of aortic regurgitation Treatment of aortic regurgitation may involve repairing or replacing the aortic valve . Regular follow-up of patients with chronic aortic insufficiency makes it possible to determine whether they are candidates for valve replacement, as well as the appropriate time to do it. In severe acute cases, urgent intervention may be required to repair or replace the damaged valve. Repair or replacement of the aortic valve can be d one by conventional surgery with sternotomy (open chest) or , more recently, by percutaneous procedures . Percutaneous procedures are an alternative to open surgery with a faster recovery and with special advantages in patients who have a high surgical risk due to associated pathology or advanced age. Meet the cardiac surgery clinical team from Hospital da Luz network. The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
