Aortic regurgitation (AR) is a heart valve condition where the aortic valve does not close tightly, causing blood to flow backward into the heart. This chronic condition ranges from mild to severe. Advancements in treatment allow many individuals to lead full lives.
Understanding Aortic Regurgitation
The aortic valve, located between the left ventricle and the aorta, normally opens to allow oxygen-rich blood to flow to the body and then closes to prevent backflow. In aortic regurgitation, the valve does not fully close, causing blood to leak back into the left ventricle. This backflow means the left ventricle must work harder to pump enough blood forward. Over time, this increased workload can cause the left ventricle to enlarge and weaken, impacting its ability to pump effectively. Aortic regurgitation can develop slowly over many years, often without noticeable symptoms in early stages.
Factors Influencing Life Expectancy
The prognosis for individuals with aortic regurgitation varies depending on several factors. The severity of the regurgitation plays a role; mild cases may not impact life expectancy, but severe, untreated aortic regurgitation can reduce it. Research indicates that about 75% of people with severe aortic regurgitation live at least 5 years with conservative treatment, but only 50% live 10 years. If severe aortic regurgitation remains untreated and progresses to heart failure, life expectancy estimates can drop to about 2 years.
The presence and progression of symptoms, such as shortness of breath, chest pain, fatigue, or fainting, serve as important indicators. The onset of symptoms often signals disease progression and may prompt intervention. The heart’s function, particularly left ventricle enlargement and pumping efficiency (ejection fraction), are major predictors of long-term outcomes. Left ventricular dilation and a reduced ejection fraction are associated with increased mortality risk.
The underlying cause of aortic regurgitation can influence its progression. Conditions like a bicuspid aortic valve (a congenital defect), rheumatic fever, or age-related valve degeneration can lead to AR, with some causes presenting earlier. Age and other existing health conditions, known as comorbidities, also affect outcomes. Older age and conditions like high blood pressure, coronary artery disease, or diabetes can complicate the course of AR. Early diagnosis and appropriate management improve the outlook.
Treatment Approaches
Managing aortic regurgitation depends on its severity and symptoms. For mild to moderate cases without symptoms, a “watchful waiting” approach is often adopted, involving regular monitoring. This may include controlling blood pressure with medications like ACE inhibitors or ARBs, and using diuretics to manage fluid retention. Medications can help manage symptoms and reduce complications, but they do not cure the underlying valve issue.
When aortic regurgitation becomes severe, or if symptoms develop or heart function declines, surgical intervention is recommended. Aortic valve replacement (AVR) is a common surgical option, replacing the damaged valve with either a mechanical or tissue valve. For appropriate candidates, surgery can improve prognosis. Valve repair, where the existing valve is fixed, is another option, though less common for aortic regurgitation than replacement.
Transcatheter Aortic Valve Implantation (TAVI), also known as Transcatheter Aortic Valve Replacement (TAVR), offers a less invasive alternative for some patients, particularly those high-risk for traditional open-heart surgery. This procedure replaces the valve using a catheter, avoiding a large incision. While TAVR is primarily used for aortic stenosis, its application for aortic regurgitation is being explored.
Monitoring and Lifestyle Adjustments
Regular medical monitoring is important for individuals diagnosed with aortic regurgitation. This includes routine check-ups and diagnostic tests, such as echocardiograms, to track the condition’s progression and assess heart function. These assessments help healthcare providers determine the optimal timing for intervention, aiming to prevent irreversible heart damage.
Adopting heart-healthy lifestyle habits can complement medical management. A balanced, low-sodium diet supports heart health and helps manage fluid balance. Regular physical activity, guided by a doctor, can strengthen the heart. Maintaining a healthy weight, quitting smoking, and moderating alcohol intake are also beneficial for cardiovascular well-being.
Individuals with aortic regurgitation should report any new or worsening symptoms promptly to their healthcare provider. Symptoms such as increasing shortness of breath, chest pain, or ankle swelling can indicate a change in the condition. Managing stress contributes to heart health. Good dental hygiene is advised to reduce the risk of endocarditis, a heart valve infection.