Treatment of aortic valve insufficiency abroad
Aortic valve insufficiency is an acquired heart defect that results in the regurgitation (backward flow) of blood from the aorta into the left ventricle during the diastole, i.e. period of the relaxation of the heart muscle.
This is a very common disease, which occurs among 10% of people over the age of 45 years. 75% of these cases are the non-severe stage of the disease, and about 3% - severe. Aortic valve insufficiency is rare during a person’s youth. About 1.2 % of people experience the disease between the ages of 23 to 35 years.
Causes of Aortic valve insufficiency
Aortic valve insufficiency may appear because of the valve damage itself or the damage of the aortic root.
The most common reason of the cardiac valve damage is an acute rheumatoid fever (rheumatism), which is accompanied by the infectious endocarditis (inflammation of the endocardium, the inner heart layer).
Aortic valve insufficiency can appear as a result of the damage or perforation of the leaflets (the appearance of the through-holes).
The second reason is the age-related changes. They develop slowly and are observed among the elderly people as a result of atherosclerosis and cardiac valve structures involution. Though the size of the leaflets is not changed, they cannot fully block the increased lumen of the fibrous ring anymore.
Other reasons of the aortic valve damage are rare. They include:
- Injuries with rupture of the ascending aorta
- Congenital bicuspid valve
- Complications after surgical operations and procedures
- Destruction of the valve bioprothesis
The root of the aorta is its beginning part, which is coming from the left ventricle. With its expansion, the valve is unable to block the lumen of the aorta completely, and there is a regurgitation (back flow) of the blood.
Possible reasons for the defeat of the aortic root:
- Age-related expansion
- Aortic dissection
- Marfan syndrome
- Reiter's syndrome;
- Behcet's syndrome
The gradual expansion of the aortic root is possible due to the action of certain drugs, as well as during the severe artery hypertension.
Aortic valve insufficiency - Symptoms
Symptoms depend on how fast the aortic valve insufficiency is developing.
The acute and chronic aortic regurgitation are differentiated.
The chronic develops slowly and is asymptomatic for a long period of time. The left ventricle is expanding slowly among such patients, the cardiomegaly is formed and the phenomenon of ischemia is growing.
There are the symptoms:
- Shortness of breath after physical exertion
- Orthopnea (gain or the appearance of dyspnea in the horizontal position)
- Paroxysmal nocturnal dyspnea
- Increase in blood pressure
- Swinging head when the heart beats (a symptom of de Musset)
- Pulsation of the liver and spleen (symptoms Rosenbach and Gerhard)
- Strong pulsation of vessels of the nail bed (Quincke's sign)
The signs of the breast pang (stenocardia) followed by (pressing pain in the heart), tachycardia, ventricular premature beats (extraordinary contraction of the ventricles) can appear.
During the acute form of regurgitation, when the aortic valve insufficiency is developing rapidly, the symptoms are more pronounced, as the left ventricle does not manage to increase large enough to carry the burden of the reverse blood flow.
Therefore, the patient arises:
- Severe weakness
- Decrease in blood pressure
- Severe shortness of breath
- Cyanosis of the skin
The condition of these patients is always difficult. They require surgical treatment.
Aortic valve insufficiency- Diagnostics
Diagnosis is established starting first with the physical examination of the patient. Signs, pointing to the aortic valve insufficiency development are:
- Maine symptom - diastolic blood pressure decreased by more than 15 mm Hg if the patient raises his hand
- Trade sign - dual tone can be heard on the femoral artery during its compression
- Hill-Vleck sign - blood pressure on the legs is higher by at least 15 mmHg than in on the arms
- Austin-Flint noise can be auscultated on the apex of the heart; it imitates mitral stenosis
- Korrigan pulse is characterized by rapid growth and equally rapid fall of the pulse amplitude at the radial artery
Instrumental methods of diagnostics:
ECG. Left ventricular hypertrophy, its dilatation (cavity expansion), signs of ischemia (insufficient blood supply) can be identified during this procedure.
Chest X-ray is done to detect that the heart takes the form of a "boot". There may also be a calcification of the aortic valve.
Echocardiography. Ultrasound, including Doppler, establishes the severity of aortic valve regurgitation. Its classified by the length of the blood jet which is thrown in the opposite direction, either according to the amount of the regurgitation (percentage of cardiac output).
MRI is held at the non-informative results of the echocardiography.
Cardiac catheterization with angiography is an invasive method of investigation. It is carried out only in the case where the data obtained in the course of instrumental studies contradict the clinical manifestations and the general condition of the patient.
Coronary angiography isappointed before the surgical treatment of aortic valve insufficiency, if there is a risk of coronary heart disease.
Treatment of Aortic valve insufficiency abroad
Treatment can be conservative as well as with the help of the surgery. Stable clinical improvement can only be reached with the use of the surgery.
Medications are prescribed to slow down the progress of the heart changes and improve the life quality of the patient. Drugs that reduce the amount of blood regurgitation and increase the heart output are indicated.
Surgical methods of treatment:
Aortic valve prothesis. It is the basic method of eliminating the aortic regurgitation. The method increases the patient’s life expectancy and improves its quality. The aim of the surgery is to remove the aortic valve and putting the bioprothesis or a mechanical one instead.
Plastic surgery of the aortic valve is a reconstructive surgery that doesn’t need the prosthesis placement. Depending on the situation, the doctor can sew the defects, sew the leaflet at their cleavage, establish a flexible support ring in the case of expansion of the fibrous ring, or perform other actions aimed at restoring the structure of the valve.
The advantage over the plastic prosthesis is that the risk of postoperative complications is significantly reduced and the patient need not take anticoagulant during his/her lifetime and antiplatelet agents for the prevention of thrombus formation. But such an operation cannot be carried out in all cases. If there are gross violations of the structure of the aortic valve, which cannot be reconstructed, then the doctor has to place the prosthesis.
Aortic valve insufficiency - Prognosis
Acute aortic regurgitation results in a negative prognosis. Without the surgery, patient’s death may occur within days or weeks because of the acute left ventricular heart failure.
Chronic flow of the disease prognosis depends on the severity of the disease during the aortic valve insufficiency. Five-year survival after diagnosis is around 75%, ten-year - 50%. The death of patients who did not receive surgery, occurs on average 4 years after the onset of stenocardia, or 2 years after the diagnosis of chronic heart failure.
Surgical treatment significantly improves the prognosis, as it prevents an increase of the left side of the heart and myocardial ischemia. 73% of patients during 2-3 years postoperatively are observed with the regression of left ventricular hypertrophy. Ten-year survival after aortic valve replacement is 80%.