Mild/Mod Aortic Regurgitation, what are "symptoms"?

[gzc1]

Some doctors at the cleveland clinic wrote an article describing when to opt for valve replacement surgury. For the Aortic valve with regurgitation, they say:

Patients with chronic mild-to-moderate
regurgitation and normal left ventricular
function are at low risk and are not candidates
for aortic valve replacement. Appropriate follow-
up consists of an annual history and physical
examination and echocardiography every
2 to 3 years.

However, in other places I see "replace if symptomatic" even if all other parameters are normal.

So, if a patient is having PVCs, some exercise issues (high exercise HR), fatigue, angina, etc., but otherwise has normal LV shape and function (ejection fraction, dimensions, etc), and mild aortic root dialation (3.8cm) should they consider surgery to prevent damage? Or just go in for echos to monitor the heart?

In this case, might the symptoms be unrelated to the aortic regurgitation, and instead indicative of another rhythm disorder that needs to be explored?  And are beta-blockers an appropriate medication for such an individual (she has low-normal BP and is 38 years old)

Thanks,

Citation:
JOEL P. REGINELLI, MD
Department of Cardiovascular Medicine,
The Cleveland Clinic Foundation
BRIAN GRIFFIN, MD
Department of Cardiovascular Medicine,
The Cleveland Clinic Foundation
The challenge of valvular heart disease:
When is it time to operate?

[kenkeith]

I have moderate to severe valve regurgitation for the past 5 years with no sumptoms other than unable to tolerate rigorous exercise without a nitrate med.  

You are correct there are differing views when to intervene with an operation.  I have a doctor's visit every 6 months, and the doctor asks if I am experiencing shortness of breath?  It is a wait and see and act based on symptoms.  However, a renown cardiologist at the Mayo Clinic who does valve surgeries (well over a thousand) states the biggest problem he sees is that the patient has waited too long.  Cardiologis and surgeons may have different views, but it is the surgeon who should know what is best.  I will talk to a surgeon before the end of the  year.  It makes no sense to me to wait!

The risk with waiting is the heart can enlarge without intervention and if that condition happens the surgery becomes a higher risk.  There may be treatment that can reduce the size prior to an operation, I don't know.

We are all individuals with different health conditions, age, etc.  You are young and the valve issue will not improve.  You may want to find a cardiac surgeon to consult, and a surgeon you will be comfortable with and not wait until there are possibly serious heart issues.    

Beta blocker is appropriate for heart rhythm disorder, but there is no medication for valves other than reduce the heart's afterload (reduce blood pressure) and keep heart rate to an acceptable level.

[gzc1]

Thanks. Do you know the name of the Mayo cardiologist?

Question is, how quickly does the heart (or aorta) enlarge when it starts?

There are also issues with longevity of the replacement valve, side effects of the surgery and risk of death during surgery to consider in the decision.

[kenkeith]

Joseph A. Dearani, M.D.  Rochester, Minn. is the doctor.

If I remember correctly when the aorta is larger than 4.0 cm, it is classified as an aneurysm if and when it reaches 5.0 surgery begins to be an option.

Aortic aneurysms often grow slowly and usually without symptoms, making them difficult to detect. Some aneurysms will never rupture. Many start small and stay small, although many expand over time. Some aortic aneurysms enlarge slowly.  Others expand at a faster rate, which increases the risk of rupture. How quickly an aortic aneurysm may grow is difficult to predict.

Risk and side effects should be available with consultation with a surgeon.  There are non-biological valves that last longer, but require blood thinner medication.  If I remember correctly a bilogical valve least about 15 years and probably more appropriate for an older individual.