What are the dangers of moderate bicuspid aortic regurgitation?

Mitral regurgitation may lead to congestive heart failure, infective endocarditis, arrhythmia, sudden death, cerebral ischemia, cerebral thrombosis and other diseases. The mortality rate of aortic regurgitation is very high, and it may develop into heart failure or even death in just a few years.

Dangers of mitral regurgitation:

(I) Congestive heart failure Severe mitral regurgitation leads to congestive heart failure, which is caused by the enlargement of the valve ring and the gradual elongation of the chordae tendineae, and the gradual aggravation of mitral regurgitation. It can also occur acutely, mostly when the chordae tendineae rupture or complicated by infective endocarditis.

(ii) Infective endocarditis is more common in men and people over 45 years old, with an incidence rate of 1% to 10%. Infective endocarditis should be considered in patients with an isolated click who have a systolic murmur or a prolonged murmur and who have an unexplained fever.

(III) Arrhythmia and sudden death Patients with mitral valve prolapse are prone to arrhythmia, which generally has no impact on their health. Ventricular arrhythmia is the most common, with an incidence of over 50%. Paroxysmal supraventricular tachycardia is also common. The mechanism is unclear, but it may be related to the stretching of the mitral valve leaflets, papillary muscle chordae, or increased sympathetic nerve activity.

Sudden death may occasionally occur, and the risk of sudden death is higher in the following situations: severe mitral valve prolapse with left ventricular decompensation; complex ventricular arrhythmias; significantly prolonged QT interval; positive ventricular late potentials; atrial flutter or quiver with preexcitation syndrome; young women with a history of amaurosis, syncope and difficulty breathing.

(IV) Transient cerebral ischemia and embolism are mostly caused by cerebral embolism, and the incidence rate in patients with mitral valve prolapse under the age of 45 can reach 40%. Studies have shown that patients with mitral valve prolapse often have increased platelet activity. In addition, the friction between the atrial surface and chordae tendineae of the mitral valve and the left ventricular wall causes left endocardial fibrosis, which is prone to thrombosis. Thrombus detachment can cause cerebral embolism, retinal artery embolism, and systemic circulation (coronary artery, renal artery, splenic artery, mesenteric artery, etc.) embolism. Paroxysmal atrial fibrillation is often a precursor to cerebral embolism.

Dangers of aortic regurgitation:

The natural history of patients with aortic regurgitation: patients with mild or moderate regurgitant aortic regurgitation generally remain asymptomatic for about 10 to 30 years, and the non-operative mortality rate is only 5% to 15% within 10 years. However, for patients with severe regurgitant aortic regurgitation, the mortality rate is 30% in 10 years and 50% in 20 years. Patients with severe aortic regurgitation have a very good prognosis if their diastolic blood pressure is normal, there are no ECG changes and left ventricular hypertrophy and enlargement, and their left ventricular function is normal. If a patient has severe aortic regurgitation combined with left ventricular dysfunction, he or she will develop heart failure and die within a very short period of time. If symptoms occur, the prognosis is poor. About 50% of patients die within 5 years after the onset of angina pectoris. If combined with severe left ventricular dysfunction, 50% of patients die within 2 years and 96% of patients die within 10 years.

Congestive heart failure is common and is the main cause of death from aortic valve regurgitation. Once symptoms of heart failure appear, death often occurs within 2 to 3 years. Infective endocarditis may also occur, but embolism is rare.