While drug therapy (specifically, treatment with with blood vessel dilating drugs such as Procardia or Lisinopril) can improve symptoms to some degree, the fundamental problem in aortic regurgitation is mechanical. So, the solution requires a mechanical "fix" - namely, repairing or replacing the damaged valve.
When Should I Have Valve Surgery?
As a general rule, aortic valve surgery should be performed once the aortic regurgitation begins producing symptoms like shortness of breath or reduced ability to exercise. The longer you wait before performing surgery, the more damage is caused to the heart. If you have been diagnosed with aortic regurgitation but don't show any outward symptoms, your doctor may recommend periodic physical examinations echocardiograms, looking for signs that the left ventricle is dilating excessively.In many patients with mild aortic regurgitation, less frequent evaluations are necessary, and surgery never has to be done. However, which particular individuals will be able to escape surgery is never really obvious. So even if you have mild aortic regurgitation it is still important to be under the care of a doctor who can keep an eye on your valve problem.
Replacement or Repair?
Repairing the aortic valve has potential advantages over replacing it. An artificial valve may require you to take an anticoagulation drug like Coumadin, and if a second valve operation is needed later on, that procedure is likely to be less complicated than if a valve replacement had been done. However, the aortic valve can only be repaired if you don't have aortic dilation, which many patients do. Also, aortic valve repair is still a relatively new procedure, and many surgeons do not have extensive experience with it. So chances are good that if you need valve surgery for aortic regurgitation, you will get the valve replaced entirely.Which Artificial Valve Should Be Used?
The prosthetic valves used to replace your diseased aortic valve can either consist entirely of man-made materials (mechanical valves) or be made from the heart valve of an animal, generally a pig (bioprosthetic valve). Deciding which type of artificial valve to use depends on your age and whether you can take Coumadin.All artificial heart valves have an increased propensity to form blood clots. However, blood clotting is less of a problem with bioprosthetic than mechanical valves, so people with the bioprosthetic valves generally do not have to take Coumadin, while those with mechanical valves do.
But mechanical valves generally seem to last longer than bioprosthetic valves. So: If you need a valve replacement, are under age 65, and you can take Coumadin, your doctor will likely recommend a mechanical valve. If you are older than 65, or you are younger but can't take Coumadin, a bioprosthetic valve will probably be recommended.
Sources:
Bonow, RO, Carabello, BA, Chatterjee, K, et al. 2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation 2008; 118:e523.
