Aortic Aneurysm and Aortic Dissection
How to Find the Cause of Aortic Regurgitation
Aortic regurgitation is when there is damage to the aortic valve, causing blood to leak backwards from the aorta (the body's largest blood vessel) back into the heart after each heartbeat. There are a number of things that can cause aortic regurgitation, including infection, trauma, rheumatic heart disease, aneurysm, and congenital and hereditary causes. The main way to determine the cause of aortic regurgitation is through cardiac imaging. Other medical tests may also be ordered to confirm the underlying cause of aortic regurgitation as well as assess overall cardiac health.
Testing for Specific Causes of Aortic Regurgitation
Look for a possible infectious cause ("infectious endocarditis").An infection of the aortic valve — called "infectious endocarditis" — may damage the valve permanently leading to a leaky aortic valve (aortic regurgitation). To assess for this as a cause for aortic regurgitation, ask about the person's medical history and whether they have had any recent infections. Infective endocarditis normally begins as a less serious infection somewhere else in the body (such as in the lungs or in the urinary tract) that then progresses into the bloodstream (called "sepsis") and then affects the heart.
- A transthoracic echocardiogram (TTE) will be used for diagnosis and assessment of aortic regurgitation from a possible infection.
- A transesophageal echocardiogram (TEE) may be used once a TTE has been performed. It can be used to assess overall heart function as well as to detect the presence of valvular regurgitation from an infection on one or more heart valves.
- A blood test and blood culture can identify the presence of bacteria in the blood, which would mean it is possible that endocarditis is the cause. Bacteremia is fairly common, but only a minority of cases are due to endocarditis.
Inquire about recent trauma to the chest.Chest trauma can cause damage to the aorta (the big blood vessel leading out of the heart to distribute blood throughout the body). If the aorta is damaged near the aortic valve, or if there is a tear in the aorta, it may lead to the backflow of blood through the aortic valve.
- Ask about a history of recent trauma to the chest area.
- A chest x-ray or CT scan may also help to visualize damage from trauma, pointing toward this as a potential cause of aortic regurgitation.
Consider rheumatic heart disease as a cause in developing countries.Rheumatic fever (and subsequent rheumatic heart disease) is typically a complication of a group A strep infection that is not treated with antibiotics. It is uncommon in the United States because people diagnosed with strep throat receive antibiotic treatment, which prevents the development of complications; however, in developing countries, untreated group A strep infections can cause ongoing heart problems.
- An echocardiogram can be helpful in the diagnosis of rheumatic heart disease leading to aortic regurgitation.
Evaluate for a congenital or hereditary cause of aortic regurgitation.Many people with aortic regurgitation develop it as a result of congenital or hereditary causes. The most common is a congenital bicuspid aortic valve, meaning that the aortic valve that only has two leaflets as opposed to the usual three. It is thus more prone to wearing down with time, leading to the backflow of blood that is characteristic of aortic regurgitation.
- There are also hereditary conditions, such as Marfan's syndrome (a connective tissue disorder), that may lead to the development or aortic regurgitation at an abnormally young age.
- Congenital or hereditary abnormalities can be tested for with an echocardiogram, a CT scan, and/or a cardiac MRI.
Using Imaging Tests to Evaluate Aortic Regurgitation
Receive a transthoracic echocardiogram.A transthoracic echocardiogram (commonly called an "echo") is usually the first specific investigation to look at the function of the aortic valve. It uses ultrasound waves to create an image of the heart as it functions in real time. It shows each heartbeat, and can assess blood flow through the various chambers of the heart with each heartbeat.
- An echo can also be used to determine the underlying cause of aortic regurgitation.
Have a transesophageal echocardiogram.If a transthoracic echocardiogram is insufficient to determine the underlying cause of aortic regurgitation, the next step is to proceed to a transesophageal echocardiogram. This is when, rather than having the test performed from outside your chest, an ultrasound probe is instead inserted down your esophagus to provide a more close-up and detailed view of your heart.
Obtain other diagnostic tests as needed.Depending upon what is suspected as the underlying cause of aortic regurgitation, additional investigations may be ordered to provide more information. For instance, if an infection of the heart valve is suspected, blood tests and a blood culture will likely be ordered to test for the presence of bacteria. If trauma is suspected, a chest x-ray or CT scan will likely be needed to evaluate for injury to the surrounding structures. If there is concern for atherosclerosis, a cardiac catheterization may need to be performed to plan a comprehensive treatment strategy.
Treating Aortic Regurgitation
Opt for "watchful waiting."Most cases of aortic regurgitation do not require immediate treatment. In the majority of cases, the heart is able to compensate on its own up until a certain point (with the help of medications), and then eventually surgery becomes necessary.
- Ask your doctor whether it is safe for you to continue with "watchful waiting" for the moment.
- Your doctor will then let you know how frequently to come back for check-up appointments to assess your aortic valve function.
Receive regular echocardiograms to evaluate your aortic valve function.They key to watchful waiting is to not miss any appointments scheduled to assess your aortic valve function. This is because, at a certain point, the heart can no longer compensate for a dysfunctional aortic valve and surgery becomes necessary to prevent serious damage.
- In order to identify this point promptly, you will need routine echocardiograms.
- An echocardiogram with Doppler can look at the blood flow out of your heart, through your aortic valve, and the regurgitation back into your heart after each heartbeat.
- It can quantify the amount of damage and indicate to your doctor when surgery is needed.
Take medication to reduce the stress on your heart and minimize the rate of further damage.While you are in the period of "watchful waiting," medications may help to decrease the stress of "afterload" (pressure) on your heart with each heartbeat. These medications include vasodilators such as Hydralazine or Nifedipine, other blood pressure lowering drugs, and other cardiovascular medications depending on your risk factors and any other concurrent medical conditions you may have.
Ask your doctor about aortic valve replacement surgery.The only definitive treatment for aortic regurgitation is to receive surgery. You will need a valve replacement surgery — it can either be replaced with a mechanical valve, or a biological valve. The valve replacement is normally done via open-heart surgery, and it will require three to five days in the hospital following the procedure for recovery.There are also minimally invasive techniques which include smaller incisions to replace your aortic valve.
Video: What is an abdominal aortic aneurysm
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