Download Aortic Valve Regurgitation The aortic valve is one of four valves that

Aortic Valve Regurgitation
The aortic valve is one of four valves that regulate blood flow through the heart. The
aortic valve is located between the left lower chamber of the heart (left ventricle) and the
aorta, which is the vessel that carries blood to the rest of the body.
Aortic regurgitation occurs when the flaps (leaflets) of the aortic valve do not close
properly, allowing blood to leak backward into the left ventricle. Over time, a leaking
aortic valve decreases the amount of blood flow to the body and increases the work of
the heart. In addition, the aorta may become enlarged in patients with aortic
regurgitation. This can also lead to the aortic valve leaflets not closing properly.
Patients with aortic regurgitation rarely have symptoms until the valve is severely
leaking. These symptoms include difficulty breathing, trouble exercising and fatigue.
Your doctor will often recommend treatment for severe aortic regurgitation before you
develop symptoms. Severe aortic regurgitation over time can lead to serious heart
complications, particularly failure of the left ventricle.
Treatments for Aortic Regurgitation
Depending on the severity of your aortic regurgitation, your cardiologist may
recommend the following:
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Medications
Surgical treatments
Non-surgical, less invasive treatments
Medications
No medications have been proven to help the flaps of the aortic valve close properly.
However, your doctor may recommend medications to help reduce the symptoms of
aortic regurgitation.
If you are diagnosed with mild (grade 1) or moderate (grade 2) aortic regurgitation, your
doctor may decide the best approach is to continue monitoring your condition and
prescribe drugs to help treat its symptoms. These medications may include the
following:
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Diuretics, drugs that help reduce fluid accumulation in your body by increasing
fluid loss through urination.
Medications (antihypertensive medication) to decrease high blood pressure,
which can complicate aortic regurgitation. One or more of these medications may
be prescribed to help manage your blood pressure:
o Beta blockers, which act to reduce heart rate and the heart’s output of
blood
o Vasodilators, which act to dilate (widen) blood vessels. Examples include
ACE inhibitors and calcium channel blockers

Antibiotics, or drugs that kill bacteria may help prevent or treat endocarditis, an
infection of the heart valves. However, the American Heart Association no longer
recommends that people with leaky heart valves take antibiotics prior to routine
dental cleaning.
Even if you are on medications, you may notice an increase in fatigue or shortness of
breath. If this occurs, you should let your doctor know immediately.
Surgical Treatments
If you are diagnosed with moderate to severe (grade 3) or severe (grade 4) aortic
regurgitation, your doctor may recommend a surgical treatment.
One measure used to determine whether a surgical approach should be taken is called
the “ejection fraction.” The ejection fraction measures the fraction of blood your heart’s
left lower chamber is able to pump out to the body during a heartbeat.
Surgery is recommended to treat the aortic valve if the ejection fraction drops below 60
percent, or if the left ventricle is enlarged (larger than 50 millimeters). Your doctor may
recommend surgical treatment of the valve if these changes in your left ventricle are
detected by ultrasound, even if you do not have symptoms. Depending on your
condition, your doctor may recommend:


Valve repair, or
Valve replacement
Valve repair, when possible, is preferred over valve replacement.
What to expect during valve surgery. Before surgery, you will receive a general
anesthetic, which is a medicine that will put you into a deep sleep during the procedure.
Your doctor will make an incision (cut) along the length of your breastbone (the flat bone
in the center of your chest) to expose your heart. You will be connected to a heart-lung
machine, which will take over your breathing and blood circulation during the surgery.
The surgeon will stop your heart, make a cut in it to expose the valve, then repair or
replace the valve.
Aortic valve repair. Various techniques may be used alone or in combination to repair
the aortic valve:
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Leaflet reconstruction: The surgeon will “remodel” the valve by removing or
adding to the leaflet tissue that is present.
Aorta reconstruction: The surgeon may replace or remodel part of the aorta if it is
enlarged and re-suspend the aortic valve leaflets within the new aorta.
Aortic valve replacement. If your valve cannot be repaired and it must be replaced,
your surgeon will implant an artificial, or prosthetic, valve. An artificial valve can be
mechanical (made of metallic components) or tissue.
Mechanical valves
 Mechanical valves are devices made of metallic materials, such as titanium.
They offer life-long durability. The main risk with mechanical valves is blood clot
formation (thromboembolism). In order to prevent blood clots, you will need to
take blood thinners for the rest of your life after receiving a mechanical valve.

A secondary risk is associated with taking the blood-thinning medications. Bloodthinning medications increase the risk of bleeding. If the blood-thinning drugs
make the blood too “thin,” you can experience excessive bleeding, even with
minor cuts. If the blood is too “thick,” clots can form on the valve. If a clot later
breaks off, it may lodge in the blood vessels to the heart or brain and cause heart
attack or stroke.
Tissue valves
 Tissue valves are made of valve tissue taken from a cow (bovine), pig (porcine)
or human cadaver (homograft). Because they do not encourage blood clot
formation, patients who receive tissue valves do not need to take blood-thinning
medicines.

However, tissue valves have not historically been as long lasting as mechanical
valves. A tissue valve (also called a bioprosthetic) can wear out over a period of
10 to 15 or more years. If it deteriorates significantly, it must be replaced.
Replacement, of course, requires repeat surgery, with its associated risks.
Because of durability concerns, tissue valves are implanted primarily in older
patients. However, newer tissues valves have improved steadily and are being
used more and more frequently.
Risks of aortic valve surgery
 Death. The overall mortality risk (risk of death) for heart valve surgery is about 5
percent (5 out of every 100 patients).
 Irregular heartbeat or arrhythmia. Arrhythmias can make you tired or short of
breath and put you at risk of blood clots. You may need to take anticoagulant
(blood thinning) medications to lower the risk of blood clots.
 Infection. After valve surgery, you may be prone to endocarditis, an infection or
inflammation of the heart valves. It occurs when bacteria enter the bloodstream
and infect damaged valve leaflets. People who have abnormal or damaged heart
valves or who have received an artificial heart valve are more vulnerable to the
infection. After valve surgery, an antibiotic must be taken before dental
procedures or colonoscopy.
 Risks associated with being put to sleep with general anesthesia.
 Risks associated with surgery, including bleeding.
After aortic valve surgery. Your recovery in the hospital may last from four to 10 days,
depending on your condition. You may spend the first days after surgery in an intensive
care unit (ICU) where your heart will be closely monitored.
While in the ICU, you may have a number of tubes in your body to help recovery,
including a tube to help you breathe, a tube to drain fluids from the stomach while you
are not eating, tubes to drain fluid from your chest, a small tube to empty your bladder
and a tube in your arm to measure blood pressure. These will be removed when you
are moved out of the ICU to another care unit.
You will receive therapy to prevent complications such as pneumonia, collapsed lung or
infection. A nurse or therapist may lead you in deep breathing exercises and coughing
and encourage you to move your legs to lower the chance of blood clot formation. Your
therapy may also include gentle patting on the back to loosen fluids in the lungs.
Physical therapy will also be part of the recovery process. In the hospital, you will be
encouraged to walk around and will be shown how to move your arms without hurting
your breastbone. Pain medication will be given to ease the discomfort of the surgical
incision. You will also learn how to do daily activities in ways that will not interfere with
the healing process.
Non-Surgical, Less Invasive Treatments
In the future, your doctor may be able to recommend less invasive, non-surgical
treatments for aortic regurgitation using a catheter (a flexible tube that is inserted from a
small hole in the blood vessel in your leg and guided through the arteries to your heart).
Currently catheter-based therapies are experimental and will require more study before
they can be offered to patients.