I. What are the causes of aortic valve insufficiency?
The cause can be a lesion of the valve itself, such as senile aortic valve degenerative disease, congenital diastasis or tetralogy of the aortic valve, rheumatic lesions, and infectious lesions. It can also be secondary to aortic root lesions, such as Marfan syndrome and hypertensive aortic root dilatation.
What tests are needed for aortic valve insufficiency?
1.Routine examination includes: electrocardiogram, frontal and lateral chest X-ray, cardiac ultrasound and corresponding blood tests;
2.If there are dilated changes in the aortic root, aortic CT or magnetic resonance examination is also required;
3.Patients older than 50 years old need to do coronary angiography.
How about the progression of aortic valve insufficiency lesions?
For acute severe aortic valve closure insufficiency caused by infection or trauma, the disease will progress rapidly and the prognosis is very bad, requiring surgical treatment as soon as possible.
In patients with chronic severe aortic valve insufficiency, if symptoms of chest tightness, shortness of breath, precordial pain or dizziness occur, the annual mortality rate for patients not treated surgically will be as high as 10-20%; even if there are no symptoms, if the left ventricular systolic end-diameter is greater than 50 mm, the annual chance of patient death, related symptoms and cardiac insufficiency is about 19%.
For patients with chronic severe or moderate aortic valve closure insufficiency, if there are no symptoms, good cardiac function, and no significant enlargement changes in the ventricle, the chance of related adverse events is relatively small and can be observed by regular follow-up review.
Fourth, what is the severity of aortic valve insufficiency that requires active surgical treatment?
For patients with aortic valve lesions that are already severely occluded.
1.If symptoms appear, active surgery is required (Class I recommendation)
2.No symptoms, if the EF value of the left ventricle is less than 50%, active surgery is also required (Class I recommendation)
3.Without symptoms, if the EF value of the left ventricle is greater than 50%, and if the left ventricle is significantly dilated (left ventricular end-diastolic diameter is greater than 70 mm, or end-systolic diameter is greater than 50 mm), surgery should also be performed (Class IIa recommendation).
4. If the patient is asymptomatic but requires coronary artery bypass surgery, ascending aortic replacement surgery, other valve surgery or other happy surgery, the aortic valve needs to be replaced at the same time (Class I recommendation)
p5. If the patient has rapid deterioration of various cardiac examination indexes in a short period of time during follow-up observation, it suggests that the patient needs to consider recent surgical treatment.
V. What is the effect of aortic valve replacement therapy for aortic valve insufficiency?
The mortality rate of aortic valve replacement surgery alone is between 1-4%.
If the patient is older (>70 years), has too poor cardiac function, or requires concomitant bypass surgery, the operative mortality rate increases, typically between 3-7%.
The most important risk factors for surgery include old age, poor cardiac function, left ventricular EF less than 50%, and left ventricular end-systolic diameter greater than 50 mm.
VI. What medications are used to treat aortic valve insufficiency?
For patients with severe heart failure who are ready for surgery, short-term application of vasodilators and positive inotropic drugs can be used to improve symptoms.
For hypertensive patients with chronic heart failure symptoms, ACEI or ARB drugs can be applied to improve the symptoms.
Seven, how to follow up patients with aortic valve insufficiency?
For patients with mild to moderate aortic valve insufficiency, you can see your doctor once a year and have a cardiac ultrasound every two years.
For patients with severe aortic valve insufficiency, early detection of the disease requires a cardiac ultrasound examination every 6 months; if the disease is severe or the heart changes are more obvious, the examination needs to be done every 6 months; if the disease is stable, the examination interval can be extended to once a year.