Valvular Insufficiency . Valvular insufficiency is what we commonly know as a “leak” in one of the valves of the heart. In other words, a percentage of the blood flows in the opposite direction to normal flow. On the left side of the heart , blood flows from the left atrium to the left ventricle through the mitral valve; From the left ventricle, blood flow passes through the aortic valve to the aorta and the rest of the body.
When we speak of valve insufficiency, we refer to blood flow that moves from the aorta to the left ventricle or from the left ventricle to the left atrium. The valves of the heart (mitral, aortic, tricuspid, and pulmonary ) function as gates that open or close as needed during the various phases of the heart’s pumping, so that blood always flows forward and blood circulation is maintained. .
However, sometimes these valves are unable to keep fully closed when they have to be, and allow blood to leak backwards. This is what is called regurgitation or valve failure.
For example, in the case of mitral regurgitation, there is an escape of blood from the left ventricle to the left atrium through the mitral valve, instead of all the blood being expelled from the left ventricle to the aorta, which would be normal . The indicated treatment depends on the degree of insufficiency, its functional and clinical repercussion of the patient: if it is mild, nothing is done; medication is given in moderate-severe cases, and surgical repair is considered in severe cases.
In most people, the degree of valve insufficiency is mild and does not produce symptoms or physical limitations for the patient. These are people who can lead completely normal lives. As the degree of insufficiency worsens, especially when it becomes severe, the individual may begin to experience respiratory distress and decreased ability to exercise.
Once these symptoms appear, as long as there is no other problem that explains them, it is necessary to intervene surgically and replace the valve (sometimes the problem can be solved without having to replace the valve).
Aortic valve insufficiency: the rule of 55
The proper way to assess valve function is by echocardiogram or ultrasound of the heart. In the case of the aortic valve, if the diameter of the left ventricle, when it is at the end of the contraction phase, is greater than 5.5 cm or the ejection fraction (contraction force) is less than 55%, it is recommended have the patient undergo corrective surgery. These parameters represent a dilated chamber or left ventricle with little contraction force. Although the patient has no symptoms, the chances are very high that he will experience them in the future.
Mitral valve insufficiency: the rule of 65 and 45
An echocardiogram is also used to assess mitral valve function. In the case of mitral regurgitation in asymptomatic patients, surgical intervention is recommended when the diameter of the left ventricle at the end of its contraction phase is greater than 4.5 cm and the ejection fraction of the ventricle is less than 65%. Again, these parameters suggest that the insufficiency is severe enough to dilate and weaken the left ventricle.
The rule of 55 (for the aortic valve) and that of 65 and 45 (for the mitral valve) are guidelines that we Cardiologists use to decide when to recommend surgical treatment to a patient with asymptomatic valve insufficiency. They are based on studies done a long time ago that included a limited number of patients. However, they continue to be quite useful. It should be noted that there are professionals who are more aggressive when recommending surgery. Personally, I still use the 55 rule and the 65/45 rule; They have been useful to me in my practice.