The heart enlarges depending on the degree of aortic insufficiency. It is one of the heart diseases that enlarges the heart the most.
The first symptoms include rapid fatigue, shortness of breath, and over time, waking up at night with shortness of breath. In the later stages, chest pain and fainting attacks may occur. The risk of sudden death increases in cases where the heart is severely enlarged.
The most common cause is acute joint rheumatism. Rheumatic fever disease causes fibrous thickening and shortening of the aortic valve, causing aortic insufficiency, which causes symptoms at later ages. The second most common cause is infective endocarditis, which develops on the basis of bicuspid or normal tricuspid aortic valve. Infective endocarditis is the microbial infection of the heart valve.
Aortic insufficiency may occur over time in cases where the hole between the two ventricles (VSD: Ventricular Septal Defect) is adjacent to or close to the aortic valve, which is a congenital disease. Aortic insufficiency may occur due to rupture of any leaflet of the aortic valve in chest trauma (traffic accident, fall, etc.). Various rheumatic and systemic diseases such as Myxomatous Degeneration, Rheumatoid Arthritis, Systemic Lupus Erythromatosis, Reiter Syndrome, Psoriasis, Takayashu Disease may cause aortic insufficiency by affecting the aortic valve.
Expansion of the chest or abdominal aortic vessel. In Marfan Syndrome leading to (Aortic Aneurysm) or in Arteriosclerotic or Syphilitic Aortic Aneurysm with a similar mechanism, again in Marfan Syndrome or Aortic insufficiency occurs in Annuloaortic Ectasia, where there is enlargement due to the weakness of the aortic valve rim. Aortic insufficiency may occur in Aortic Dissection, which causes a tear between the layers of the aortic vessel.
A definitive diagnosis is made by echocardiography and the degree of valve insufficiency is determined. Catheterization and coronary angiography should be performed in patients with chest pain or who are over 40 years old.
Patients with complaints (NYHA III and IV), whose left heart functions have started to decrease. Patients with enlarged heart systolic and diastolic diameters should be operated on. In cases of acute (sudden) developing aortic insufficiency, urgent surgery should be performed.
In cases where the quality of the aortic valve is good, but there is aortic insufficiency due to the enlargement of the aortic valve ring, by preserving the aortic valve (David operation) and placing the valve into the artificial vessel, Aortic insufficiency can be treated. In cases where aortic valve repair is not possible, a mechanical heart valve should be installed if there is a long life expectancy and there is no obstacle to the use of blood thinners. If there is a risk that prevents the use of blood thinners (brain bleeding or other organ bleeding risks) or in patients over the age of 65-70, valves obtained from animals, which we call biological heart valves, are used. Aortic valve replacement (AVR) operation can be performed by opening the classical sternum completely (midsternotomy), opening the upper half of the sternum (mini-sternotomy) or using the armpit (minithoracotomy) surgical technique. If the aortic diameter is less than 50 mm, the aortic diameter can be reduced with Aortoplasty. Thus, the possibility of rupture and dissection is reduced. If the diameter of the Ascending Aorta exceeds 50-55 mm and there is a sinus valsalva aneurysm, the Ascending Aorta may need to be replaced with an artificial tube vessel (graft) along with the aortic valve replacement.
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