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Aortic valve regurgitation

Overview

Aortic valve regurgitation

In aortic valve regurgitation, the aortic valve doesn't close properly, causing blood to flow backward from the body's main artery (aorta) into the lower left heart chamber (left ventricle).

Aortic valve regurgitation — or aortic regurgitation — is a condition that occurs when your heart's aortic valve doesn't close tightly. As a result, some of the blood pumped out of your heart's main pumping chamber (left ventricle) leaks backward.

The leakage may prevent your heart from efficiently pumping blood to the rest of your body. As a result, you may feel fatigued and short of breath.

Aortic valve regurgitation can develop suddenly or over decades. Once aortic valve regurgitation becomes severe, surgery is often required to repair or replace the aortic valve.

Symptoms

Most often, aortic valve regurgitation develops gradually. You may have no signs or symptoms for years. You may be unaware that you have the condition. However, sometimes aortic valve regurgitation occurs suddenly, usually as a result of an infection of the valve.

As aortic valve regurgitation worsens, signs and symptoms may include:

  • Shortness of breath with exercise or when you lie down
  • Fatigue and weakness, especially when you increase your activity level
  • Heart murmur
  • Irregular pulse (arrhythmia)
  • Lightheadedness or fainting
  • Chest pain (angina), discomfort or tightness, often increasing during exercise
  • Sensations of a rapid, fluttering heartbeat (palpitations)
  • Swollen ankles and feet

When to see a doctor

Contact your doctor right away if you have signs and symptoms of aortic valve regurgitation.

Sometimes the first signs of aortic valve regurgitation are related to heart failure. Make an appointment with your doctor if you have fatigue that doesn't get better with rest, shortness of breath, and swollen ankles and feet, which are common symptoms of heart failure.

Causes

Chambers and valves of the heart

A typical heart has two upper and two lower chambers. The upper chambers, the right and left atria, receive incoming blood. The lower chambers, the more muscular right and left ventricles, pump blood out of the heart. The heart valves, which keep blood flowing in the right direction, are gates at the chamber openings.

The aortic valve is one of four valves that control blood flow through the heart. It separates the heart's main pumping chamber (left ventricle) and the main artery that supplies oxygen-rich blood to your body (aorta). The valve has flaps (cusps or leaflets) that open and close once during each heartbeat.

In aortic valve regurgitation, the valve doesn't close properly, causing blood to leak back into the heart's main pumping chamber (left ventricle). As a result, the left ventricle holds more blood, possibly causing it to enlarge and thicken.

At first, the larger left ventricle helps maintain good blood flow with more force. But eventually these changes weaken the left ventricle — and your heart overall.

Aortic valve regurgitation usually occurs gradually, but it can develop suddenly when caused by a valve infection. Any condition that damages the aortic valve can cause regurgitation. However, you can develop aortic valve regurgitation without any known risk factors.

Causes of aortic valve regurgitation include:

  • Congenital heart valve disease. Some people are born with an aortic valve that has only two cusps (bicuspid valve) or fused cusps rather than the normal three separate cusps. Sometimes a valve may only have one cusp (unicuspid) or four cusps (quadricuspid), but this is less common.

    These congenital heart defects put you at risk of developing aortic valve regurgitation at some time in your life. If you have a parent or sibling with a bicuspid valve, it increases the risk that you may have a bicuspid valve. However, you can have a bicuspid valve even if you don't have a family history of the defect.

  • Narrowing of the aortic valve (aortic stenosis). Calcium deposits can build up on the aortic valve as you age, causing the aortic valve to stiffen and become narrow. This condition, called aortic stenosis, prevents the valve from opening, causing a blockage. Aortic stenosis may also prevent the valve from closing properly.
  • Inflammation of the lining of the heart's chambers and valves (endocarditis). This life-threatening condition is usually caused by infection. It can damage the aortic valve.
  • Rheumatic fever. Rheumatic fever is a complication of strep throat and was once a common childhood illness in the United States. It can cause the aortic valve to become stiff and narrow (stenosis), causing blood to leak. If you have an abnormal heart valve due to rheumatic fever, it's called rheumatic heart disease.
  • Other diseases. Other rare conditions can enlarge the aorta and aortic valve and lead to regurgitation, including Marfan syndrome, a connective tissue disease. Some autoimmune conditions, such as lupus, also can lead to aortic valve regurgitation.
  • Tear or injury of the body's main artery (aorta). A traumatic chest injury or aortic tear (dissection) may cause backward flow of blood through the aortic valve.

Risk factors

Things that make you more likely to develop aortic valve regurgitation include:

  • Older age
  • Certain heart conditions present at birth (congenital heart disease)
  • History of infections that can affect the heart
  • Certain conditions that can affect the heart, such as Marfan syndrome
  • Other heart valve conditions, such as aortic valve stenosis
  • High blood pressure

Complications

Possible complications of aortic valve regurgitation include:

  • Fainting or feeling lightheaded
  • Heart failure
  • Infections that affect the heart, such as endocarditis
  • Heart rhythm problems (arrhythmias)
  • Death

Prevention

If you have any type of heart condition, see your doctor regularly so he or she can monitor you. If you have a parent, child, brother or sister with bicuspid aortic valve, you should have an echocardiogram to check for aortic valve regurgitation. Catching aortic valve regurgitation or another heart condition before it develops or in the early stages may make it more easily treatable.

Also, take steps to prevent conditions that can raise your risk of aortic valve regurgitation, including:

  • Rheumatic fever. If you have a severe sore throat, see a doctor. Untreated strep throat can lead to rheumatic fever. Strep throat is easily treated with antibiotics.
  • High blood pressure. Check your blood pressure regularly. Make sure it's well controlled to prevent aortic regurgitation.

Diagnosis

To diagnose aortic valve regurgitation, your doctor will do a physical exam and ask questions about your signs and symptoms and you and your family's medical history. Your doctor may hear an abnormal sound (murmur) when listening to your heart with a stethoscope. A doctor trained in heart disease (cardiologist) may evaluate you.

Your doctor may order several tests to diagnose aortic valve regurgitation and determine its cause. Tests may include:

  • Echocardiogram. Sound waves directed at your heart from a wandlike device (transducer) held on your chest create pictures of your heart in motion. This test can help doctors closely look at the condition of the aortic valve and the aorta. It can help doctors determine the cause and severity of your condition and see if you have additional heart valve conditions. Doctors may also use a 3D echocardiogram.

    A transesophageal echocardiogram may be done to get a closer look at the aortic valve. In this type of echocardiogram, a small transducer attached to the end of a tube is inserted down the tube leading from your mouth to your stomach (esophagus).

  • Electrocardiogram (ECG or EKG). In this test, wires (electrodes) attached to pads on your skin measure the electrical activity of your heart. An ECG can detect enlarged chambers of your heart, heart disease and abnormal heart rhythms.
  • Chest X-ray. A chest X-ray can show if your heart or aorta is enlarged. It can also help doctors determine the condition of your lungs.
  • Exercise tests or stress tests. Exercise tests help doctors see whether you have signs and symptoms of aortic valve disease during physical activity. These tests can help determine the severity of your condition. If you are unable to exercise, medications that have similar effects as exercise on your heart may be used.
  • Cardiac MRI. Using a magnetic field and radio waves, this test produces detailed pictures of your heart, including the aorta and aortic valve.
  • Cardiac catheterization. This test isn't often used to diagnose aortic valve regurgitation, but it may be done if other tests aren't able to diagnose the condition or determine its severity. Doctors may also do cardiac catheterization prior to valve replacement surgery to see if there are blockages in the coronary arteries, so they can be fixed at the time of the valve surgery.

    In cardiac catheterization, a doctor threads a thin tube (catheter) through a blood vessel, usually in your groin, to an artery in your heart. Dye flows through the catheter to make your blood vessels show up more clearly on X-ray. This provides your doctor with a detailed picture of your heart arteries and how your heart functions. It can also measure the pressure inside the heart chambers.

Treatment

Biological valve replacement

In biological valve replacement, a valve made from cow, pig or human heart tissue replaces the damaged valve.

Mechanical valve replacement

In mechanical valve replacement, a mechanical valve replaces the damaged valve.

Treatment of aortic valve regurgitation depends on the severity of your condition, whether you're having signs and symptoms, and if your condition is getting worse. The goals of aortic valve regurgitation treatment are to ease symptoms and prevent complications.

If your symptoms are mild or you aren't having symptoms, your doctor may monitor your condition with regular follow-up appointments and recommend healthy lifestyle changes. You may need regular echocardiograms to be sure your aortic valve regurgitation doesn't become severe.

Medications

Your doctor may recommend that you take medications to treat symptoms of aortic valve regurgitation or reduce your risk of complications. Medications may be prescribed to lower blood pressure.

Surgery or other procedures

You may eventually need surgery to repair or replace the diseased aortic valve, particularly if you have severe aortic regurgitation and symptoms. However, some people need surgery even if it's not severe, or when they aren't having symptoms.

The decision to repair or replace a damaged aortic valve depends on your symptoms, age and overall health, and whether you need heart surgery to correct another heart problem. If you're having another heart surgery, doctors may perform aortic valve surgery at the same time.

Surgery to repair or replace an aortic valve may be done as open-heart surgery, which involves a cut (incision) in the chest. Sometimes doctors can perform minimally invasive heart surgery to replace the aortic valve. This procedure, called transcatheter aortic valve replacement (TAVR), uses smaller incisions than those used in open-heart surgery.

Surgery for aortic valve regurgitation includes:

  • Aortic valve repair. To repair an aortic valve, surgeons may separate valve flaps (cusps) that have fused, reshape or remove excess valve tissue so that the cusps can close tightly, or patch holes in a valve. Doctors may use a catheter procedure to insert a plug or device to repair a leaking replacement aortic valve.
  • Aortic valve replacement. In aortic valve replacement, your surgeon removes the damaged valve and replaces it with a mechanical valve or a valve made from cow, pig or human heart tissue (biological tissue valve). Transcatheter aortic valve replacement (TAVR) is a minimally invasive heart procedure to replace a narrowed aortic valve with a biological tissue valve.

    Sometimes, the aortic valve is replaced with your own lung (pulmonary) valve. Your pulmonary valve is replaced with a biological lung tissue valve from a deceased person. This more complicated surgery is called the Ross procedure.

    Biological tissue valves break down over time and may eventually need to be replaced. People with mechanical valves will need to take blood-thinning medications for life to prevent blood clots. Your doctor will discuss with you the benefits and risks of each type of valve to choose the best one for you.

Lifestyle and home remedies

You'll have regular follow-up appointments with your doctor to monitor your condition.

While lifestyle changes can't prevent or treat your condition, your doctor might suggest that you incorporate several heart-healthy ones into your life. These may include:

  • Eating a heart-healthy diet. Eat a variety of fruits and vegetables, low-fat or fat-free dairy products, poultry, fish, and whole grains. Avoid saturated and trans fat, and excess salt and sugar.
  • Maintaining a healthy weight. Aim to keep a healthy weight. If you're overweight or obese, your doctor may recommend that you lose weight. Ask your doctor what goal weight is healthy for you.
  • Getting regular physical activity. Aim to include about 30 minutes of physical activity, such as brisk walks, into your daily fitness routine. Ask your doctor for guidance before starting to exercise, especially if you're considering competitive sports.
  • Managing stress. Find ways to help manage your stress, such as through relaxation activities, meditation, exercise, and spending time with family and friends.
  • Avoiding tobacco. If you smoke, quit. Ask your doctor about resources to help you quit smoking. Joining a support group may be helpful.
  • Controlling high blood pressure. If you're taking blood pressure medication, take it exactly as your doctor has prescribed.

Pregnancy and aortic valve regurgitation

For women with aortic valve regurgitation, it's important to talk with your doctor before you become pregnant. Your doctor can discuss with you which medications you can safely take, and whether you may need a procedure to treat your valve condition prior to pregnancy.

You'll likely require close monitoring by your doctor during pregnancy. Doctors may recommend that women with severe valve conditions avoid pregnancy to avoid the risk of complications.

Preparing for an appointment

You're likely to start by seeing your family doctor. After your initial appointment, your doctor may refer you to a doctor who specializes in the diagnosis and treatment of heart conditions (cardiologist).

If you have aortic valve regurgitation, consider being evaluated and treated at a medical center with a team of cardiologists, cardiovascular surgeons, and other doctors and medical staff who specialize in heart valve disease treatment.

Here's some information to help you prepare for your appointment.

What you can do

  • Write down your symptoms and how long you've had them.
  • Make a list of your key medical information, including other recent health problems you've had and all prescription and over-the-counter medications and supplements you're taking.
  • Take a family member or friend with you to the appointment, if possible. Someone who accompanies you can help remember what the doctor says.
  • Write down questions to ask your doctor.

For aortic valve regurgitation, questions to ask your doctor include:

  • What is likely causing my symptoms?
  • Are there any other possible causes?
  • What tests do I need?
  • What treatment approach do you recommend?
  • What are the alternatives to the approach you're recommending?
  • Will I need surgery? If so, what surgeon do you recommend for aortic valve surgery?
  • I have other health conditions. How can I best manage them together?
  • Are there restrictions I need to follow?
  • Should I see a specialist?

Don't hesitate to ask other questions, as well.

What to expect from your doctor

Your doctor is likely to ask you a number of questions, including:

  • When did your symptoms begin?
  • Have your symptoms been continuous or occasional?
  • How severe are your symptoms?
  • What, if anything, seems to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?
  • Do you have heart disease in your family?
Last Updated: August 12th, 2021