Understanding Aortic Valve Regurgitation
Aortic Valve Regurgitation
Aortic valve regurgitation, also called aortic insufficiency, is a heart condition where the aortic valve doesn't close properly, allowing blood to leak backwards into the left ventricle (the heart's main pumping chamber). To understand this condition better, imagine your heart's aortic valve as a one-way door that should open to let blood flow from your heart to your body, then close tightly to prevent blood from flowing backwards.
What Happens When You Have Aortic Valve Regurgitation?
In a healthy heart, the aortic valve opens when your heart contracts to pump blood to your body, then closes completely when your heart relaxes between beats. When you have aortic regurgitation, this valve doesn't seal properly, causing blood to leak back into the left ventricle. This means your heart must work harder to pump the same amount of blood to your body, as it needs to handle both the new blood coming from your lungs and the blood that has leaked back.
Over time, this extra workload can cause your left ventricle to enlarge and eventually weaken, potentially leading to heart failure if left untreated. The condition can develop suddenly (acute) or gradually over many years (chronic), with each type presenting different challenges and requiring different approaches to treatment.
Types of Aortic Regurgitation
Acute Aortic Regurgitation
Acute aortic regurgitation develops suddenly and is considered a medical emergency. It most commonly occurs due to infections of the heart valve (endocarditis) or when there's a tear in the main artery leading from your heart (aortic dissection). This sudden onset means your heart hasn't had time to adapt to the extra volume of blood, leading to rapid development of severe symptoms, including difficulty breathing, chest pain, and potentially life-threatening complications.
Other causes of acute aortic regurgitation can include complications from heart procedures or traumatic chest injuries. Because the heart cannot quickly adapt to this sudden change, patients typically experience severe symptoms and require immediate medical attention.
Chronic Aortic Regurgitation
Chronic aortic regurgitation develops gradually over months or years. Your heart has time to adapt by enlarging and strengthening to handle the extra blood volume. This adaptation means you might not experience symptoms for many years, even with significant valve leakage. However, over time, even the strongest heart muscle can become overwhelmed by this extra work.
Common causes of chronic aortic regurgitation include age-related wear and tear of the valve, congenital heart defects (particularly bicuspid aortic valve, where the valve has two leaflets instead of the normal three), rheumatic heart disease, and conditions affecting the aorta, such as high blood pressure or connective tissue disorders.
Recognizing the Symptoms
The symptoms of aortic regurgitation depend on whether the condition is acute or chronic, and how severe the leakage has become.
Acute symptoms develop rapidly and may include severe shortness of breath, especially when lying flat, chest pain, rapid heartbeat, dizziness or fainting, and sudden weakness or fatigue. These symptoms require immediate emergency medical care.
Chronic symptoms develop gradually and may include shortness of breath during physical activity or when lying flat, unusual fatigue during normal activities, awareness of your heartbeat (palpitations), chest discomfort, swelling in your ankles or feet, and reduced ability to exercise or perform daily activities.
Many people with mild to moderate chronic aortic regurgitation have no symptoms at all, which is why regular check-ups with your healthcare provider are important if you've been diagnosed with this condition.
How Is Aortic Regurgitation Diagnosed?
Diagnosing aortic regurgitation typically begins with your doctor listening to your heart with a stethoscope. Aortic regurgitation often creates a distinctive heart murmur that trained healthcare providers can recognize. However, additional tests are needed to confirm the diagnosis and determine the severity.
Echocardiography is the most important test for diagnosing and monitoring aortic regurgitation. This ultrasound test of your heart can show how well your aortic valve is working, how much blood is leaking backward, and how your heart is coping with the extra workload. There are two types: transthoracic echocardiography (TTE), where the ultrasound probe is placed on your chest, and transesophageal echocardiography (TEE), where a probe is passed down your throat for more detailed images.
Additional imaging tests may be needed in certain situations. Cardiac MRI can provide very detailed information about valve function and heart muscle condition. CT scans are particularly useful when acute aortic dissection is suspected as a cause of sudden aortic regurgitation.
Blood tests might be performed to check for infections or other conditions that could be causing or contributing to your valve problems.
Treatment Options
Treatment for aortic regurgitation depends on the severity of the condition, whether you have symptoms, how well your heart is functioning, and whether the condition is acute or chronic.
Medical Management
For chronic aortic regurgitation, especially in patients without symptoms, careful monitoring may be all that's needed initially. Regular check-ups with echocardiograms allow your healthcare team to track any changes in your condition.
Medications may be prescribed to help manage your condition. These might include medications to control blood pressure and reduce the workload on your heart, diuretics (water pills) to help reduce fluid buildup if you develop heart failure symptoms, and medications to manage abnormal heart rhythms if they develop.
It's important to maintain good overall cardiovascular health through regular exercise (as recommended by your doctor), a heart-healthy diet, avoiding smoking, and managing other conditions like diabetes or high blood pressure.
Surgical Treatment
Surgery becomes necessary when aortic regurgitation is severe and you develop symptoms, or when your heart begins to show signs of being overwhelmed by the extra workload, even if you don't have symptoms yet.
Aortic Valve Replacement is the most common surgical treatment. Your surgeon removes the damaged valve and replaces it with either a mechanical valve (made of durable materials that can last decades) or a biological valve (made from animal tissue or human donor tissue). Each type has advantages and disadvantages that your healthcare team will discuss with you.
Aortic Valve Repair may be possible in some cases, particularly when the valve structure is basically sound but needs adjustment. This approach preserves your original valve while correcting the problem causing the regurgitation.
Transcatheter Procedures are newer, less invasive options that may be suitable for some patients, particularly those at high risk for traditional surgery. These procedures involve replacing or repairing the valve through a catheter inserted through a blood vessel, avoiding the need for open-heart surgery.
Emergency Treatment
Acute severe aortic regurgitation is a medical emergency requiring immediate surgery. Medical treatments can provide temporary stabilization, but surgery should not be delayed if there are signs of heart failure or shock.
What to Expect: Prognosis and Long-term Outlook
The outlook for people with aortic regurgitation varies significantly depending on the severity of the condition and how early it's detected and treated.
Mild aortic regurgitation may never cause problems and many people live normal, full lives with regular monitoring to ensure the condition doesn't worsen.
Moderate to severe chronic aortic regurgitation has an excellent prognosis when treated appropriately. Surgery, when performed at the right time, can restore normal life expectancy and quality of life for most patients.
Acute aortic regurgitation requires immediate treatment, but with prompt surgical intervention, most patients can expect good outcomes.
The key to the best possible outcome is regular follow-up care. Your healthcare provider will recommend a schedule of check-ups and tests based on the severity of your condition. This monitoring allows for timely intervention before irreversible heart damage occurs.
Living with Aortic Regurgitation
If you've been diagnosed with aortic regurgitation, there are several important steps you can take to protect your heart health:
Stay consistent with your follow-up appointments and recommended tests. These allow your healthcare team to monitor your condition and recommend treatment at the optimal time.
Maintain a heart-healthy lifestyle through regular exercise (as approved by your doctor), a diet low in salt and saturated fats, maintaining a healthy weight, and avoiding tobacco use.
Be aware of your symptoms and report any new or worsening symptoms to your healthcare provider promptly. These might include increased shortness of breath, chest pain, unusual fatigue, or swelling in your legs or ankles.
If you need dental work or certain medical procedures, inform your healthcare providers about your heart valve condition, as you may need antibiotic treatment to prevent infection.
Consider wearing medical identification jewelry that identifies your heart condition in case of emergency.
Questions to Ask Your Healthcare Provider
Understanding your specific situation is important for making informed decisions about your care. Consider asking your healthcare provider about the severity of your aortic regurgitation, how often you need follow-up appointments and tests, what symptoms should prompt you to seek immediate medical care, any activity restrictions you should observe, and when surgical intervention might become necessary.
Your healthcare team is your best resource for understanding your individual situation and developing a care plan that's right for you. Don't hesitate to ask questions or express concerns about your condition or treatment options.
August 2025
Prepared by Professor Eric Lim for PEACHealth with background research and drafting assistance by LLM.