Ask an expert
Question

02 Aug 2006

Aortic Regurgitation
Dear Heartdoc,

I am young and this is the reason I am worried. I have an appointment with my cardiologist next month. Yes I am tall and skinny, he sais something about the Marfan Syndrome due to the stretch marks on my lower back and the flexibilty of the hand joints.

My leakage or opening is currently 3MM as of last year October but I am getting very tired and out of breath. Over the past month I am experiencing alot of chest pain during the day and an uncomfortable tightness. Please advise what the cause could be??

Also, I honestly would like to know if due my age and condition, if my lifespan will be affected??

Thank you for your very efficient responses.

Eagerly awaiting a reply.

Thanks





Subject:
Posted by: HeartDoc
Message:
Dear Jet,

You are very young to have Aortic Regurgitation (AR) : has your doctor given you any idea about what has caused it? What is the degree of regurgitation (the amount of leakage?) Have you had Rheumatic fever in childhood? Are you very tall and skinny? What is your overall heart function like? Do you have high blood pressure?

The answers to these questions may significantly affect how soon you need surgery. In general, aortic valves are replaced, as they cannot really be repaired (there are a few RARE exceptions). Valve replacement surgery is a commonly done operation, with a good results. Surgery involves the use of a heart-lung machine to take over the function of the heart and lungs, so that the heart can be stopped to give the surgeon a still, bloodless field in which to work. This allows him to work very quickly and safely. The damaged valve is removed and a replacement is stitched into its place. For a young person like you, a special prosthetic valve made of pyrolytic carbon would be chosen – this type of valve has been known to last in perfect working order for 20 years already. After this time, (or even longer if this valve maintains its good track record) a repeat operation can be done, if necessary, to insert another new valve. One disadvantage of this type of valve is that you will have to take blood-thinning medication for the rest of your life. However, that may be a small price to pay.

If you have AR due to an underlying disorder such as mucoid degeneration or Marfan’s syndrome, then the surgery may be different, as you may need surgery to the aorta itself in addition to your valve replacement.

The timing of surgery is important : if it is delayed too long, you may develop heart strain, and then not do very well after you eventually do have surgery. The best idea is to have your cardiologist confer with a surgeon, to decide on the best time for surgery. Be aware of your exercise limits, shortness of breath, tiredness etc., and report any such symptoms to your cardiologist, as they will help him assess how soon you need surgery.

However, the most important thing for you to know for now, is that you do have a leaking valve. Because of this IT IS ESSENTIAL THAT YOU ALWAYS HAVE THE CORRECT ANTIBIOTIC TREATMENT BEFORE, BEFORE, BEFORE YOU UNDERGO ANY PROCEDURE WHATSOEVER, INCLUDING MINOR SURGERY, DENTAL WORK OF ANY KIND ( FILLINGS TOO) AND ANY VISITS TO THE DENTAL HYGIENIST. The reason for this is to prevent the development of Infective Endocarditis, a potentially fatal infection which affects damaged valves.

Good luck.

Heartdoc

Date: 28/7/2006



Subject: Aortic Regurgitation
Posted by: Jet
Message:
Does anyone here suffer from Aortic Regurgitation. Im 21 and was diagnosed last year. The doc said I will have to go for an op in a few years. Has anyone experienced it or gone through the process???
Date: 27/7/2006
Answer 658 views
Expert
HeartDoc

01 Jan 0001

Dear Jet,

If you have Marfan’s syndrome, then you must realise that this places a rather different spin on your valve problems. The underlying problem in Marfan’s results in weakness of connective tissues. Where this affects the cardiovascular system is that the ring housing the aortic valve becomes stretched, so that the valve leaflets no longer reach each other: this means the valve can never close properly, and results in a leak. The cardiac effects of this are that for every beat of the heart, only a portion of the blood which should be pumped “forwards” into the aorta actually goes there – the rest leaks back into the heart. For the next beat, the heart thus has more blood than it should (the normal amount coming to it from the lungs, plus the bit which has leaked back). This overloads the pump, and causes even more dilatation, and tiredness……..your heart just has to work harder to perfuse your body, day and night. If you go into mild heart failure(the pump is getting tired) then you will feel tired.

The other very important consideration is that it is not only your aortic valve affected by the Marfan’s: the aorta itsself becomes weakened and dilated. As a result, it is likely that you will need to have your aorta, or part of it, replaced in the future as well. It is also possible that your aorta is already affected, and if that is the case, you may need a combined aorta + aortic valve replacement, done in a single procedure. Please be aware that this is major, life-saving surgery, and should only be attempted by experienced senior surgeons.

Jet, there are a lot of possible problems facing Marfan’s patients, but they don’t always appear. This condition can be only “partly expressed”, meaning that any individual patient may be affected to a greater or lesser degree. You will need to be fully assessed by a specialist, and should also inform yourself as much as possible about the condition. You will need to know what to be on the lookout for in the future.

A good web site, written especially for patients is www.mayoclinic.com : type in marfans in the search bar, then go to the Marfan syndrome overview first. There is a lot of information there, which should answer most of your long-term questions. The other articles dealing specifically with heart problems are also relevant to you. For now, please see your cardiologist once you have read these articles, to discuss your symptoms, and whether or not you need surgery soon.

Good luck.

HeartDoc
The information provided does not constitute a diagnosis of your condition. You should consult a medical practitioner or other appropriate health care professional for a physical examination, diagnosis and formal advice. Health24 and the expert accept no responsibility or liability for any damage or personal harm you may suffer resulting from making use of this content.
Voting Booth
Have you entered our Health of the Nation survey?
Please select an option Oops! Something went wrong, please try again later.
Results
Yes
34% - 9269 votes
No
66% - 17897 votes
Vote