Aortic Valve Regurgitation
Aortic valve regurgitation — also called aortic regurgitation — is a type of heart valve disease. The valve between the lower left heart chamber and the body’s main artery doesn’t close tightly. As a result, some of the blood pumped out of the heart’s main pumping chamber, called the left ventricle, leaks backward.
The leakage may prevent the heart from doing a good enough job of pumping blood to the rest of the body. You may feel tired and short of breath.
Aortic valve regurgitation can develop suddenly or over many years. Once the condition becomes severe, surgery often is needed to repair or replace the valve.
Most often, aortic valve regurgitation develops over time. You may have no symptoms for years. You might not realize that you have the condition. But sometimes, aortic valve regurgitation occurs suddenly. Usually, this is due to an infection of the valve.
As aortic valve regurgitation becomes worse, symptoms may include:
- Shortness of breath with exercise or when lying down.
- Tiredness and weakness, especially when being more active than usual.
- Irregular heartbeat.
- Lightheadedness or fainting.
- Pain, discomfort or tightness in the chest, which often gets worse during exercise.
- Sensations of a rapid, fluttering heartbeat, called palpitations.
- Swollen ankles and feet.
When to see a doctor
Call a member of your health care team right away if you have symptoms of aortic valve regurgitation.
Sometimes the first symptoms of aortic valve regurgitation are related to heart failure. Heart failure is a condition in which the heart can’t pump blood as well as it should. Make an appointment with your health care team if you have:
- Tiredness, also called fatigue, that doesn’t get better with rest.
- Shortness of breath.
- Swollen ankles and feet.
These are common symptoms of heart failure.
The aortic valve is one of four valves that control blood flow through the heart. It separates the heart’s main pumping chamber, called the left ventricle, and the body’s main artery, called the aorta. The aortic valve has flaps, also called cusps or leaflets, that open and close once during each heartbeat.
In aortic valve regurgitation, the valve doesn’t close properly. This causes blood to leak back into the lower left heart chamber, called the left ventricle. As a result, the chamber holds more blood. This could cause it to get larger and thicken.
At first, the larger left ventricle helps maintain good blood flow with more force. But eventually, the heart becomes weak.
Any condition that damages the aortic valve can cause aortic valve regurgitation. Causes may include:
Heart valve disease present at birth. Some people are born with an aortic valve that has only two cusps, called a bicuspid valve. Others are born with connected cusps rather than the typical three separate ones. Sometimes the valve may have only one cusp, called a unicuspid valve. Other times, there are four cusps, called a quadricuspid valve.
Having a parent or sibling with a bicuspid valve raises your risk of the condition. But you can have a bicuspid valve even if you don’t have a family history of the condition.
- Narrowing of the aortic valve, called aortic stenosis. Calcium deposits can build up on the aortic valve as you age. The buildup causes the aortic valve to stiffen and become narrow. It prevents the valve from opening properly. Aortic stenosis also may prevent the valve from closing properly.
- Inflammation of the inner lining of the heart’s chambers and valves. This life-threatening condition also is called endocarditis. It’s usually caused by an infection. It can damage the aortic valve.
- Rheumatic fever. This condition was once a common childhood illness in the United States. Strep throat can cause it. Rheumatic fever can cause the aortic valve to become stiff and narrow, in turn causing blood to leak. If you have an irregular heart valve due to rheumatic fever, it’s called rheumatic heart disease.
- Other health conditions. Other rare conditions can cause the aorta to get bigger and damage the aortic valve. These include a connective tissue disease called Marfan syndrome. Some immune system conditions, such as lupus, also can lead to aortic valve regurgitation.
- Tear or injury of the body’s main artery. The body’s main artery is the aorta. A traumatic chest injury may damage the aorta and cause aortic regurgitation. So might a tear in the inner layer of the aorta, called an aortic dissection.
Things that raise the risk of aortic valve regurgitation include:
- Older age.
- Heart problems present at birth, also called congenital heart defects.
- History of infections that can affect the heart.
- Certain conditions passed down through families that can affect the heart, such as Marfan syndrome.
- Other types of heart valve disease, such as aortic valve stenosis.
- High blood pressure.
The condition also can happen without any known risk factors.
Complications of aortic valve regurgitation can include:
- Fainting or feeling lightheaded.
- Heart failure.
- Certain heart infections such as endocarditis.
- Heart rhythm problems, called arrhythmias.
- Death.
If you have any type of heart disease, get regular health checkups.
If you have a parent, child or sibling with a bicuspid aortic valve, you should have an imaging test called an echocardiogram. This can check for aortic valve regurgitation. Early diagnosis of heart valve disease, such as aortic valve regurgitation, is important. Doing so may make the condition easier to treat.
Also, take steps to prevent conditions that can raise the risk of aortic valve regurgitation. For example:
- Get a health checkup if you have a severe sore throat. Untreated strep throat can lead to rheumatic fever. Strep throat is treated with medicines that fight bacteria, called antibiotics.
- Check your blood pressure regularly. Have your blood pressure checked at least every two years starting at age 18. Some people need more-frequent checks.
To diagnose aortic valve regurgitation, a member of your health care team examines you. You usually are asked questions about your symptoms and health history. You also might be asked about your family’s health history.
Your blood pressure is checked using a cuff, usually placed around your arm. A device called a stethoscope is used to listen to your heart. Your health care professional may hear an irregular sound called a heart murmur.
You may be referred to a doctor trained in heart diseases, called a cardiologist.
Tests
Tests may be done to check your heart health and learn the cause of aortic valve regurgitation. Tests may include:
Echocardiogram. Sound waves are used to create pictures of the beating heart. This test shows how blood flows through the heart and heart valves. It can show the aortic valve and the aorta. An echocardiogram can help tell how severe aortic regurgitation is.
There are different types of echocardiograms. If a standard test doesn’t provide enough information, you may have one called a transesophageal echocardiogram. This type creates pictures of the heart from inside the body. It gives a detailed look at the aorta and aortic valve.
- Electrocardiogram (ECG or EKG). An ECG measures the electrical activity of the heart. It shows how fast or how slowly the heart is beating. Sticky patches are placed on the chest and sometimes the arms and legs. Wires connect the electrodes to a computer, which displays the results.
- Chest X-ray. A chest X-ray can show if the heart or aorta is enlarged. It also can help determine the condition of the lungs.
- CT scan of the heart. Also called a cardiac CT, this test uses a series of X-rays to make a detailed image of the heart. You lie on a table inside a doughnut-shaped machine. A CT scan also can help confirm a tear in the aorta.
- Exercise tests or stress tests. These tests often involve walking on a treadmill or riding a stationary bike while the heart is checked. Exercise tests show how the heart reacts to physical activity. The tests can show whether valve disease symptoms occur during exercise. If you can’t exercise, you might get medicines that affect the heart like exercise does.
- Cardiac MRI. This test uses a magnetic field and radio waves to make detailed pictures of the heart, including the aorta and aortic valve.
Cardiac catheterization. This test isn’t always used to find aortic valve regurgitation. But it may be done if other tests aren’t able to diagnose the condition or determine how serious it is. Cardiac catheterization may be done before valve replacement surgery to check for blockages.
In cardiac catheterization, a doctor inserts a long, thin flexible tube called a catheter in a blood vessel, usually in the groin or wrist. It’s guided to the heart. Dye flows through the catheter to arteries in the heart. The dye helps the arteries show up more clearly on X-ray images and video.
Heart valve disease stages
After testing confirms a diagnosis of heart valve disease, your health care team may tell you the stage of disease. Staging helps determine the most appropriate treatment.
The stage of heart valve disease depends on many things, including symptoms, disease severity, the structure of the valve or valves, and blood flow through the heart and lungs.
Heart valve disease is staged into four basic groups:
- Stage A: At risk. Risk factors for heart valve disease are present.
- Stage B: Progressive. Valve disease is mild or moderate. There are no heart valve symptoms.
- Stage C: Asymptomatic severe. There are no heart valve symptoms but the valve disease is severe.
- Stage D: Symptomatic severe. Heart valve disease is severe and is causing symptoms.
Treatment of aortic valve regurgitation depends on:
- How serious the condition is.
- The symptoms, if any.
- Whether the 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 don’t have symptoms, you may only need regular health checkups. You may need regular echocardiograms to check the health of the aortic valve. Heart-healthy lifestyle changes also are usually recommended.
Medications
If you have aortic valve regurgitation, you may be given medicines to:
- Treat symptoms.
- Reduce the risk of complications.
- Lower blood pressure.
Surgery or other procedures
Surgery may be needed to repair or replace the diseased valve, especially if the condition and symptoms are severe. Heart valve surgery may be needed even if aortic regurgitation isn’t severe or when there are no symptoms.
The decision to repair or replace a damaged aortic valve depends on:
- Your symptoms.
- Your age and overall health.
- Whether you need heart surgery to correct another heart condition.
If you’re having another heart surgery, surgeons may do aortic valve surgery at the same time.
Surgery to repair or replace an aortic valve may be done as open-heart surgery. This involves a cut, also called an incision, in the chest. Sometimes surgeons can do minimally invasive heart surgery to replace the aortic valve.
Surgery for aortic valve regurgitation includes:
- Aortic valve repair. To repair an aortic valve, surgeons may separate valve flaps, also called cusps, that have connected. They might reshape or remove excess valve tissue so that the cusps can close tightly. Or they might patch holes in a valve. A catheter procedure may be done to place a plug or device in a leaking replacement aortic valve.
Aortic valve replacement. The surgeon removes the damaged valve and replaces it. The replacement might be a mechanical valve or one made from cow, pig or human heart tissue. A tissue valve also is called a biological tissue valve.
Sometimes, surgeons can do minimally invasive heart surgery to replace the aortic valve. This procedure is called transcatheter aortic valve replacement (TAVR). It uses smaller incisions than those used in open-heart surgery.
Sometimes the aortic valve is replaced with your own lung valve, also called the pulmonary valve. Your pulmonary valve is replaced with a biological lung tissue valve from a deceased donor. This more complicated surgery is called the Ross procedure.
Biological tissue valves break down over time. Eventually, they may need to be replaced. People with mechanical valves need blood thinners for life to prevent blood clots. Ask your health care team about the benefits and risks of each type of valve.
References
- Heart valve disease. National Heart, Lung, and Blood Institute. https://www.nhlbi.nih.gov/health-topics/heart-valve-disease. Accessed April 29, 2021.
- Problem: Aortic valve regurgitation. American Heart Association. https://www.heart.org/en/health-topics/heart-valve-problems-and-disease/heart-valve-problems-and-causes/problem-aortic-valve-regurgitation. Accessed June 30, 2023.
- Bonow RO, et al., eds. Aortic valve disease. In: Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine. 11th ed. Elsevier; 2019. https://www.clinicalkey.com. Accessed April 29, 2021.
- Gaasch WH. Clinical manifestations and diagnosis of chronic aortic regurgitation in adults. https://www.uptodate.com/contents/search. Accessed April 29, 2021.
- Gaasch WH. Natural history and management of chronic aortic regurgitation in adults. https://www.uptodate.com/contents/search. Accessed April 29, 2021.
- Rawasia WF, et al. Safety and efficacy of transcatheter aortic valve replacement for native aortic valve regurgitation: A systematic review and meta-analysis. Catheterization and Cardiovascular Interventions. 2019; doi:10.1002/ccd.27840.
- AskMayoExpert. Aortic valve regurgitation. Mayo Clinic; 2022.
- Otto CM, et al. 2020 ACC/AHA Guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Journal of the American College of Cardiology. doi:10.1016/j.jacc.2020.11.018.
- How can I make my lifestyle healthier? American Heart Association. https://www.heart.org/en/health-topics/consumer-healthcare/answers-by-heart-fact-sheets/answers-by-heart-fact-sheets-lifestyle-and-risk-reduction. Accessed June 30, 2023.
- Otto CM. Acute aortic regurgitation in adults. https://www.uptodate.com/contents/search. Accessed April 26, 2023.
- Ami TR. Allscripts EPSi. Mayo Clinic. May 3, 2023.
- Medical review (expert opinion). Mayo Clinic. May 17, 2021.
- American Heart Association adds sleep to cardiovascular health checklist. American Heart Association. https://newsroom.heart.org/news/american-heart-association-adds-sleep-to-cardiovascular-health-checklist. Accessed June 30, 2023.
- Lloyd-Jones DM, et al. Life’s essential 8: Updating and enhancing the American Heart Association’s construct of cardiovascular health: A presidential advisory from the American Heart Association. Circulation. 2022; doi:10.1161/CIR.0000000000001078.
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