Aortic Valve Regurgitation: Overview

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Overview

What is aortic valve regurgitation?

Aortic valve regurgitation develops when the aortic valve does not function correctly. To understand this condition, it's helpful to know how the aortic valve normally functions. The aortic valve works like a one-way gate, opening so that blood from the left ventricle (the heart's main pump) can be pushed into the aorta, the large artery leaving the heart. From the aorta, oxygen-rich blood flows into the branching arteries and through the body to feed the cells. When the heart rests between beats, the aortic valve closes to keep blood from flowing backward into the heart. See a picture of how the aortic valve works .

In aortic valve regurgitation, the aortic valve does not close properly. With each heartbeat, some of the blood pumped into the aorta leaks back (regurgitates) through the faulty valve into the left ventricle. The body doesn't receive enough blood, so the heart must work harder to make up for it (compensation). See a picture of aortic valve regurgitation .

Typically, symptoms do not develop for decades because the heart compensates by getting bigger so that it can pump out more blood. But, if it is not corrected, regurgitation usually gets worse over time, and symptoms such as shortness of breath and fatigue develop. At this point, an aortic valve replacement is typically needed to prevent abnormal heartbeats (arrhythmias), heart failure, and irreversible damage to the heart muscle.

In rare cases, aortic valve regurgitation comes on suddenly and requires immediate medical attention.

Some people have very small amounts of blood that leak back into the left ventricle. This usually doesn't cause any symptoms or problems. This topic focuses on the more serious cases of aortic valve regurgitation where large amounts of blood flow back across the aortic valve into the left ventricle.

What causes aortic valve regurgitation?

Any condition that damages the aortic valve can cause aortic valve regurgitation. Common causes include being born with a defective aortic valve, wear and tear from aging, infection of the lining of the heart (endocarditis), and rheumatic fever. Enlargement of the aorta, associated with high blood pressure and hardening of the arteries (atherosclerosis), can also cause aortic valve regurgitation. On rare occasions, radiation treatments to the chest can damage the aortic valve.

Rarer conditions that cause aortic valve regurgitation include a disorder of the body's connective tissues (Marfan's syndrome), a type of arthritis (ankylosing spondylitis), some autoimmune diseases, and syphilis.

The most common causes of sudden (acute) aortic valve regurgitation include:

• Endocarditis, which is an infection in the heart caused by bacteria.
• Aortic dissection, which is the separation of the inner layer of the aorta from the middle layer.
• Problems with the replacement (prosthetic) aortic valve.

Other conditions that cause acute regurgitation include trauma to the heart valve or aorta.

What are the symptoms?

In the early stages, people with chronic aortic valve regurgitation often do not have any symptoms. However, to make up for the reduced blood flow, the heart has to pump harder, and over a period of years, the left ventricle may slowly enlarge. As the heart compensates for the regurgitation, it eventually weakens, and symptoms develop. These symptoms include:

• Fatigue or weakness.
• Shortness of breath, especially with increased activity.
• Abnormal heart rhythms (arrhythmias).
• Palpitations, an uncomfortable awareness of the heart beating rapidly or irregularly.
• Angina, chest pain often brought on by exertion.
• Fainting (syncope).

In acute aortic valve regurgitation, the above symptoms develop suddenly and are often more intense. People with acute aortic valve regurgitation also may have a fast heartbeat (tachycardia). Acute aortic valve regurgitation is life-threatening and requires immediate medical attention.

How is aortic valve regurgitation diagnosed?

Your doctor may suspect that you have aortic valve regurgitation after hearing a characteristic heart murmur through a stethoscope . He or she will ask you whether you've had any symptoms and about your health in general and any family history of heart disease.

If your physical examination indicates aortic valve regurgitation, an electrocardiogram (EKG or ECG) is usually done. An echocardiogram (echo) is then done to confirm whether you have aortic valve regurgitation and, if you do, how much the valve is leaking.

How is it treated?

Treatment for aortic valve regurgitation depends on its cause and your symptoms.

Most commonly, when people are first diagnosed with chronic aortic valve regurgitation, treatment is not needed. But it is important to see your doctor regularly to monitor your condition. In some cases, one of several medicines—the calcium channel blocker nifedipine (such as Procardia), an angiotensin-converting enzyme (ACE) inhibitor, or the vasodilator hydralazine—is used to lower blood pressure and delay the progression of the disease.

In long-standing (chronic) aortic valve regurgitation, once symptoms appear—even if they are mild—or your left ventricle loses pumping power, valve replacement surgery is usually recommended to prevent or reverse heart damage.

In sharp contrast, sudden (acute) aortic valve regurgitation requires immediate surgery to prevent death.

Last updated:	January 24, 2008
Author:	Robin Parks, MS
Reviewed By:	E. Gregory Thompson, MD - Internal Medicine, Stephen Fort, MD, MRCP, FRCPC - Interventional Cardiology
Editors:	Kathleen M. Ariss, MS, Pat Truman, MATC