Aortic Insufficiency (AI)
Aortic insufficiency is a leakage in the main heart valve, which is called the aortic valve. Aortic regurgitation is another name used for this leakage. The leakage in the aortic valve occurs when there is incomplete coaptation of the valve leaflets (cusps). In other words, when the valve closes up, it does not seal completely and lets some of the blood in the aorta return back into the left ventricle.
A small percentage of the normal population has a trace of aortic insufficiency, undetected by the human ear, and is diagnosed at the time that a patient has a color Doppler echocardiogram. In other words, a normal heart can have a very mild degree of aortic insufficiency and, if the valve is structurally normal, there is no need to worry.
In many cases, the aortic insufficiency is associated with a thickened or deformed aortic valve. This malformed aortic valve may or may not have an obstruction in addition to the leakage.
A bicuspid aortic valve can develop aortic insufficiency. In fact, about one-fourth of patients with a bicuspid aortic valve develop some degree of aortic insufficiency during their lifetime. The leakage is usually mild, but it could become more severe as the child grows.
A trace of aortic insufficiency may be associated with a structurally normal aortic valve and may be seen in a small percentage of the normal population. At other times the condition is associated with a congenital defect of the aortic valve. Aortic insufficiency may also be an acquired condition. The causes of aortic valve insufficiency include rheumatic fever, Kawasaki disease, hypertension, endocarditis, and other diseases.
Patients with other types of heart defects and those who have undergone aortic valve surgery may have some degree of leakage in the aortic valve.
Patients with mild leakage usually lead a normal life and do not experience any symptoms or restrictions. Their quality of life is normal. On the other hand, patients with more severe aortic insufficiency may develop symptoms depending on:
Severity of the leakage.
Whether it is acute or a chronic condition.
If there is associated heart defects or heart failure.
If the valve has an active infection (endocarditis).
Symptoms may include:
Shortness of breath, especially during exercise.
Poor exercise tolerance.
Problems with weight.
Changes in blood pressure.
Tests and Treatment:
Cardiovascular testing usually includes an electrocardiogram and echocardiogram. In cases of trace to mild aortic insufficiency, there may not be need of any further testing, just periodic follow up by Dr. Villafañe. A chest x-ray usually is obtained in cases of moderate to severe leakage of the aortic valve. A stress test may be indicated in order to determine exercise performance and evaluation of any symptoms that may be linked to the aortic insufficiency.