Aortic Valve Regurgitation
A leaky aortic valve that lets blood flow back into the heart
Quick Facts
- Type: Heart valve disease
- Valve affected: Aortic valve
- Problem: Backward leakage of blood
- Symptoms: Fatigue, breathlessness, palpitations
Overview
Aortic valve regurgitation, also called a leaky aortic valve, occurs when the aortic valve does not close completely. This valve normally opens to let blood leave the heart for the body and then closes to keep it from flowing back. When it leaks, some blood flows backward into the heart's main pumping chamber after each beat.
To compensate, the heart has to handle extra blood and pump harder, which over time can cause the left ventricle to enlarge and weaken. Aortic regurgitation can develop slowly over years or, less often, suddenly. Mild leakage may cause no problems, while significant regurgitation needs monitoring and sometimes surgery to repair or replace the valve.
Symptoms
Chronic aortic regurgitation often causes no symptoms for many years. As it progresses, symptoms may include:
- Fatigue and reduced exercise tolerance
- Shortness of breath, especially with exertion or when lying down
- Heart palpitations or an awareness of a forceful heartbeat
- Swelling in the ankles and feet
- Chest discomfort, sometimes at night
- Lightheadedness
Sudden, severe aortic regurgitation, for example from an infection or a tear in the aorta, can cause rapid, severe breathlessness and is a medical emergency. Seek emergency care for sudden severe shortness of breath, fainting, or severe chest pain.
Causes
Aortic regurgitation can result from problems with the valve itself or with the aorta it connects to. Causes include:
- Age-related valve changes: Wear and calcium deposits that prevent full closure.
- Bicuspid aortic valve: A valve with two leaflets from birth.
- Enlargement of the aorta: A widened aorta can stretch the valve so it cannot seal.
- Infective endocarditis: Infection that damages the valve.
- Rheumatic fever: Valve scarring from a past infection.
- Aortic dissection or chest injury: Which can cause sudden, severe leakage.
Risk Factors
- Older age
- A bicuspid (two-leaflet) aortic valve
- High blood pressure
- A history of rheumatic fever
- Conditions that enlarge the aorta
- A previous heart valve infection
Diagnosis
Aortic regurgitation is often first detected as a heart murmur. Tests confirm the diagnosis and assess severity.
- Echocardiogram: The main test, an ultrasound that shows the valve, measures the leak, and assesses heart size and function.
- Electrocardiogram (ECG): Checks the heart's rhythm and any strain.
- Chest X-ray: May show an enlarged heart or widened aorta.
- Cardiac MRI or CT: Provide detailed images of the valve and aorta when needed.
Treatment
Treatment depends on how severe the leak is, whether there are symptoms, and how the heart is coping.
- Monitoring: Regular echocardiograms for mild regurgitation or when there are no symptoms.
- Medications: To control blood pressure and ease the heart's workload and symptoms, though they do not fix the valve.
- Valve repair or replacement: Surgery to fix or replace the valve when the leak is severe or the heart is becoming enlarged or weakened.
- Emergency surgery: May be needed for sudden, severe regurgitation.
The timing of surgery is guided by symptoms and measurements of heart size and function.
Prevention
- Manage high blood pressure to reduce strain on the valve and aorta
- Treat strep throat promptly to help prevent rheumatic fever
- Maintain good dental and skin hygiene to lower the risk of valve infection
- Attend regular check-ups if you have a murmur, bicuspid valve, or aortic enlargement
- Follow your clinician's advice on monitoring and activity
When to See a Doctor
See a clinician if you have a known heart murmur or develop fatigue, breathlessness, palpitations, or ankle swelling. Regular follow-up is important if you have known aortic regurgitation or an enlarged aorta. Seek emergency care for sudden severe shortness of breath, fainting, or severe chest pain, which may indicate sudden severe leakage or an aortic emergency.
Frequently Asked Questions
What is aortic valve regurgitation?
It is a condition in which the aortic valve does not close tightly, so some blood leaks back into the heart's main pumping chamber after each beat. The heart then has to work harder, and over time the chamber can enlarge and weaken.
What causes a leaky aortic valve?
Causes include age-related wear and calcium on the valve, being born with a two-leaflet valve, an enlarged aorta that stretches the valve, infection of the valve, and past rheumatic fever. A tear in the aorta or chest injury can cause sudden, severe leakage.
What are the symptoms of aortic regurgitation?
Chronic cases often cause no symptoms for years. Later symptoms include fatigue, shortness of breath with activity or lying down, palpitations or a forceful heartbeat, and ankle swelling. Sudden severe leakage causes rapid, severe breathlessness and is an emergency.
How is aortic regurgitation treated?
Mild cases are monitored with regular echocardiograms. Medications can control blood pressure and ease symptoms but do not fix the valve. Severe leakage, or signs that the heart is enlarging or weakening, is treated with valve repair or replacement surgery.
Is aortic regurgitation life-threatening?
Chronic mild regurgitation is often not dangerous and is simply followed over time. Severe leakage can lead to heart failure if untreated, and sudden severe regurgitation is a medical emergency. Regular monitoring helps catch worsening early.
References
- American Heart Association. Problem: Aortic Valve Regurgitation.
- MedlinePlus, U.S. National Library of Medicine. Aortic regurgitation.
- Mayo Clinic. Aortic valve regurgitation — Symptoms and causes.
- National Heart, Lung, and Blood Institute (NHLBI). Heart Valve Diseases.