DR. MARK J. RUSSO, MD, MS

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Aortic Insufficiency

What is Aortic Insufficiency?

Aortic insufficiency (AI), also known as aortic regurgitation (AR), is the leaking of the aortic valve of the heart that causes blood to flow in the reverse direction during ventricular diastole, from the aorta into the left ventricle. Aortic insufficiency can be due to abnormalities of either the aortic valve or the aortic root (the beginning of the aorta).
What are the causes of aortic insufficiency?
About half of the cases of aortic insufficiency are due progressive enlargement of the aortic root. Other causes include aging, high blood pressure syphilitic aortitis, osteogenesis imperfecta, aortic dissection, Behçet’s disease, and reactive arthritis. Other potential causes that affect the valve directly include Marfan’s syndrome, Ehlers–Danlos syndrome, ankylosing spondylitis and systemic lupus erythematosus.

 

About half of the cases of aortic insufficiency are due progressive enlargement of the aortic root. 

What is ALIGN-AR?

The objective of this study is to evaluate the safety and effectiveness of the transfemoral JenaValve Pericardial TAVR System in treating subjects with symptomatic severe aortic regurgitation requiring replacement/repair of their native aortic valve who are at high risk for open surgical aortic valve replacement/repair (SAVR), using a minimally invasive transcatheter aortic valve replacement (TAVR) procedure. Thus avoiding the need for surgery. RWJUH is one of only 15 centers in the US that can offer this technology.

How is aortic insufficiency diagnosed?

Persons with AI often have no symptoms and a murmur may be discovered during a routine examination.

AI may be detected by listening with a stethoscope which reveals a murmur. The murmur is caused by some of the blood leaking back into the left ventricle.

In addition to a complete medical history and physical examination, diagnostic procedures for MS may include any, or a combination, of the following:

  • electrocardiogram (ECG or EKG):a test that records the electrical activity of the heart, shows abnormal rhythms (arrhythmias or dysrhythmias), and detects heart muscle damage.
  • echocardiogram (Echo): a noninvasive test that uses sound waves to produce a study of the motion of the heart’s chambers and valves. The echo sound waves create an image on the monitor as an ultrasound transducer is passed over the heart. 

Echocardiography is the most useful diagnostic test for AI.

In some situations where symptoms are more severe, additional diagnostic procedures may be performed. Additional procedures may include:

  • stress test (treadmill or exercise ECG): a test that is performed while a patient walks on a treadmill to monitor the heart during exercise. Breathing and blood pressure rates are also monitored.
    cardiac catheterization: with this procedure, x-rays are taken after a contrast agent is injected into an artery to locate the narrowing, occlusions, and other abnormalities of specific arteries. In addition, the function of the heart and the valves may be assessed.
  • cardiac MRI: this is a noninvasive test that produces comprehensive images of the heart. It may be used as a complement to Echo for a more precise look at the heart valves and heart muscle, or in preparation for heart valve surgery.

What is the aortic valve?

The aortic valve is the valve between the left ventricle of the heart and the aorta, which is the largest artery in the body and carries the entire output of blood. The aortic valve normally consists of three leaflets. When the left ventricle, the main pumping chamber of the heart, contracts, it forces blood through the valve to the aorta and then to the rest of the body. When the LV expands again, the aortic valve prevents the blood from returning to the ventricle.

RWJUH is one of only 15 centers in the US that can offer transcatheter aortic valve replacement for aortic regurgitation.

What are the symptoms of aortic insufficiency?

The initial presenting symptoms include progressive shortness of breath with activity, which may be so subtle that the the patient is unaware of them and may cut down on exertion without being aware of his/her reduced capacity. More advanced symptoms include syncope, chest pain, and frank heart failure.

What is the treatment for aortic insufficiency?

Specific treatment for AI will be determined by your physician based on:

  • your overall health and medical history
    extent of the disease
  • your signs and symptoms
    your tolerance for specific medications, procedures, or therapies
  • expectations for the course of the disease
    your opinion or preference

There is no medical treatment to correct aortic insufficiency. To correct this problem, surgery is required. Surgery may be necessary to repair or replace the malfunctioning valve(s). Surgery may include:

  • Heart valve repair: In some cases, surgery on the malfunctioning valve can help alleviate symptoms. Examples of heart valve repair surgery include cutting scarred flaps so they open more easily or remodeling valve tissue that has enlarged. In many cases, heart valve repair is preferable, because a person’s own tissues are used. But in the case of severe aortic insufficiency, that type of surgery is often not effective.
  • Heart valve replacement: When heart valves are severely malformed or destroyed, they may need to be replaced with a new mechanism. Replacement valve mechanisms fall into two categories: tissue (biologic) valves, which include animal valves and donated human aortic valves and mechanical valves, which can be metal, plastic, or another artificial material.