Learn more about the symptoms and treatment of this condition in which the heart's aortic valve doesn't close tightly.
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.
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).
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:
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.
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.
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.
Things that make you more likely to develop aortic valve regurgitation include:
Possible complications of aortic valve regurgitation include:
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:
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).
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 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.
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.
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 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.
In a biological valve replacement, a biological or tissue valve replaces the damaged valve.
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:
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.
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.
For aortic valve regurgitation, questions to ask your doctor include:
Don't hesitate to ask other questions, as well.
Your doctor is likely to ask you a number of questions, including: