Description. Radiological Exam. Clinical forms. Complications. Evolution. Treatment.
Aortic insufficiency consists of incomplete closure of aortic valves during diastole. With the extra strain imposed on the left ventricle, blood reflux leads to dilation and hypertrophy.
With time, the disease evolves, initially beginning with a left ventricular failure with pulmonary stasis and then a right heart failure by releasing the right ventricle.
- Rheumatoid endocarditis is the most common cause, especially in young people.
- Rarely, the disease is due to atherosclerosis, syphilis or a cardiac trauma.
- Pure lesions are rare, usually accompanied by aortic or mitral stenosis.
Aortic insufficiency symptoms:
- The disorder is well tolerated for a long time; the patient is asymptomatic or less likely to feel the heartbeat in the neck, precordial or to the extremities.
- Over time, dyspnoea in the effort, occasional dizziness and signs of heart failure occur.
- The patient is pale.
- The top of the heart is globular, heavily draws the chest wall, is lowered and moved out.
- Peripheral signs due to the sudden fall of diastolic blood pressure and systolic blood pressure are very characteristic: noticeable pulse at inspection, alternating redness and paleness in the skin and especially the lightly compressed nails, radial pulse and amputation on palpation, blood pressure with maximum normal or high and low, sometimes to zero.
The radiological exam of aortic insufficiency shows a lying heart with a globular left ventricular arch and a lively, vibrant peak with a synchronous systolic expansion of the aorta.
Aortic insufficiency forms:
- Rheumatic aortic insufficiency is characterized by the young age of the patients, rheumatic antecedents, the association of other valvular diseases (mitral stenosis).
- Atherosclerotic aortic insufficiency occurs after 50 years, usually in men, and is accompanied by other atherosclerotic manifestations (severe diastolic bloating, high blood pressure, wider peripheral signs).
- Aortic luetic insufficiency has been meeting lately. There is a history of syphilis, manifestations of nervous syphilis, aortic aneurysm.
Aortic insufficiency complications:
- heart failure,
- slow endocarditis,
- rheumatic relapses,
- angina pectoris,
- Aortic aneurysm in arterial forms(atherosclerotic and leutic).
Evolution and prognosis depend on the condition of myocardial status, the frequency of rheumatic fevers, the coexistence of other valvular lesions and the occurrence of complications.
Arterial forms have a more reserved prognosis.
Generally, with time, the left heart fails and left ventricular failure occurs. Finally, the right heart also succumbs, and right heart failure occurs.
Aortic insufficiency treatment:
- Surgery is an open heart surgery. Replace the injured valve with either a Starr-Edwards prosthesis or homo- or heterogrefa.