Aortic valve regurgitation
— or aortic regurgitation — is a condition that occurs when your
heart's aortic valve doesn't close tightly. Aortic valve regurgitation
allows some of the blood that was just pumped out of your heart's main
pumping chamber (left ventricle) to leak back into it.
The leakage of blood may prevent your heart from efficiently pumping
blood out 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. Aortic
valve regurgitation has a variety of causes, ranging from congenital
heart defects to complications of infectious illnesses. Once aortic
valve regurgitation becomes severe, surgery is usually required to
repair or replace the aortic valve.
Most often aortic valve regurgitation develops gradually, and your heart
compensates for the problem. You may have no signs or symptoms for many
years, and you may even be unaware that you have this condition.
However, as aortic valve regurgitation gets worse, signs and symptoms usually appear and may include:
* Fatigue and weakness, especially when you increase your activity level
* Shortness of breath with exertion or when you lie flat
* Chest pain, discomfort or tightness, often increasing during exercise
* Rapid or irregular pulse
* Heart palpitations — sensations of a rapid, fluttering heartbeat
* Swollen ankles and feet
When to see a doctor
Take the signs and symptoms of aortic valve regurgitation seriously and
see a doctor right away if they develop. Sometimes the first indications
of aortic valve regurgitation are those of its major complication,
congestive heart failure. Signs and symptoms of congestive heart failure
— a serious condition — include fatigue, shortness of breath, and
swollen ankles and feet.
Aortic valve regurgitation disrupts the way blood normally flows through your heart and its valves.
Your heart, the center of your circulatory system, consists of four
chambers. The two upper chambers, the atria, receive blood. The two
lower chambers, the ventricles, pump blood to your lungs and to the rest
of your body. Blood flows through your heart's chambers, aided by four
The aortic valve consists of three tightly fitting, triangular-shaped
flaps of tissues called leaflets. These leaflets connect to the aorta
through a ring called the annulus.
Heart valves open like a one-way gate. The leaflets of the aortic valve
are forced open as the left ventricle contracts and blood flows into the
aorta. When all of the blood has gone through the valve and the left
ventricle has relaxed, the leaflets swing closed to prevent the blood
that has just passed into the aorta from flowing back into the left
A defective heart valve is one that fails to either open or close fully.
When a valve doesn't close tightly, blood can leak backward. This
backward flow through a valve is called regurgitation.
Any condition that damages a valve can cause regurgitation. Causes of aortic valve regurgitation may be:
* A congenital heart defect. You may have been born with an aortic
valve that has one leaflet (unicuspid valve) or two leaflets (bicuspid
valve) rather than the normal three leaflets. This puts you at risk of
developing aortic valve regurgitation at some time in your life.
* Deterioration of the valve with age. The aortic valve opens and
shuts tens of thousands of times a day, every day of your life. Aortic
valve regurgitation may result from age-related wear and tear on the
* Endocarditis. The aortic valve may be damaged by endocarditis — an infection inside your heart that involves heart valves.
* Rheumatic fever. Rheumatic fever — a complication of strep throat
and once a common childhood illness in the United States — can damage
the aortic valve, leading to aortic valve regurgitation later in life.
Rheumatic fever may damage more than one heart valve, and in more than
one way. A damaged heart valve may not open fully or close completely —
or both. Rheumatic fever is still prevalent in developing countries, and
many older adults in the United States were exposed to rheumatic fever
* Other causes. Other, rarer conditions that can damage the aortic
valve and lead to regurgitation include Marfan syndrome (a disease of
connective tissue), ankylosing spondylitis (a spine disorder) and
syphilis (a sexually transmitted disease). Damage to the aorta near the
site of the aortic valve, such as damage from injury to your chest or
from a tear in the aorta, also can cause backward flow of blood through
Aortic valve regurgitation — of any cause — can weaken your heart. In
aortic valve regurgitation, some blood leaks back into the left
ventricle instead of flowing onward to the rest of your body after being
pumped into the aorta. This forces the left ventricle to hold more
blood. In response, this chamber of your heart may enlarge and thicken.
At first these adaptations help the left ventricle pump blood with more
force. But eventually these changes weaken the left ventricle — and your
Your risk of aortic regurgitation is greater if:
* Your aortic valve has already been damaged by some other condition, such as endocarditis or rheumatic fever
* You were born with a unicuspid or bicuspid aortic valve
* You have a medical condition that increases your risk of
developing a leaky aortic valve, such as Marfan syndrome, ankylosing
spondylitis or syphilis
Aortic valve regurgitation — or any heart valve problem — puts you at
risk of endocarditis. Endocarditis is an infection of the heart's inner
lining — the endocardium. This membrane lines the four chambers and four
valves of your heart. Typically, this infection involves one of the
heart valves, especially if it's already damaged. If the aortic valve is
leaky, it's more prone to infection than is a healthy valve. You can
develop endocarditis when bacteria from another part of your body spread
through your bloodstream and lodge in your heart.
When it's mild, aortic valve regurgitation may never cause a serious
threat to your health. But when it's severe, aortic valve regurgitation
may lead to congestive heart failure. Congestive heart failure is a
serious condition in which your heart is unable to pump enough blood to
meet your body's needs.
You're likely to start by first 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
Here's some information to help you prepare for your appointment, and what to expect from your doctor.
What you can do
* Write down any symptoms you're experiencing, and for how long.
* Make a list of your key medical information, including other
recent health problems you've had and the names of any prescription and
over-the-counter medications you're taking.
* Find a family member or friend who can come with you to the
appointment, if possible. Someone who accompanies you can help remember
what the doctor says.
* Write down the questions you want to be sure to ask your doctor.
Questions to ask your doctor at your initial appointment include:
* What is likely causing my signs or symptoms?
* Are there any other possible causes for these signs or symptoms?
* What tests do I need?
* Should I see a specialist?
* Should I follow any restrictions in the time leading up to my appointment with a cardiologist?
Questions to ask if you are referred to a cardiologist include:
* What is my diagnosis?
* What treatment approach do you recommend?
* If you're recommending medications, what are the possible side effects?
* If you're recommending surgery, what procedure is most likely to be successful in my case? Why?
* If you're recommending surgery, what will my recovery be like?
* If you don't think I need immediate treatment, how will you determine the right time to treat my condition?
* How frequently will you see me for follow-up visits?
* What is my risk of long-term complications from this condition?
* Will physical activity, including sexual activity, increase my risk of complications?
* What diet and lifestyle changes should I make?
* I have these other health conditions. How can I best manage them together?
In addition to the questions that you've prepared to ask your doctor,
don't hesitate to ask questions during your appointment at any time that
you don't understand something.
What to expect from your doctor
A doctor who sees you for possible aortic valve regurgitation may ask:
* What are your symptoms?
* When did you first begin experiencing symptoms?
* Have your symptoms gotten worse over time?
* Do your symptoms include rapid, fluttering or pounding heartbeats?
* Have you experienced any chest pain or tightness?
* Do your symptoms include shortness of breath?
* Have you ever fainted?
* Have you ever coughed up blood?
* Does exercise or physical exertion make your symptoms worse?
* Does lying down make your symptoms worse?
* Are you aware of any history of heart problems in your family?
* Have you ever knowingly had rheumatic fever?
* Are you being treated or have you recently been treated for any other health conditions?
* Do you or did you smoke? How much?
* Do you use alcohol or caffeine? How much?
* Are you planning to become pregnant in the future?
What you can do in the meantime
While you wait for your appointment, check with your family members to
find out if any close relatives have been diagnosed with cardiac
disease. The symptoms of aortic valve regurgitation are similar to a
number of other heart conditions, including some that tend to run in
families. Knowing as much as possible about your family's health history
will help your doctor determine next steps for your diagnosis and
If exercise makes your symptoms worse, avoid intense physical activity until you've been seen by your doctor.
Identifying aortic valve regurgitation early is important because the
condition can worsen with time, and you may need surgery to correct it.
Your doctor may first suspect that you have aortic valve regurgitation
during a routine office visit after listening to your heart with a
stethoscope and hearing an abnormal heart sound (heart murmur). Blood
leaking through the aortic valve often makes a distinct sound.
To begin the evaluation of your heart, your doctor will ask you
questions about your personal and family health history. Next your
doctor will perform a physical examination that concentrates on your
From this information, your doctor decides what tests you may need in
order to make a diagnosis and develop a treatment plan. For testing, you
may be referred to a cardiologist — a doctor who specializes in the
study of the heart and its function.
Other heart problems can cause signs and symptoms similar to those of
aortic valve regurgitation, and it's possible to have more than one
disorder at the same time. Common tests doctors use to diagnose aortic
valve regurgitation include:
* Echocardiogram. This test uses sound waves to produce an image of
your heart. In an echocardiogram, sound waves are directed at your heart
from a wand-like device (transducer) held on your chest. The sound
waves bounce off your heart and are reflected back through your chest
wall and processed electronically to provide video images of your heart.
An echocardiogram helps your doctor get a close look at your aortic
valve. A specific type of echocardiogram, a Doppler echocardiogram, may
be used. It allows measurements of the volume of blood flowing backward
through an aortic valve. This volume is expressed in cubic centimeters
* Chest X-ray. With an X-ray of your chest, your doctor can study
the size and shape of your heart to determine whether your left
ventricle is enlarged — a possible sign of damage to the aortic valve.
* Electrocardiogram (ECG). In this test, patches with wires
(electrodes) are attached to your skin to measure the electrical
impulses given off by your heart. Impulses are recorded as waves
displayed on a monitor or printed on paper. An ECG can provide clues
about whether the left ventricle is enlarged, a problem which can occur
with aortic valve regurgitation.
* Transesophageal echocardiogram. This type of echocardiogram allows
an even closer look at your aortic valve. The esophagus, the tube that
runs from your throat to your stomach, lies close to your heart. In a
traditional echocardiogram, a device called a transducer is moved across
your chest to produce the sound waves necessary to create the image of
your beating heart. In a transesophageal echocardiogram, a small
transducer attached to the end of a tube is inserted down the esophagus.
Because the esophagus lies close to your heart, having the transducer
there provides a clear picture of your aortic valve and blood flow
* Exercise tests. Different types of exercise tests help measure
your tolerance for activity and check your heart's response to exertion
* Cardiac catheterization. Your doctor may order this procedure if
noninvasive tests haven't provided enough information to firmly
diagnosis the type or severity of your heart condition. Your doctor
threads a thin tube (catheter) through a blood vessel in your arm or
groin, into your heart. Dye is injected through the catheter into your
heart, making details visible on an X-ray. Cardiac catheterization can
show if blood is leaking back from the aorta into the heart's left
ventricle. Some catheters with special sensors also can measure pressure
within heart chambers, such as the left ventricle. Pressure may be
increased in the left ventricle with aortic valve regurgitation.
These tests help your doctors diagnose aortic valve regurgitation,
determine how serious the problem is, and decide whether your aortic
valve needs repair or replacement.
Treatment of aortic valve regurgitation depends on how severe your
regurgitation is, your signs and symptoms, and whether the regurgitation
is affecting your heart function. If you have aortic valve
regurgitation, your doctor will evaluate your heart with regular
echocardiograms to determine whether damage to your heart is getting
Some people, especially those with mild regurgitation, don't need
treatment. However, even if you don't have signs and symptoms of aortic
valve regurgitation, schedule regular evaluations with your doctor.
Observation isn't the same as ignoring the condition. Actively observing
the stability or the progression of the condition is important so that
you can receive the right treatment at the right time.
Medication can't eliminate aortic valve regurgitation. However, your
doctor may prescribe certain medications to reduce the severity of
aortic valve regurgitation, control blood pressure and try to prevent
fluid buildup. If you have aortic valve regurgitation, your doctor may
recommend that you take antibiotics before certain dental or medical
procedures to prevent the heart infection endocarditis.
Once signs and symptoms of aortic valve regurgitation develop, you'll
usually need surgery. However, if aortic valve regurgitation is
weakening your heart, you may need surgery even if you feel well. While
the heart is generally good at counteracting problems caused by a leaky
aortic valve, the problem is that if the valve isn't fixed or replaced
in time, the strength of your heart may decline so much that it's
permanently weakened. You can avoid that by having surgery at the
The overall function of your heart and the amount of regurgitation help
to determine when surgery is necessary. Surgical procedures include:
* Valve repair. Aortic valve repair is surgery to preserve the valve
and to improve its function. Occasionally, surgeons can modify the
original valve (valvuloplasty) to eliminate backward blood flow. You
don't need long-term medications to prevent blood clots (anticoagulation
therapy) after a valvuloplasty.
* Valve replacement. In many cases, the aortic valve has to be
replaced to correct aortic valve regurgitation. Your surgeon removes the
narrowed aortic valve and replaces it with a mechanical valve or a
tissue valve. Mechanical valves, made from metal, are durable, but they
carry the risk of blood clots forming on or near the valve. If you
receive a mechanical aortic valve, you'll need to take an anticoagulant
medication, such as warfarin (Coumadin), for life to prevent blood
clots. Tissue valves — which may come from a pig, cow or human cadaver
donor — often need to be replaced. Another type of tissue valve
replacement that uses your own pulmonary valve (autograft) is sometimes
possible. Your doctor can discuss the risks and benefits of each type of
heart valve with you.
Aortic valve regurgitation can be eliminated with surgery, and you can
usually resume normal activities within a few months. The prognosis
following surgery is generally good.
To improve your quality of life if you have aortic valve regurgitation,
your physician may — in addition to other treatments — recommend that
* Control high blood pressure. Lowering blood pressure reduces the strain on your aortic valve.
* Consume less salt. Cutting back on your salt intake helps you
maintain your blood pressure within a normal range, which is important
if you have aortic valve regurgitation.
* See your dentist regularly. Follow your recommended schedule for care.
* Maintain a healthy weight. Keep your weight within a range
recommended by your doctor. Extra weight makes extra work for your
* Exercise. Follow an exercise program within guidelines recommended
by your doctor. Exercise itself does not fix aortic valve
regurgitation, but it can help to lower your blood pressure. Exercise
also helps maintain your general fitness, which will help with your
recovery if you need heart surgery.
* See your doctor regularly. Establish a regular evaluation schedule with your cardiologist or primary care provider.
If you're a woman of childbearing age with aortic valve regurgitation,
discuss pregnancy and family planning with your doctor because your
heart works harder during pregnancy. How a heart with aortic valve
regurgitation tolerates this extra work depends on the degree of leakage
and how well your heart pumps. If you become pregnant, you'll need
evaluation by your cardiologist and obstetrician throughout your
pregnancy, labor and delivery, and after delivery.
One possible way to prevent aortic valve regurgitation is to prevent
rheumatic fever. You can do this by making sure you see your doctor when
you have a sore throat. Untreated strep throat can develop into
rheumatic fever. Fortunately, strep throat is easily treated with
antibiotics. Avoiding infections of the blood, including those caused by
intravenous drug use, can prevent damage to the aortic valve that leads
to aortic valve regurgitation. In addition, taking good care of your
teeth helps prevent bloodstream infections that can damage your heart
You may be able to prevent aortic valve regurgitation from high blood
pressure by taking care of your cardiovascular system. Getting your
blood pressure under control is important because high blood pressure
can lead to aortic valve damage and aortic valve regurgitation. High
blood pressure can also cause your aorta to stretch out, which pulls the
aortic valve leaflets apart and leads to regurgitation.