Aortic Insufficiency

(Aortic Regurgitation, Aortic Incompetence)
Definition
Aortic insufficiency occurs when blood leaks back into the heart’s aorta through the aortic valve each time the left ventricle relaxes. The aorta is the artery that carries oxygen-rich blood from the left ventricle (one of the heart’s pumping chambers) to the body. The aortic valve is the structure that controls the blood flow between the left ventricle and the aorta, closing after each heartbeat to keep blood from leaking back into the left ventricle.
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.

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, which could complicate your condition.