Generality
Aortic insufficiency is a particular pathological condition in which the heart's aortic valve is not functioning properly, allowing blood to flow back from the aorta to the left ventricle.
Figure: the heart and aortic valve, during aortic insufficiency. Blood flow flows back through the aortic valve, returning to the left ventricle. From the site: //en.wikipedia.org
This reflux is caused by a malformation of the aortic valve, which does not close more tightly.
The valve defect is often linked to congenital syndromes or autoimmune diseases developed during the course of life. It is not excluded, however, that there may be other motivations.
The diagnosis of aortic insufficiency is based on a stethoscopic examination, very rapid and almost always reliable. The therapy depends on the severity of the condition, for example the most severe cases are also treated by cardiac surgery.
Brief anatomical reference: the heart and heart valves
The heart is composed of two halves, right and left. The right half is formed by the right atrium and by the underlying right ventricle . The left half is formed by the left atrium and by the underlying left ventricle .
Each ventricle has two valves with a particular anatomy:
- The right ventricle has
- the tricuspid valve, which controls the incoming blood coming from the right atrium
- and the pulmonary valve, which allows the blood to escape and reach the lungs.
- The left ventricle possesses
- the mitral valve, which controls the incoming blood coming from the left atrium
- and the aortic valve, which allows blood to flow out and flush the body's tissues and organs.
The valves therefore control the passageways of the blood, functioning as gates. To do this, they use special structures, called flaps or cusps, which can open and close as needed.
THE AORTIC VALVE
The aortic valve is the valve that allows oxygenated blood to pass from the left ventricle to the aorta, through which it will be distributed to the tissues and organs of the body. It is formed by three flaps.
What is aortic insufficiency?
With the term aortic insufficiency, or aortic regurgitation, a particular pathological condition is identified in which the aortic valve of the heart no longer closes hermetically. This means that, as the blood enters the aorta, part of it returns back to the left ventricle, complicating the normal course of blood circulation.
The aortic insufficiency corresponds, therefore, to a malformation of the aortic valve, which, depending on the case under examination, can be more or less serious.
Causes
The causes that cause the aortic valve to malfunction can be of two types:
- Congenital, if the valve malformation is present from birth.
- Acquired, if the valve malformation develops over a lifetime; for example for old age or after an autoimmune disease, a bacterial infection, an inflammation etc.
The main congenital diseases associated with aortic insufficiency:
- Marfan syndrome
- Ehlers-Danlos syndrome
CONGENITAL NATURE OF CARDIAC DEFECT
The congenital defect of the aortic valve can be of a pathological or idiopathic nature (where, due to idiopathic, we mean the absence of a precise cause).
In both cases, the valve does not have the usual anatomical structure: in fact, instead of three cusps (or flaps), it is formed by only one or two flaps.
ACQUIRED CAUSES
An individual who is born with a normal and healthy heart may be subject, during the course of life, to pathological states that modify the anatomy of the aortic valve and the region presided over by it.
In these cases, the cusps are always three, but undergo structural changes such that they no longer close the passage between the left ventricle and the aorta. Alternatively, if the cusps are not modified, the caliber of the aorta can increase, at the point where it is joined to the heart.
The diseases and / or potentially responsible pathological conditions are numerous. These are often autoimmune diseases, but it is possible that valvular regurgitation may depend on bacterial infections or inflammatory states of the heart muscle.
The main diseases responsible for aortic insufficiency:
- Rheumatic fever
- Rheumatoid arthritis
- Ankylosing spondylitis
- Reiter syndrome
- Endocarditis
- Syphilis
Symptoms and Complications
The symptoms and signs of aortic insufficiency depend on the severity of the insufficiency itself. In other words, the more the regurgitation of blood is voluminous, the more the patient will feel the heart disorder; conversely, if the anatomy of the aortic valve is not seriously compromised, aortic insufficiency may not even cause any obvious symptoms.
Three degrees of severity have been recognized:
- Mild aortic insufficiency . The symptomatology is often absent.
- Moderate aortic insufficiency . In these conditions, the heart struggles to send blood into the circulation, because the latter goes back from the aorta to the left ventricle. The patient complains of dizziness, pain in the chest (angina pectoris from poor blood supply to the coronaries) and palpitation. The hard work done by the heart can lead to hypertrophy of the left ventricle.
- Severe aortic insufficiency . The conditions in which the heart is affected are worse than the previous ones. The following symptoms are added: dyspnea, shortness of breath, sense of tiredness and water retention in various parts of the body.
COMPLICATIONS
When aortic insufficiency is severe, the patient may experience heart failure, a serious pathological condition that compromises the functions of the heart. Heart failure is the main complication of aortic regurgitation.
Diagnosis
The diagnosis of aortic insufficiency can be established either by a simple stethoscopic examination, or by more thorough examinations, such as the electrocardiogram (ECG) or an echocardiogram.
STETHOSCOPIC EXAMINATION
Aortic insufficiency is detectable by a stethoscope, as it produces particular heart murmurs during each heartbeat. In fact, these noises originate whenever the blood, pumped in circulation by the cardiac organ, passes through the defective aortic valve. For this reason, they are considered the most important signs of the disease, even when it occurs in a mild and asymptomatic form.
ELECTROCARDIOGRAM (ECG) AND ECOCARDIOGRAM
The ECG of a patient with aortic insufficiency is particular and the resulting trace contains a lot of useful information for diagnosis.
The echocardiogram is, in fact, an ultrasound of the heart, which shows its anatomy. Therefore, if there are aortic valve defects, these are detected by the examination. The echocardiogram is also able to show the possible hypertrophy of the left ventricle (a characteristic sign of the fatigue carried out by the heart in pumping circulating blood).
Both examinations are not invasive.
Treatment
The therapy implemented in cases of aortic insufficiency depends on the severity of the insufficiency itself.
In fact, for the mild and asymptomatic forms, no treatment is foreseen, but only the periodic monitoring of the situation. In this way, if a deterioration occurs, it is identified in time.
For moderate forms, instead, a pharmacological treatment should be set up, which serves to moderate the symptoms or keep them stable.
Finally, for the more serious forms, in addition to drugs, cardiac surgery also becomes vital.
DRUGS
The main drugs, administered in case of aortic insufficiency, are:
- Diuretics : act against water retention, improving the patient's general health. Useful for preventing heart failure.
- ACE inhibitors : reduce the workload to which the heart is subjected, thus preventing heart failure.
CARDIAC SURGERY
The surgical procedure, which is usually used, consists in replacing the defective aortic valve with a mechanical or biological prosthesis.
Before and after the operation, it is very important to give the patient antibiotics, as a preventive measure against endocarditis. Endocarditis is not a trivial infection and, if it occurs, should be treated immediately; neglecting them could mean compromising the functionality of the new valve and of the heart in general.
Prognosis
What has been said for therapy also applies to the prognosis: it depends on the severity with which the aortic insufficiency occurs.
It is clear, in fact, that the worse the valve defect is, the worse the prognosis will be.
However, it should not be forgotten that a mild / moderate form of the disorder can turn into a more severe form, especially if it is not taken care of.
Heart surgery offers significant benefits and, in most cases, ends positively. Therefore, it is advocated by the doctor, especially when aortic insufficiency is severe and does not grant other therapeutic alternatives.
