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Aortic valve regurgitation

Overview

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 pumped out of your heart's main pumping chamber (left ventricle) to leak back into it.

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.

Aortic valve regurgitation

In aortic valve regurgitation, the aortic valve doesn't close properly, causing blood to leak backward from the aorta into the left ventricle.

Symptoms

Most often, aortic valve regurgitation develops gradually, and your heart compensates for the problem. You may have no signs or symptoms for years, and you may even be unaware that you have the condition.

However, as aortic valve regurgitation worsens, signs and symptoms may include:

  • Fatigue and weakness, especially when you increase your activity level
  • Shortness of breath with exercise or when you lie down
  • Swollen ankles and feet
  • Chest pain (angina), discomfort or tightness, often increasing during exercise
  • Lightheadedness or fainting
  • Irregular pulse (arrhythmia)
  • Heart murmur
  • Sensations of a rapid, fluttering heartbeat (palpitations)

When to see a doctor

Contact your doctor right away if signs and symptoms of aortic valve regurgitation develop. Sometimes the first indications of aortic valve regurgitation are those of its major complication, heart failure. See your doctor if you have fatigue, shortness of breath, and swollen ankles and feet, which are common symptoms of heart failure.

Causes

Your heart has four valves that keep blood flowing in the correct direction. These valves include the mitral valve, tricuspid valve, pulmonary valve and aortic valve. Each valve has flaps (cusps or leaflets) that open and close once during each heartbeat. Sometimes, the valves don't open or close properly, disrupting the blood flow through your heart and potentially impairing the ability to pump blood to your body.

In aortic valve regurgitation, the valve between the lower left heart chamber (left ventricle) and the main artery that leads to the body (aorta) doesn't close properly, which causes some blood to leak backward into the left ventricle. This forces the left ventricle to hold more blood, possibly causing it to enlarge and thicken.

At first, left ventricle enlargement helps because it maintains adequate blood flow with more force. But eventually these changes weaken the left ventricle — and your heart overall.

Any condition that damages a valve can cause regurgitation. Causes of aortic valve regurgitation include:

  • Congenital heart valve disease. You may have been born with an aortic valve that has only two cusps (bicuspid valve) or fused cusps rather than the normal three separate cusps. In some cases 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, but it can also occur if you don't have a family history of a bicuspid aortic valve.

  • Age-related changes to the heart. Calcium deposits can build up on the aortic valve over time, causing the aortic valve's cusps to stiffen. This can cause the aortic valve to become narrow, and it may also not close properly.
  • 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. Rheumatic fever is still prevalent in developing countries but rare in the United States. Some older adults in the United States were exposed to rheumatic fever as children, although they may not have developed rheumatic heart disease.
  • Other diseases. Other rare conditions can enlarge the aorta and aortic valve and lead to regurgitation, including Marfan syndrome, a connective tissue disease. Some autoimmune conditions, such as lupus, also can lead to aortic valve regurgitation.
  • Trauma. 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 the valve.
Chambers and valves of the heart

A normal 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 your heart. The heart valves, which keep blood flowing in the right direction, are gates at the chamber openings.

Risk factors

Risk factors of aortic valve regurgitation include:

  • Older age
  • Certain heart conditions present at birth (congenital heart disease)
  • History of infections that can affect the heart
  • Certain conditions that can affect the heart, such as Marfan syndrome
  • Other heart valve conditions, such as aortic valve stenosis
  • High blood pressure

Complications

Aortic valve regurgitation can cause complications, including:

  • Heart failure
  • Infections that affect the heart, such as endocarditis
  • Heart rhythm abnormalities
  • Death

Diagnosis

To diagnose aortic valve regurgitation, your doctor may review your signs and symptoms, discuss your and your family's medical history, and conduct a physical examination. Your doctor may listen to your heart with a stethoscope to determine if you have a heart murmur that may indicate an aortic valve condition. A doctor trained in heart disease (cardiologist) may evaluate you.

Your doctor may order several tests to diagnose your condition, and determine the cause and severity of your condition. Tests may include:

  • Echocardiogram. Sound waves directed at your heart from a wandlike device (transducer) held on your chest produces video images 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 3-D echocardiogram.

    Doctors may conduct another type of echocardiogram called a transesophageal echocardiogram to get a closer look at the aortic valve. In this test, a small transducer attached to the end of a tube is inserted down the tube leading from your mouth to your stomach (esophagus).

  • Electrocardiogram (ECG). In this test, wires (electrodes) attached to pads on your skin measure the electrical activity of your heart. An ECG can detect enlarged chambers of your heart, heart disease and abnormal heart rhythms.
  • Chest X-ray. This enables your doctor to determine whether your heart is enlarged — a possible indicator of aortic valve regurgitation — or whether you have an enlarged aorta. It can also help doctors determine the condition of your lungs.
  • Exercise tests or stress tests. Exercise tests help doctors see whether you have signs and symptoms of aortic valve disease during physical activity, and these tests can help determine the severity of your condition. If you are unable to exercise, medications that have similar effects as exercise on your heart may be used.
  • Cardiac MRI. Using a magnetic field and radio waves, this test produces detailed pictures of your heart, including the aorta and aortic valve. This test may be used to determine the severity of your condition.
  • Cardiac catheterization. This test isn't often used to diagnose aortic valve regurgitation, but it may be used if other tests aren't able to diagnose the condition or determine its severity. Doctors may also conduct cardiac catheterization prior to valve replacement surgery to see if there are obstructions 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 in your arm or groin to an artery in your heart and injects dye through the catheter to make the artery visible on an 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

Treatment of aortic valve regurgitation depends on the severity of your condition, whether you're experiencing signs and symptoms, and if your condition is getting worse.

If your symptoms are mild or you aren't experiencing symptoms, your doctor may monitor your condition with regular follow-up appointments. Your doctor may recommend that you make healthy lifestyle changes and take medications to treat symptoms or reduce the risk of complications.

You may eventually need surgery to repair or replace the diseased aortic valve. In some cases, your doctor may recommend surgery even if you aren't experiencing symptoms. If you're having another heart surgery, doctors may perform aortic valve surgery at the same time. In some cases, you may need a section of the aorta (aortic root) repaired or replaced at the same time as aortic valve surgery if the aorta is enlarged.

If you have aortic valve regurgitation, consider being evaluated and treated at a medical center with a multidisciplinary team of cardiologists and other doctors and medical staff trained and experienced in evaluating and treating heart valve disease. This team can work closely with you to determine the most appropriate treatment for your condition.

Surgery to repair or replace an aortic valve is usually performed through a cut (incision) in the chest. In some cases, doctors may perform minimally invasive heart surgery, which involves the use of smaller incisions than those used in open-heart surgery.

Surgery options include:

Aortic valve repair

To repair an aortic valve, surgeons may conduct several different types of repair, including separating valve flaps (cusps) that have fused, reshaping or removing excess valve tissue so that the cusps can close tightly, or patching holes in a valve.

Doctors may use a catheter procedure to insert a plug or device to repair a leaking replacement aortic valve.

Aortic valve replacement

Aortic valve replacement is often needed to treat aortic valve regurgitation. 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). Another type of biological tissue valve replacement that uses your own pulmonary valve is sometimes possible.

Biological tissue valves degenerate 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 and discuss which valve may be appropriate for you.

Doctors may also conduct a catheter procedure to insert a replacement valve into a failing biological tissue valve that is no longer working properly. Other procedures using catheters to repair or replace aortic valves to treat aortic valve regurgitation continue to be researched.

Biological valve replacement

In a biological valve replacement, a biological or tissue valve replaces the damaged valve.

Biological valve replacement

In a biological valve replacement, a biological or tissue valve replaces the damaged valve.

Mechanical valve replacement

In a mechanical valve replacement, a mechanical valve replaces the damaged valve.

Preparing for an appointment

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).

Here's some information to help you prepare for your appointment.

What you can do

  • Write down your symptoms and how long you've had them.
  • Make a list of your key medical information, including other recent health problems you've had and all prescription and over-the-counter medications and supplements you're taking.
  • Take a family member or friend with you to the appointment, if possible. Someone who accompanies you can help remember what the doctor says.
  • Write down questions to ask your doctor.

For aortic valve regurgitation, questions to ask your doctor include:

  • What is likely causing my symptoms?
  • Are there any other possible causes?
  • What tests do I need?
  • What treatment approach do you recommend?
  • What are the alternatives to the approach you're recommending?
  • Will I need surgery? If so, what surgeon do you recommend for aortic valve surgery?
  • I have other health conditions. How can I best manage them together?
  • Are there restrictions I need to follow?
  • Should I see a specialist?

Don't hesitate to ask other questions, as well.

What to expect from your doctor

Questions your doctor is likely to ask include:

  • When did your symptoms begin?
  • Have your symptoms been continuous or occasional?
  • How severe are your symptoms?
  • What, if anything, seems to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?
  • Do you have heart disease in your family?

Lifestyle and home remedies

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 lifestyle changes into your life. These may include:

  • Eating a heart-healthy diet. Eat a variety of fruits and vegetables, low-fat or fat-free dairy products, poultry, fish, and whole grains. Avoid saturated and trans fat, and excess salt and sugar.
  • Maintaining a healthy weight. Aim to keep a healthy weight. If you're overweight or obese, your doctor may recommend that you lose weight.
  • Getting regular physical activity. Aim to include about 30 minutes of physical activity, such as brisk walks, into your daily fitness routine. Ask your doctor for guidance before starting to exercise, especially if you're considering competitive sports.
  • Managing stress. Find ways to help manage your stress, such as through relaxation activities, meditation, physical activity, and spending time with family and friends.
  • Avoiding tobacco. If you smoke, quit. Ask your doctor about resources to help you quit smoking. Joining a support group may be helpful.
  • Controlling high blood pressure. If you're taking blood pressure medication, ensure you take it as your doctor has prescribed.

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.

Prevention

For any heart condition, see your doctor regularly so he or she can monitor you and possibly catch aortic valve regurgitation or other heart condition before it develops or in the early stages, when it's more easily treatable. If you have been diagnosed with a leaking aortic valve (aortic valve regurgitation) or a tight aortic valve (aortic valve stenosis), you'll probably require regular echocardiograms to be sure the aortic valve regurgitation doesn't become severe.

Also, be aware of conditions that contribute to developing aortic valve regurgitation, including:

  • Rheumatic fever. If you have a severe sore throat, see a doctor. Untreated strep throat can lead to rheumatic fever. Fortunately, strep throat is easily treated with antibiotics.
  • High blood pressure. Check your blood pressure regularly. Make sure it's well-controlled to prevent aortic regurgitation.

Last updated: August 2nd, 2017

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