Aortic Valve Regurgitation

What is aortic valve regurgitation?

Aortic valve regurgitation is leaking of one of the valves in the heart. The aortic valve is located at the opening from the left side of the heart (left ventricle) into the aorta. The aorta is the big blood vessel that carries blood to all the tissues of the body. The job of the aortic valve is to keep blood moving from the heart into the aorta and to the body. When the heart beats and pushes blood out to the aorta, the valve opens. In between beats, the valve closes so no blood goes back into the heart.

Valve regurgitation is when the valve does not close tightly between heartbeats. This lets blood from the aorta get back into the left side of the heart. The valve leaks. The heart must work harder to pump the same blood into the aorta with the next heartbeat. Over time, this extra work can cause the heart to enlarge and weaken.

Aortic valve regurgitation is often called aortic regurgitation or aortic insufficiency. It can happen really fast (acute) or it can happen slowly over time (chronic). If it happens fast, it can cause death, but if it gets bad over time, it can be fixed.

How does it occur?

The most common cause of acute regurgitation is an infection of the valve called infectious endocarditis. Other causes include injury to the chest and tearing of the aorta (aortic dissection).

The most common cause of chronic regurgitation is high blood pressure. Other causes include Marfan syndrome, rheumatic fever, and valve problems that you were born with. When the aorta gets stretched, it pulls on the valve and causes a leak.

What are the symptoms?

In acute regurgitation the heart cannot keep up with the body's need for blood. Fluids may collect in the lungs and other body tissues, making it hard to breathe. People quickly become very ill and need surgery right away.

Chronic regurgitation rarely causes symptoms until the leak is bad. The heart begins to weaken before symptoms start. Over several years, the added work on the heart causes the left ventricle to enlarge. This causes symptoms such as:

shortness of breath with activity
discomfort when lying flat
waking up at night very short of breath
chest pain when you are active.

How is it diagnosed?

Your doctor may see signs of an enlarged heart during a physical exam. He or she will be able to hear a certain heart sound (murmur) when listening to your heartbeat. There are also changes in the sounds heard while checking blood pressure. Your doctor may also check your pulse in your neck and groin, and look at your fingernails for clues to the diagnosis.

Chest x-rays may show the heart has enlarged. An electrocardiogram (EKG) will measure the electrical activity of your heart. The best test is the echocardiogram, which uses ultrasound waves to take pictures of the heart. This test measures the heart size and muscle thickness. If the left side of your heart is getting bigger, you may need surgery. A special part of the ultrasound test, called the Doppler exam, measures how severe the valve leak is.

How is it treated?

Acute regurgitation is an emergency. It must be quickly treated, usually by surgery to put in a new valve. Acute regurgitation is not very common.

If you have chronic regurgitation, you should take antibiotics before you have dental work or before tests to look into your bladder or rectum. Taking antibiotics before the procedures can prevent infection that can cause valve leaks.

Chronic regurgitation can weaken the heart muscle. If tests show that the muscle is getting weak, your doctor may advise you to have surgery even if you don't have symptoms. If you have few symptoms and your heart is only mildly enlarged, you may be treated with medicines such as:

diuretics to help get rid of excess fluid
vasodilators to lower blood pressure so the heart does not have to work so hard.

Surgery may be done to:

fix the aorta, if it is pulling on the valve
fix or replace the leaking valve.

Two types of artificial heart valves are available: mechanical and biological.

Mechanical valves work well, but you will need to take blood-thinner medicine for the rest of your life to prevent blood clots. These drugs cause a small increase in the risk of bleeding. You will need to see your provider regularly for check-ups.

Biological valves are made from body tissue. You do not have to take blood thinners, but these valves do not last as long as mechanical valves.

Surgery to replace the aortic valve at the proper time can improve both the quality and the length of life.

How can I take care of myself?

Follow the treatment your health care provider prescribes. In addition:

If you smoke, stop.
Get regular checkups.
With your health care provider's supervision, take antibiotics to prevent infections that could spread to the heart valve if you are having any kind of dental work or surgery, including having your teeth cleaned or procedures involving the bladder, vagina, or rectum. Damaged valves are more likely to become infected by bacteria. Infection of the valve can damage it more and may destroy it. Antibiotics can prevent this. If there is any doubt, be sure to ask if you should take antibiotics.
Lose weight if you are overweight.
Learn ways to reduce or manage stress.
Avoid taking aspirin if you're taking an anticoagulant (blood-thinning drug).
Exercise regularly according to your provider's advice.
Talk to your provider before you use any other medicines, including nonprescription medicines.
Limit the salt in your diet if recommended by your provider.
Ask your provider about a potassium supplement if you're taking diuretics that could cause potassium loss.
Tell all other health care providers you see that you have aortic valve regurgitation.

Disclaimer: This content is reviewed periodically and is subject to change as new health information becomes available. The information provided is intended to be informative and educational and is not a replacement for professional medical evaluation, advice, diagnosis or treatment by a healthcare professional.

HIA File CRD3603F.HTM Release 9.0/2006