Hi, this is Dr. Melissa Burroughs from the WellStar Center for Cardiovascular Care in Marietta, Georgia, and this is an Expert Explains Aortic Valve Regurgitation. Aortic valve regurgitation is a form of valvular heart disease affecting the aortic valve, which is located in between the aorta, which is the main artery to the body, and the left ventricle, which is the main pumping chamber of the heart. And so if that valve cannot close properly, all of the blood that's supposed to go forward to the body, some of it starts to go backwards, back into the chamber, increasing the pressures, and that, can cause symptoms and cause problems over time.

The symptoms vary depending on how slowly or how rapidly the valve becomes leaky. If it's the process is slow and gradual, then over time the heart can actually remodel and accommodate it up to a point when then a person will become symptomatic. But if it happens in a short period of time or acutely, then it can be a life-threatening condition, which can cause, really severe shortness of breath, decreased oxygen, and then, can be fatal. Symptoms of valvular heart disease like aortic valve regurgitation can be subtle. some sym- some people present with fatigue, which is challenging 'cause many people are tired.

A lot of times we don't know why, but sometimes it can be from heart disease. A symptom that is more suggestive of heart disease would be shortness of breath with physical activity. That definitely speaks to a cardiac condition or shortness of breath when, with changes in body position when lying flat or waking up in the middle of the night short of breath.

Valvular heart disease mostly affects older people, so as the valves experience wear and tear, you can get a combination of either stenosis, where it doesn't open up well, which is more common, or regurgitation, where it doesn't close well. There are younger patients who experience aortic valve regurgitation. What we see most commonly would be either congenital heart disease. If you're born with a two-leaflet aortic valve versus a three-leaflet au- aortic valve, you're more likely to experience aortic regurgitation at a younger age. And also people who get endocarditis, which is an infection of the heart valve itself.

I will say that's probably more common, in young people w-with this disease. It's infectious. And endocarditis can occur in a multitude of settings. Most commonly, when bacteria are introduced into the bloodstream, it is through the mouth, so dental infections can cause, endocarditis. And then less commonly, people who use IV drugs will sometimes introduce bacteria into their bloodstream with their needles. So aortic valve regurgitation still is primarily treated through surgery, especially in younger patients. Options for minimally invasive valve, interventions include, transcatheter aortic valve replacement, which is still mostly used in older patients who are at high risk for surgery or who have other conditions that make surgery either impossible or high risk.

Those valves are actually, were studied more for aortic valve stenosis, where the valve doesn't open as well, but some patients with aortic stenosis will also have aortic valve regurgitation.

And so in that combination, then you c- you know, someone who is not a candidate for surgery would be eligible for a transcatheter valve. Similar to other advancements in cardiology and in medicine, African Americans often don't a-access these therapies to the same degree as the rest of the US population, which could be due to a number of factors. Some of them would include structural racism and geography, access to the cardiologists who do these procedures, because not every interventional cardiologist does a transcatheter aortic valve replacement, and there's always the potential for individual bias.

So when patients are, told that they are not a candidate for surgery for, valvular heart disease, a lot of times it is dependent on the surgeon, so it's always wise to consider a second opinion, especially at a center that has higher volumes. Smaller volume surgeons will not take as much risk on higher risk patients, but someone who does the procedure every day is more likely to accept a higher risk patient. Advocating for yourself and your loved ones, can be challenging when there, are risks that have to be considered, but it's helpful to ask specific questions about what about the patient makes them high risk, whether it's age, whether it's other illnesses, or if it's something more subjective like frailty, which is a real risk.

You know, if you undergo surgery, you do need to be able to recover and rehabilitate so that you can get back to being functional, walking, and taking care of yourself.

But, I think asking specific questions can always get to the root of it and always consider a second opinion if you're initially told that surgery's not an option.