Aortic Valve Prolapse

Aortic Valve Prolapse

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Remember the old saying that " an ounce of prevention is worth a pound of cure "? This can be especially true when it comes to preventive health care. Maintaining or improving your health is important - and a focus on regular preventive care, along with following the advice of your doctor, can help you stay healthy.

Alternative names
Aortic insufficiency; Aortic regurgitation
Definition
Aortic insufficiency is a heart valve disease in which the aortic valve weakens or balloons, preventing the valve from closing tightly. This leads to backward flow of blood from the aorta (the largest blood vessel) into the left ventricle (the left lower chamber of the heart).
Causes, incidence, and risk factors
Aortic insufficiency can result from any condition that weakens the aortic valve. In the past, rheumatic fever was the primary cause of aortic insufficiency. Now that antibiotics are used to treat rheumatic fever, other causes are more commonly seen.
These include congenital conditions (abnormalities of the valve which are present at birth), endocarditis (valve infection), High blood pressure , Marfan’s syndrome, aortic dissection (a tear in the lining of the aorta), Ankylosing spondylitis , Reiter’s syndrome, Syphilis (now rare), and other disorders.
Aortic insufficiency affects approximately 5 out of every 10,000 people. It is most common in men between the ages of 30 and 60.

Note: Commonly, aortic insufficiency shows no symptoms for many years. Symptoms may then occur gradually or suddenly.
Auscultation (listening to the chest with a stethoscope) detects a heart murmur. Palpation (examination by hand) may show hyperdynamic (very forceful) beating of the heart. Pulse pressure (the difference between systolic blood pressure - the pressure during contraction of the heart - and diastolic blood pressure - the pressure during relaxation of the heart) may be widened, and diastolic blood pressure may be low. There may be signs of pulmonary edema (fluid in the lungs).
Aortic insufficiency may be seen on:

An ECG test or Chest x-ray may show left ventriclar enlargement.
Lab tests cannot diagnose aortic insufficiency, but they may be used to rule out other disorders or causative factors.
If there are no symptoms or if symptoms are mild, the disorder may only require observation. If symptoms are severe, hospitalization may be necessary. Medications such as diuretics (water pills) or digoxin may be used to stabilize the condition. These medications may also be used in people with mild symptoms to prevent the symptoms from worsening. Moderate activity restriction may be recommended.
Surgical repair or replacement of the aortic valve corrects aortic insufficiency. Surgical repair of the aorta may be required if insufficiency is caused by disorders of the aorta.
Expectations (prognosis)
Aortic insufficiency is curable with surgical repair. This can completely relieve symptoms unless severe heart failure is present or other complications develop.
Call your health care provider if symptoms indicate aortic insufficiency may be present.
Call your health care provider if you have aortic insufficiency and symptoms worsen or new symptoms develop, especially chest pain , difficulty breathing or edema (swelling).
Treat strep infections promptly to prevent rheumatic fever, which can lead to aortic insufficiency. Aortic insufficiency caused by other conditions often cannot be prevented but some of the complications can be.
Notify your health care provider or dentist about any history of heart valve disease before treatment for any condition. Any dental work, including cleaning, and any invasive procedure can introduce bacteria into the bloodstream. This bacteria can infect a weakened valve, causing endocarditis.
Follow the provider’s treatment recommendations for conditions that may cause valve disease. Notify the provider if there is a family history of congenital heart diseases.

All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.
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Bonow RO, et al., eds. Aortic valve disease. In: Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 11th ed. Elsevier; 2019. https://www.clinicalkey.com. Accessed Aug. 7, 2021.
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Crawford MH, ed. Aortic regurgitation. In: Current Diagnosis & Treatment: Cardiology. 5th ed. McGraw-Hill; 2017. https://accessmedicine.mhmedical.com. Accessed Aug. 7, 2021.
Fuster V, et al., eds. Aortic valve disease. In: Hurst's the Heart. 14th ed. McGraw-Hill; 2017. https://accessmedicine.mhmedical.com. Accessed Aug. 7, 2021.
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Aortic valve disease

Aortic valve stenosis

Associated Procedures

Aortic valve repair and aortic valve replacement

Heart valve surgery

Transcatheter aortic valve replacement (TAVR)

© 1998-2022 Mayo Foundation for Medical Education and Research (MFMER). All rights reserved.

Aortic valve stenosis causes a thickening and narrowing of the valve between the heart's main pumping chamber (left ventricle) and the body's main artery (aorta). The narrowing creates a smaller opening for blood to pass through. Blood flow from the heart to the rest of the body is reduced or blocked. Typically, the aortic valve has three cusps (tricuspid aortic valve), but some people are born with an aortic valve that has two cusps (bicuspid aortic valve).
In aortic valve regurgitation, the aortic valve doesn't close properly, causing blood to flow backward from the body's main artery (aorta) into the lower left heart chamber (left ventricle).
Aortic valve disease is a type of heart valve disease. In aortic valve disease, the valve between the lower left heart chamber (left ventricle) and the main artery to the body (aorta) doesn't work properly.
The aortic valve helps keep blood flowing in the correct direction through the heart. A damaged or diseased aortic valve can affect blood flow to the rest of the heart and body.
Aortic valve disease may be present at birth (congenital heart disease), or it may occur later in life due to other health conditions.
Treatment for aortic valve disease depends on the type and severity of disease. Some people may need surgery to repair or replace the aortic valve.
Some people with aortic valve disease may not notice symptoms for many years. Signs and symptoms of aortic valve disease may include:
If you're having sudden chest pain, get emergency medical help.
Make an appointment with a health care provider if you have signs or symptoms of valve disease, such as shortness of breath, fatigue after activity, or sensations of a pounding or an irregular heartbeat. Sometimes the first signs of aortic valve disease are related to heart failure. See a health care provider if you have fatigue that doesn't get better with rest, shortness of breath, and swollen ankles and feet, which are common symptoms of heart failure.
A typical heart has two upper and two lower chambers. The upper chambers, the right and left atria, receive incoming blood. The lower chambers, the more muscular right and left ventricles, pump blood out of the heart. The heart valves, which keep blood flowing in the right direction, are gates at the chamber openings.
Aortic valve disease may be caused by a heart defect present at birth (congenital heart defect). Other causes of aortic valve disease later in life include:
To better understand the causes of aortic valve disease, it may be helpful to know how the heart valves typically work.
The heart has four valves that keep blood flowing in the correct direction. These valves are:
In aortic valve stenosis, the aortic valve opening is narrowed (top row). The narrowing requires increased pressure within the heart to pump blood across a smaller opening. Eventually this reduces the heart's ability to pump blood to the body. This is similar to attaching smaller and smaller nozzles to the end of a garden hose (bottom row). The narrowing from the nozzle slows the forward flow of water and results in pressure buildup within the garden hose.
Each valve has flaps (cusps or leaflets) that open and close once during each heartbeat. Sometimes, a valve doesn't open or close properly. This can reduce or block blood flow through the heart to the rest of the body.
In aortic valve disease, the valve between the lower left heart chamber (left ventricle) and the body's main artery (aorta) doesn't work properly. The valve may be thickened and stiff (stenosis) or it may not close properly, causing blood to flow backward.
Many things can raise the risk of aortic valve disease, including:
Potential complications of aortic valve disease may include:
Proper diagnosis and treatment can help reduce the risk of complications.
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Last revised by Dr Henry Knipe ◉ ◈ on 22 May 2022
Trinh, K., Knipe, H. Aortic valve prolapse. Reference article, Radiopaedia.org. (accessed on 15 Oct 2022) https://doi.org/10.53347/rID-99974
1. Shapiro L, Thwaites B, Westgate C, Donaldson R. Prevalence and Clinical Significance of Aortic Valve Prolapse. Br Heart J. 1985;54(2):179-83. doi:10.1136/hrt.54.2.179 - Pubmed 2. Morganroth J, Jones R, Chen C, Naito M. Two Dimensional Echocardiography in Mitral, Aortic and Tricuspid Valve Prolapse. The Clinical Problem, Cardiac Nuclear Imaging Considerations and a Proposed Standard for Diagnosis. Am J Cardiol. 1980;46(7):1164-77. doi:10.1016/0002-9149(80)90287-8 - Pubmed 3. Golińska Grzybała K, Kabłak-Ziembicka A, Gackowski A. Unicuspid Aortic Valve Prolapse with Severe Reg
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