Aortic insufficiency: causes and treatments

Normal functioning of the heart ensures that the work of the Atria and ventricles. A full-fledged cardiac blood should be pumped in on one direction. Oxygen-rich blood enters the left ventricle from the left atrium. At this time, the valves located between these structures of the body are closed tightly, making atrial and ventricular blood do not mix. When the ventricles contract, opens the sash semilunar valve, blood enters the aorta, and then through the arteries distributed throughout the body.

 

Aortic insufficiency is a condition in which disturbed the functioning of the valve device of the aorta (the large vessel). In this pathology after the reduction of the ventricle and the blood enters the aorta of the sash of the aortic valve do not completely close, causing some of the blood is thrown back into the ventricle. On the next contraction, the ventricle tries to push the blood again, but part of it is returned.

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Malfunctioning aortic valve is the reason that the left ventricle permanently is experiencing increased stress as the volume of blood in it exceeds norm. Because of this, the structure of the heart hypertrophies (increases in size due to the thickening of the walls). Aortic insufficiency both provokes a pathological state permanent backward reflux of blood in the ventricle causes a deficiency of nutrient-rich and oxygenated blood into the systemic circulation. For this reason, the operation of many organs.

Reasons

Aortic insufficiency in most cases is acquired, but congenital abnormality is also found. Valve apparatus malfunctions in such congenital diseases:

  • antoanella ectasia;
  • Marfan’s syndrome;
  • cystic fibrosis;
  • Erdheim-Chester disease.

The aortic valve can no longer fully operational after the transfer of such ailments:

  • Rheumatism: the most common cause of the disease.
  • Syphilis.
  • Lupus erythematosus.
  • Rheumatoid arthritis.
  • Injury of the sternum.
  • Endocarditis, etc.

In these diseases the aortic valve is thickened and deformed. Hypertension, aortic aneurysm and sinus of Valsalva cause expansion of the fibrous ring of the aortic valve and the aortic lumen, which during diastole divergence of the valve.

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Classification and symptoms

The degree of pathology are determined, such parameter as the amount abandoned in the left ventricle of blood. There are 5 degrees of aortic valve regurgitation:

1) grade I: volume regurgitation blood does not exceed 15 % of the total volume ejected from the ventricle during the first reduction. Initial aortic insufficiency does not cause any symptoms, but the pathology can be detected when carrying out the ultrasonography.

2) II degree: the amount of regurgitation can reach 30 %. In most patients, is not observed any signs of heart failure, however, during the echocardiography detected hypertrophy of the left ventricle. In congenital defect of the aortic valve detected with wrong number of valves. The amount of emissions is determined when carrying out the sensing of the heart cavities. With regard to the symptoms of the disease, some people with II degree of aortic valve insufficiency there is increased fatigue and shortness of breath during physical exertion. The physical examination the cardiologist determined:

  • a significant gap between the upper and lower blood pressure;
  • pseudocyphellaria pulse;
  • intense throbbing of the carotid and subclavian arteries;
  • the heart murmur.

3) grade III in the left ventricle is thrown 50% of the blood needs to flow into the aorta. A person experiences pain in the heart. Also, the patient is forced to limit physical activity. Aortic insufficiency is determined when carrying out electrical and echocardiography — marked left ventricular hypertrophy and secondary coronary insufficiency. When conducting a chest x-ray can detect signs of stagnation of venous blood in the lungs, and expansion of the ventricle and the lumen of the aorta.

4) fourth degree: more than half of the blood needs to get to the aorta back into the ventricle. Severe aortic valve insufficiency is manifested by tachycardia, hepatomegaly and attacks of cardiac asthma. At this stage of the disease occurs in heart failure.

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5) V degree: heart failure progresses, dystrophy of other organs. The aortic valve the last stage often ends with the death of the patient.

Treatment

Treatment of the disease depends on its stage. If a person has discovered I and stage II insufficiency of aortic valve that needed treatment. The patient should only be monitored regularly by a cardiologist and follow the advice of the doctor. Moderate aortic insufficiency, which occurs without any symptoms, requires medical treatment. The patient is prescribed:

  • Diuretics (Furosemide, Veroshpiron): diuretics to prevent swelling and stagnation in the lungs.
  • ACE inhibitors (Captopril, Perindopril): these drugs are neurohumoral modulators and at the same time coronary vasodilators. Inhibit the activity of substances, the production of which contribute to the development of hypertension.
  • Calcium channel blockers (Verapamil, Cordy Cor, Stugeron): help to reduce the load on the heart and improve coronary blood flow.
  • Glycosides (Isolang, Strophanthin, Digoxin): contribute to the reduction of systole and its frequency.
  • People with aortic insufficiency should take antibiotics before and after invasive procedures. This approach allows to limit the risk of infectious lesions of the heart.

    If the disease poses a threat of complications, the decision is made in favor of cardiac surgery in which the affected aortic valve is replaced with an artificial counterpart. Indications for prosthetic valve:

    • stenosis, calcification and scarring of the valve leaflets;
    • hemodynamic disorders;
    • high risk of developing heart failure;
    • myocardial infarction in anamnesis;
    • the dissection of the aortic root.

    Before surgery the patient should undergo the following studies:

    • the aortography;
    • echocardiography;
    • electrocardiography;
    • coronary angiography;
    • x-rays of the lungs.

    Before prosthesis it is necessary to perform a readjustment of foci of infection in the body.

    The valve replacement is an open cardiac surgical operation that lasts a minimum of 2 hours. Replacement of the aortic valve takes place under constant monitoring (transesophageal echocardiography, cardiac monitoring). The diseased valve is replaced with mechanical or biological prosthesis.

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    Surgery to replace the valve allows you to provide 10-year survival in 75% of patients diagnosed with aortic insufficiency. The first year after surgery is associated with high risk of postoperative complications, particularly thromboembolism. For this reason, people with prosthetics, given oral anticoagulants. The drug is taken in accordance with the scheme, painted by the doctor.

    All patients, the aortic valve which was removed surgically, should be monitored regularly by a cardiologist.

    The prosthetic valve is prohibited under these conditions:

    • The diastolic volume of the left ventricle reaches 300 milliliters.
    • Ejection fraction greater than 50 %.
    • Diastolic pressure is 40 mm Hg. article and less.

    Forecast

    Aortic insufficiency has a favorable prognosis only in the initial stages. If the pathology is expressed, the life expectancy of patients with the diagnosis does not exceed 10 years. If you have developed coronary and cardiac insufficiency, and drug treatment does not bring results, the death occurs in approximately 1-2 years. But if the aortic valve prosthesis will be cured, life expectancy will be significantly improved, but only subject to the recommendations of the cardiac surgeon to limit the risk of postoperative complications.

    Prevention of disease is the prevention and timely treatment of illnesses in which there is insufficiency of the aortic valve (syphilis, atherosclerosis, lupus erythematosus, rheumatoid arthritis, rheumatism, etc.). Congenital abnormality of the valve apparatus in a patient requires clinical examination by a cardiologist. This approach will allow you to detect the progression of the disease and prevent complications of the disease.