Aortic Insufficiency

I am a 29 year old male.  A year ago I had a physical and was sent on to the Minneapolis Heart Institute.  At the Heart Institute I was diagnosed with what the doctor described as a "somewhat more than mild" aortic insufficiency.  I was told that I wouldn't have to worry about this for a number of years.  I wasn't really given much more information than the fact that I have a valve that doesn't close all the way and that later in life I will most likely have to have a valve replacement.  Up to that point I had always been very active and athletic.  I participated in sports and worked out 4 to 5 times a week.  Around that time I had a sports related accident that kept me from being active for about 5 months.  Since the accident, it has been extremely hard for me to get back into shape and when working out I often feel like I am having trouble catching my breath.  My question is can a change in activity level cause this problem to progress?  Should I go back and have more tests?  Where can I learn about this problem so I can know what to expect over the years?

Thanks.

[Cleveland Clinic, MD]

Dear  Tim,

Thank you for your question.    Aortic insufficiency is a leaking of the aortic valve.  If this is not repaired over the long term (months to years - depending on the severity) it can lead to heart failure.  The timing of valve replacement is not always an easy decision and for this reason a person with this condition should have regular follow up with a cardiologist who is knowledgeable in the area of valve surgery.  In general the replacement should be before the onset of any symptoms or heart failure. I doubt your current symptoms are due to the valve leakage nor would the valve be worsened by a sports injury but your doctor should be made aware of what is happening.

Symptoms include shortness of breath with activity, swelling in the lower extremities, chest discomfort and palpitations.    Some medications such as ACE inhibitors (i.e. acupril, vasotec, captopril) decrease the workload of the heart and can help prevent heart failure.  Surgery is however the only cure.

The valve used in surgery may be mechanical,  bioprosthetic (animal valve) or homograft (human cadaver donor).  The only type that requires coumadin is the mechanical.  The advantage of the mechanical is that it will not wear out as opposed to the others which only last 10-15 years.  You and your doctor can discuss which type of valve is right for you when it is time for replacement.  Hope this information helps.  Good luck.