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Aortic Insufficiency (AI) is a cardiac condition characterized by the inability of the aortic valve to close completely, resulting in the reflux of blood from the aorta to the left ventricle.
AI is a type of valvulopathy, a term used to describe diseases of the heart valves. Other examples of valvulopathies include aortic stenosis, mitral stenosis, mitral valve prolapse, and mitral insufficiency. AI disrupts the normal flow of blood circulation, leading to a series of consequences that further impact heart health.
The aortic valve, located in the left ventricle where it connects to the aorta, is responsible for controlling the passage of blood between these two compartments, preventing its reflux. The valve is a tricuspid semilunar valve, meaning it has three flaps of connective tissue, also called cusps, that regulate its opening and closing. When functioning properly, the aortic valve does not allow retrograde flow of blood.
AI is a valvular disease that primarily affects older adults. In younger adults, the presence of a more or less severe form of AI is generally associated with congenital heart malformations or genetic diseases that also affect the cardiac organ.
AI can be attributed to both congenital and acquired causes. Congenital causes refer to causal factors present from birth, such as a developmental error, while acquired causes refer to causal factors developed or occurred during life due to reasons like infection, trauma, or the normal aging process.
The list of congenital causes of AI includes a bicuspid aortic valve (a valvular malformation where the aortic valve has two cusps instead of three), Marfan syndrome, Ehlers-Danlos syndrome, and Osteogenesis imperfecta. All of these are genetic diseases that affect connective tissues or bones.
Acquired AI may be due to aging, rheumatic fever, endocarditis (an inflammatory condition, generally of infectious origin, which affects the heart valves and/or the membrane that lines the internal walls of the heart), chest trauma, and hypertension. Other acquired conditions that can lead to AI include systemic lupus erythematosus, ankylosing spondylitis, syphilitic aortitis, reactive arthritis, Behçet's disease, and aortic dissection.
Various factors increase the risk of developing AI. These include aging, congenital anomalies of the heart, a past history of infections that may affect heart health, conditions such as Marfan syndrome or Ehlers-Danlos syndrome, aortic stenosis, and hypertension.
AI often manifests symptoms only when the blood reflux is moderate/severe, while it may be asymptomatic or slightly asymptomatic when the regurgitation is minimal and detectable only during a cardiological examination.
Moderate/severe forms of AI typically manifest with a sense of tiredness and weakness, especially during activities that require physical effort, dyspnea on exertion, edema of the lower limbs, chest pain, syncope or presyncope, palpitations, and alterations in heart rhythm.
AI can result in various complications, including heart failure, endocarditis, various types of arrhythmias, and sudden cardiac death.
For a precise diagnosis of AI, information from the medical history and physical examination, electrocardiogram (ECG), echocardiography, chest x-ray, cardiac catheterization, and stress test are generally required.
Treatment of AI varies based on the severity of blood regurgitation and whether or not there are symptoms. If AI is not severe and does not cause symptoms, the therapeutic approach is limited to periodic monitoring of the condition. However, if the AI is severe and/or produces important symptoms, surgical therapy is essential, aimed at correcting the valve defect.
Surgical therapy for AI basically includes two intervention techniques: aortic valve replacement and aortic valve repair.
This involves removing the original defective aortic valve and replacing it with a new valve, either artificial or biological.
This involves remodeling the aortic valve in order to restore its original functions.
While there are no specific drugs for the treatment of AI, patients often follow pharmacological therapy to control some symptoms, possible complications, and/or associated conditions.
Individuals suffering from AI should adhere to a healthy lifestyle. This includes not smoking, eating a balanced and healthy diet, maintaining a healthy body weight, controlling blood pressure levels, and remaining active without undergoing excessively intense physical activities.
The prognosis for AI depends mainly on the extent of blood regurgitation. In the most serious cases, surgery is mandatory and, in many cases, proves to be fundamental in prolonging the lives of patients.
While forms of AI due to aging or developmental errors are not preventable, those connected to rheumatic fever or hypertension can be prevented, provided that the treatment of the aforementioned conditions is timely and appropriate.
