E. Aortic Valve regurgitation/ Insufficiency

Leakage of the aortic valve. Each time the left ventricle relaxes, blood leaks back into it. (Atria are contracting while ventricles are relaxing).




Causes of Valvular Aortic regurgitation/ Insufficiency

Aortic regurgitation may be due either to intrinsic abnormalities of the aortic valve leaflets or disease of the aortic root. In rheumatic fever and endocarditis, the aortic leaflets are directly affected.

In congenitally bicuspid valves, the larger cusp may become redundant, resulting in diastolic prolapse and progressive aortic regurgitation. The aortic valve may also become incompetent due to aortic root dilation. As the aortic root dilates, the aortic annulus becomes so large that the valve cusps no longer approximate, resulting in regurgitation.




Signs and Symptoms

1. Most of the patients with chronic aortic regurgitation are often asymptomatic for few years. But its usually common symptoms of aortic regurgitation include fatigue and exertional dyspnea.
2. Diastolic murmur blood is backing up into left ventricle from aorta during diastole and it will make some changing in the papillary muscle within few years.So you will hear heart sound S1, S2, then the murmur, e.g.,lub, dub, whoosh.
3. Left-sided heart failure such as nocturnal dyspnea, S3, pink frothy sputum, cough, crackles, orthopnea, tachycardia, restlessness.





Diagnostic Test

1. Echocardiography use for identifying the cause of aortic regurgitation. Echocardiography can indicate left ventricular volume overload by the increased internal diameter of the ventricular chamber during both systole and diastole. Doppler echocardiography is the best noninvasive means to detect aortic regurgitation. Transesophageal echocardiography is especially useful in imaging both the ascending and descending aorta in patients with suspected aortic dissection.

2. Cardiac catheterization should be performed to visualize and quantify the extent of regurgitation. However, physical findings and noninvasive tests are sufficient to role out the diagnosis of aortic insufficiency. In patients are suspected CHD, coronary angiography should be done. In patients with aortic root dilation, aortic root angiography may be done concurrently with coronary angiography.

3. Radionuclide imaging can be used to estimate ejection fraction and determine myocardial perfusion defects in patients with concomitant CHD.




Treatment


Anyone who have asymptomatic aortic regurgitation should be received appropriate antibiotic prophylaxis as well as afterload reduction with vasodilators.
Vasodilators usfull to reduce systolic load and regurgitant volume Valve replacement with prosthetic valve.

Low-sodium diet, Diuretics, Nitroglycerin.