Aortic valve disease and surgery

Aortic regurgitation, or aortic insufficiency or aortic incompetence, is when blood flows backward from a widened or weakened aortic valve into the heart's lower chamber (the left ventricle). In the United States, the most serious form of this disease is caused by an infection that leaves holes in the valve leaflets.

Causes of aortic regurgitation
Aortic regurgitation is most common in men between the ages of 30 and 60. In adults, the most common cause of severe aortic regurgitation is rheumatic fever. Mild cases are often caused by a bicuspid aortic valve (where the valve has two leaflets instead of three) and severe high blood pressure (a diastolic pressure more than 110 mm Hg). Other causes, though rare, may include:

• Ankylosing spondylitis (arthritis of the spine)

• Aortic stenosis, a narrowing of the aortic valve that often causes some degree of aortic regurgitation

• Dissecting aortic aneurysm

• Endocarditis

• Marfan syndrome, a connective tissue condition where patients have long bones and very flexible joints

Symptoms of aortic regurgitation
Like other valve defects, symptoms may not appear for years. When they do appear, they can come on slowly or suddenly. Symptoms begin because the left ventricle has to work harder. In time, the ventricle gets larger and fluid backs up. Symptoms may include:

• Chest pain that gets worse with exercise and goes away with rest

• Fast or fluttering pulse

• Fatigue

• Shortness of breath

• Swelling in the ankles

Severe cases can lead to heart failure. In most of these cases, the aortic valve will eventually need to be replaced to fix the backflow of blood into the left ventricle.

Aortic stenosis is a narrowing or blockage of the aortic valve, which happens when the valve leaflets become coated with deposits. The deposits change the shape of the leaflets and reduce blood flow through the valve. The left ventricle has to work harder to make up for the reduced blood flow, which can weaken the heart muscle over time.

Causes of aortic stenosis
Aortic stenosis is more common in men. Congenital defects (those you are born with) and rheumatic fever are the main causes of aortic stenosis in people under 50.

In some cases, people are born with a bicuspid aortic valve, meaning the valve has two leaflets instead of three, which may also cause aortic stenosis.

In elderly patients, calcium deposits and the growth of fibrous tissue on the aortic valve can distort the leaflets or cause them to fuse together. This is called calcification, and it can make the different leaflets almost look like a single leaflet.

Other causes include a history of other valve diseases, coronary artery disease or a heart murmur.

Symptoms of aortic stenosis
People with aortic stenosis may not have symptoms for years. When symptoms do appear, they may include:

• Angina-like chest pain that gets worse with exercise and goes away with rest

• Coughing

• Fainting, especially during exercise

• Heart palpitations (the feeling that the heart has skipped a beat)

• Shortness of breath

Patients who have aortic stenosis are advised not to exercise too hard. Those with mild aortic stenosis may not need further treatment beyond regular doctor visits. Surgery to replace the valve is the treatment of choice for people with severe aortic stenosis.