The aortic valve is located at the connection between the left ventricle and the aorta. When the left ventricle contracts, the aortic valve opens and blood flows through the aortic valve into the aorta, and when the pressure in the left ventricle is lower than the pressure in the aorta, the aortic valve closes, at which time the pressure in the aorta is higher than the pressure in the left ventricle, and diastolic pressure is generated due to the dense blood vessels and the elasticity of the vessels. After the aortic valve closes, the ventricle enters diastole, at which time blood passes through the The coronary arteries perfuse the heart. Aortic valve closure insufficiency causes the left ventricle to drain blood to the aorta during systole and backflow of blood into the left ventricle during diastole. Depending on the severity of aortic valve closure insufficiency, the backflow accounts for 10% to 60% or more of the left ventricular drainage blood volume.
I. What are the causes of aortic valve insufficiency?
The cause can be the valve itself, such as senile aortic valve degenerative disease, congenital diastasis or quadruple valve malformation 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.
Second, what tests are needed for aortic valve insufficiency?
1. Routine tests include 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.
Third, 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 poor, 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, to what extent is aortic valve insufficiency severe enough to require active surgical treatment?
For patients with aortic valve lesions that are already severely occluded.
1.If relevant symptoms appear, active surgical treatment is needed (Class I recommendation)
2.No symptoms, if the EF value of the left ventricle is less than 50%, also need active surgical treatment (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)
5. If the patient’s cardiac examination indexes deteriorate rapidly in a short period of time during the 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, a cardiac ultrasound is needed every 6 months in the early stages of the disease, or every 6 months if the disease is severe or the heart changes are more obvious. If the disease is stable, the interval between examinations can be extended to once a year.