What is aortic valve regurgitation?

When your aortic valve leaks, it's called aortic valve regurgitation or aortic insufficiency. The aortic valve is one of the heart’s 4 valves. These valves help the blood flow through the heart and out to the body. Normally, the aortic valve stops blood from flowing back into the left ventricle. The left ventricle pumps blood rich in oxygen and nutrients to the body. With aortic valve regurgitation, some blood leaks back through the valve as the heart relaxes. The valve is normally made of 3 tissue flaps (leaflets) that open and close together like a door to allow blood to pass. Aortic valve regurgitation happens more often with age. It can affect anyone.

Aortic valve regurgitation can be acute or chronic. With acute aortic valve regurgitation, the valve suddenly becomes leaky. The heart doesn’t have time to get used to the leak in the valve. With chronic aortic valve regurgitation, the valve slowly becomes leakier. This gives the heart time to get used to the leak.

What causes aortic valve regurgitation?

Aortic valve regurgitation can be caused by any condition in which the leaflets or the ring structure of the valve is damaged. This can occur with the following conditions:

• Weakening and calcification of the valve from aging

• High blood pressure

• Defects of the aortic valve present at birth (congenital). This might be a bicuspid valve instead of the normal tricuspid. A bicuspid valve has 2 leaflets instead of the normal 3 leaflets.

• Rheumatic heart disease, an inflammatory disease caused by Strep bacteria

• Widening of the aorta for unknown reasons

• Marfan syndrome, a connective tissue disorder

• Certain types of arthritis. These include ankylosing spondylitis, rheumatoid arthritis, and reactive arthritis.

• Syphilis, a sexually transmitted infection (STI)

• Ehlers-Danlos syndrome, a connective tissue disorder

• Use of certain appetite-suppressing medicines

• Bacterial infection of the heart valve (endocarditis)

• Tearing of the aorta

• Injury

Who is at risk for aortic valve regurgitation?

Advancing age is a common risk factor for aortic regurgitation. You can reduce some risk factors for aortic valve regurgitation, such as:

• Manage high blood pressure with lifestyle and medicines

• Use antibiotics to treat rheumatic fever and prevent rheumatic heart disease

• Don't use IV (intravenous) drugs. This lowers the risk for heart valve infection.

• Promptly treat health conditions that can lead to the disorder

There are other risk factors, such as age, that you can’t change. You also can’t change certain genetic conditions, such as Marfan syndrome.

What are the symptoms of aortic valve regurgitation?

You may not have any symptoms from mild aortic regurgitation. If the condition becomes more severe, you may develop symptoms that get worse over time. These may include:

• Shortness of breath with exertion

• Shortness of breath when lying flat

• Fatigue

• Unpleasant awareness of your heartbeat (palpitations)

• Swelling in your legs, abdomen, and the veins in your neck

• Chest pain or tightness with exertion

• Strong pulses felt in the neck

Sudden severe aortic valve regurgitation is a medical emergency, and includes symptoms, such as:

• Symptoms of shock (such as pale skin, unconsciousness, or rapid breathing)

• Severe shortness of breath

• Abnormal heart rhythms that make the heart unable to pump effectively

How is aortic valve regurgitation diagnosed?

Your healthcare provider will take your health history and give you a physical exam. Using a stethoscope, they will check for heart murmurs or congestion in your lungs. You may also have tests, such as:

• Transthoracic echocardiogram (ultrasound of the heart, TTE) to make the diagnosis, assess severity and evaluate for a possible cause. This ultrasound is done by putting a probe on the surface of the skin to take images.

• Transesophageal echocardiogram (ultrasound of the heart taken from the esophagus) to further assess severity and evaluate for tearing of the aorta if needed

• Stress testing may be advised to assess how well your heart works under physical stress

• CT or MRI can also be used to assess for tearing of the aorta

• MRI may be advised to assess severity and heart function if echocardiogram images are not ideal

• Cardiac catheterization, aortography, or coronary angiography may be advised before aortic valve surgery or when initial testing provides unreliable data

• Electrocardiogram(ECG), to assess heart rhythm

• Chest X-ray can identify enlargement of the heart and aorta

How is aortic valve regurgitation treated?

Treatment varies according to how bad your condition is. If you have a mild form of the condition, you may need only regular check-ups with your healthcare provider. You may not have symptoms for many years. Symptoms may get worse slowly over time and not affect daily life.

In severe aortic regurgitation, surgery is commonly advised. The timing of surgery is important to discuss with your healthcare provider and surgeon. In some cases, severe aortic regurgitation may be treated with medicine. Medicine may also be used in the short-term before valve replacement surgery. Or it may be used ongoing if you are not able to have valve replacement surgery.

It's also important to manage your blood pressure.

Treatment options may include:

• Medicines to lower blood pressure and help the heart relax

• Antiarrhythmic medicines to help maintain the heart’s rhythm

• Water pills (diuretics) to reduce swelling

For people with severe aortic regurgitation, symptoms, enlargement of the left ventricle or abnormal pump function, the treatment is often somewhat different:

• You may need surgery to replace the valve.

• Your healthcare provider may recommend surgery even if you don’t yet have symptoms. People with advanced symptoms are less likely to recover well from the surgery. Because of this, it's important to closely follow up with your healthcare provider to make sure timing of surgery is right for you.

• You may need to take medicines until you have surgery.

• Most people need an artificial aortic valve. In some cases, an aortic valve repair may be advised. The surgeon may do open surgery or may use a minimally invasive approach.

• If you need heart surgery for another reason, your healthcare provider may advise aortic valve replacement at the same time.

Sometimes aortic valve regurgitation is acute:

• Acute, severe aortic valve regurgitation needs surgery right away. You may need medicines for a short time to stimulate your heart or to dilate or constrict your blood vessels.

• In some cases, an infection of the heart valves can cause acute valve regurgitation. This may only need to be treated with antibiotics.

What are possible complications of aortic valve regurgitation?

Complications are sometimes associated with aortic valve regurgitation, such as:

• Complications from valve replacement surgery

• Bacterial infection of the heart valves

• Heart failure

• Sudden cardiac death

To reduce the risk of these complications, your healthcare provider may prescribe medicines to help the heart pump better.

Living with aortic valve regurgitation

See your healthcare provider for regular checkups. Visit them right away if your symptoms change. Make note of your symptoms when you exercise. They may get worse during physical activity. It's common for symptoms to first be noticeable during exercise. Talk with your healthcare provider about your exercise habits. Tell all your healthcare providers and your dentist about your health history.

Your healthcare provider may prescribe treatments for heart problems related to aortic valve regurgitation, such as:

• A low-salt, heart-healthy diet to decrease blood pressure and stress on your heart

• Medicines to lower your blood pressure

• Medicines to reduce the risk for irregular heart rhythms

• Reduction of caffeine and alcohol to reduce the risk of arrhythmias

• Cholesterol-lowering medicines

• Smoking cessation

• Regular physical activity as you are able. This can help control cholesterol and blood pressure and keep your lungs and heart muscle strong.

When should I call my healthcare provider?

If you notice your symptoms gradually getting worse, plan to see your healthcare provider soon. You may need surgery or a medicine change.

Get medical help right away if:

• You have symptoms of acute severe aortic valve regurgitation. These may include sudden shortness of breath, a rapid heartbeat, chest pain, severe lightheadedness, and loss of consciousness.

• You notice sudden new symptoms.

Key points about aortic valve regurgitation

• In aortic valve regurgitation, the heart’s aortic valve does not work right. It becomes leaky allowing some blood flow back into the left ventricle instead of forward into the body.

• You may not have symptoms for many years.

• Chronic aortic valve regurgitation may get worse. It may need surgery.

• Acute, severe aortic valve regurgitation is a medical emergency. You should get help right away.

• See your healthcare provider regularly to monitor your aortic valve regurgitation. If your symptoms are severe or get worse, see your healthcare provider right away.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.

• Before your visit, write down questions you want answered.

• Bring someone with you to help you ask questions and remember what your provider tells you.

• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.

• Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.

• Ask if your condition can be treated in other ways.

• Know why a test or procedure is recommended and what the results could mean.

• Know what to expect if you do not take the medicine or have the test or procedure.

• If you have a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your healthcare provider if you have questions, especially after office hours or on weekends.