The therapy of aortic valve insufficiency can be either conservative or surgical. Conservative therapy: In general, patients who do not feel any symptoms and who also have good function of the left ventricle can be treated conservatively. This includes drug therapy with the aim of reducing the resistance against which the left ventricle works and keeping it as low as possible so that enough blood is expelled from the heart and as little blood as possible flows back into the left ventricle.
If high blood pressure exists at the same time, it must be consistently controlled and efficiently treated, otherwise aortic valve insufficiency will worsen. If left heart failure exists, which usually causes symptoms and where surgery is not possible, left heart failure should be treated with the usual medication. These include ACE inhibitors, beta blockers, diuretics, aldosterone antagonists and cardiac glycosides such as digitalis.
These drugs are used according to a phased plan of the New York Heart Association (NHYA). Without symptoms and in stable condition, the patient should see a doctor every 12 months. If the changes in the heart are more advanced or if there is a change in the condition, a doctor should be consulted every 3 to 6 months.
In case of acute aortic valve insufficiency, the resulting acute left heart failure must be treated quickly. If there is no rapid improvement within the scope of this drug therapy, surgery must be performed. If the acute aortic valve insufficiency is caused by bacterial colonisation of the inner heart skin (endocarditis), antibiotic therapy must also be initiated.
Operative therapy: An operation should be considered when symptoms occur. Conservative therapy is then no longer recommended. In some cases, surgery is also appropriate for patients without symptoms.
This is the case if the so-called ejection fraction (EF) is less than 50%. The ejection fraction (EF) is the ratio of the blood ejected from the heart during a contraction to the total blood in the left ventricle. With the help of the ejection fraction a statement about the heart function can be made.
Normally it is calculated by means of an ultrasound examination of the heart and should be above 55%. Surgery may also be necessary in patients who do not feel any discomfort and who also have an ejection fraction (EF) of more than 50%. This is the case if the diameter of the left ventricle is greater than 70 mm at the end of the relaxation and filling phase (diastole) or greater than 50 mm at the end of the contraction and ejection phase (systole).
The easiest way to determine this is to perform an ultrasound examination of the heart. Surgical therapy for aortic valve insufficiency usually involves valve replacement, i.e. the patient’s own aortic valve is removed and replaced. The replacement can either be biological, i.e.
made of human or animal tissue, or mechanical, i.e. artificially produced. A recommendation for surgical treatment of aortic valve insufficiency is made as soon as the disease becomes symptomatic. Symptoms include shortness of breath and reduced exercise tolerance, measurable by cardiac ultrasound. If the ejection performance of the left ventricle is less than 50% (so-called ejection fraction) or the diameter at the end of the ejection phase of the heart (systole) is greater than 50mm, these would be objective criteria for the beginning weakness of the left ventricle. The aortic valve should then be replaced in order to avoid greater damage to the heart muscle caused by the insufficiency.