Aortic Regurgitation

What is aortic regurgitation or insufficiency?

The heart has 4 heart valves. These work like doors or gates which open and close in a perfectly coordinated fashion to allow proper flow of blood in the heart. The aortic valve is an outlet valve which directs blood out of the heart when it contracts. Regurgitation ( aka insufficiency) is the medical term for abnormal backflow or back leak.

Thus aortic regurgitation is like having a door that doesn’t close properly. When this happens, blood that should go out to the body can leak back into the heart. This makes the heart work harder to pump the blood out again.

What causes aortic regurgitation?

1. Rheumatic heart disease ( a streptococcal infection in the past leading to a immune mediated damage to the heart valve)
2. Bacterial endocarditis (  Bacterial infection which damages the valve
3. Congenital heart valve disease ( eg bicuspid valves – where most people have a  3 leaflet aortic valve 1% of people have a 2 leaflet valve which is more prone to degeneration.
4. Dilated aortic root ( eg from age, hypertension of certain rate connective tissue disease which result in the weakening of the wall of the aortic leading to its dilation) In these cases the leak occurs not because of direct valve damage but because of the 3 leaflets being pulled outwards by the dilated aorta

What do patients feel when they have severe aortic valve regurgitation?

1. Breathlessness
2. Fatigue
3. Palpitations
4. Lack of energy

How is aortic regurgitation treated?

1. Medications: While there is no specific drug to cure aortic regurgitation, medications can help relief symptoms and reduce the heart’s workload. These include medications called vasodilators (e.g., ACE inhibitors, ARBs), diuretics, and beta-blockers
2. Surgical Aortic Valve Replacement (AVR) or repair: This conventional treatment for severe aortic regurgitation. It can be done via open-heart surgery or minimally invasive valve replacement.
3. TAVR (Transcatheter Aortic Valve Replacement): This is the least invasive option. Up to recently, transcatheter valves used to treat aortic stenosis was used to treat this condition with some success. The new valve is delivered via a catheter through the femoral artery and implanted within the existing valve. A few new valves designed specifically for aortic regurgitation are now available.  These innovative options have been shown to be effective in treating high surgical risk patients. A recent study called the ALIGN AR trial evaluated patients at high surgical risks undertaking this procedure. Procedural success was high and it met the primary safety endpoint at 30 days and effectiveness endpoint at 1 year of follow-up. This provides an excellent alternative to surgery for patients who are suitable.