What is the cause of aortic valve insufficiency?

Aortic valve insufficiency is most likely caused by degenerative calcification of the aortic valve, so you should pay attention to its symptoms and observe whether symptoms such as angina pectoris and atrial fibrillation will occur.

1. Cause

Many common causes of aortic stenosis can also cause aortic regurgitation; degenerative calcification of the aortic valve cannot completely close due to the fixation of the valve leaflets; rheumatic aortic valve lesions cannot close due to the curling and hardening of the valve leaflets; bicuspid aortic valve malformation can cause aortic regurgitation due to fibrosis and calcification of the valve leaflets. In addition, due to cystic necrosis in the middle layer of the aortic valve ring, degenerative changes in the elastic fibers of the aortic valve ring are caused, and the expansion of the aortic valve ring also causes aortic valve insufficiency. In addition, any dilatation, aneurysm, or dissecting aneurysm of the ascending aorta can cause aortic valve insufficiency. Finally, myxomatous degenerative changes in the aortic valve leaflets cause thinning and prolapse of the aortic valve, and perforation and damage of the valve leaflets caused by infective endocarditis are also common causes of aortic regurgitation.

2. Clinical manifestations

Aortic valve insufficiency causes part or even most of the blood discharged by the heart to the ascending aorta to flow back into the left ventricle. The left ventricle receives blood from the ascending aorta and left atrium during each cardiac diastole, which increases the load on the left ventricle. The left ventricle then discharges the excess blood into the ascending aorta by contracting forcefully, which increases the work done by the left ventricle. In the early stage, the left ventricle compensates by increasing the contractility of the myocardium. Later, left ventricular hypertrophy gradually occurs, and then left ventricular dilatation occurs further. Progressive left ventricular dilatation leads to a decrease in the left ventricular contractile function and the ejection fraction. When the left ventricle dilates to a certain extent and cannot maintain the required cardiac output, left ventricular congestive heart failure is inevitable. Sometimes, even the first-time left ventricular failure may be irreversible, which deprives the patient of the opportunity for further treatment. Large amounts of aortic regurgitation also cause a drop in diastolic blood pressure, which reduces the perfusion of the heart to the coronary arteries during diastole, and the patient may experience symptoms of angina pectoris. Increased left ventricular diastolic pressure causes increased left atrial pressure, leading to left atrial enlargement and atrial fibrillation.

3. Treatment

Due to the compensatory function of the heart, patients with aortic valve regurgitation can be asymptomatic for many years. When patients show symptoms of heart failure, they should be actively treated with surgery. In addition, recent studies have shown that when left ventricular dilation occurs, the left ventricular contractile function decreases, and the left ventricular end-diastolic pressure increases, it means that the patient's heart has experienced anatomical decompensation. Although the patient may not have obvious symptoms at this time, there are clear indications for surgery and surgical treatment should be performed as soon as possible. Only in this way can the heart function be fully restored and the quality of life be significantly improved after the operation, and the risk of surgery can be minimized.