Aortic Valve Regurgitation

Aortic valve regurgitation (also known as aortic regurgitation) is a type of heart valve disease. The valve between the lower left heart chamber and the body’s main artery does not close tightly. As a result, some of the blood pumped out of the heart’s main pumping chamber, called the left ventricle, leaks backwards.

The leak can prevent the heart from doing a good enough job of pumping blood to the rest of the body. You may feel tired and short of breath.

Aortic valve insufficiency may develop suddenly or over years. When the condition becomes serious, surgery is often required to repair or replace the valve.

Symptoms

Most often, aortic valve regurgitation develops over time. You may have no symptoms for years. You may not be aware that you have this condition. However, sometimes aortic valve insufficiency occurs suddenly. Usually this is caused by a valve infection.

As aortic valve regurgitation worsens, symptoms may include:

• Shortness of breath when exercising or lying down.
• Fatigue and weakness, especially when being more active than usual.
• Irregular heartbeat.
• Dizziness or fainting.
• Pain, discomfort, or tightness in the chest that often worsens during exercise.
• A feeling of a fast, pounding heartbeat, called palpitations.
• Swollen ankles and feet.

When should you see a doctor?

If you have symptoms of aortic valve regurgitation, call a member of your healthcare team immediately.

Sometimes the first symptoms of aortic valve regurgitation are associated with heart failure. Heart failure is a condition in which the heart cannot pump blood as it should. Make an appointment with your healthcare team if:

• Fatigue, also called fatigue, does not improve with rest.
• Shortness of breath.
• Swollen ankles and feet.

These are common symptoms of heart failure.

Reasons

The aortic valve is one of four valves that control blood flow in the heart. It separates the heart’s main pumping chamber, called the left ventricle, and the body’s main artery, called the aorta. The aortic valve has flaps, also called valves or leaflets, that open and close once during each heartbeat.

In aortic valve insufficiency, the valve does not close properly. This causes blood to leak back into the lower left heart chamber, called the left ventricle. As a result, the chamber holds more blood. This can cause it to grow and thicken.

At first, the larger left ventricle helps maintain good blood flow with more power. But eventually the heart becomes weak.

Any condition that damages the aortic valve can cause aortic valve regurgitation. Causes may include:

• Heart valve disease present at birth: Some people are born with an aortic valve that has only two protrusions, called a bicuspid valve. Others are born with connected ends rather than the typical three separate ends. Sometimes the valve may have a single protrusion, called a single valve. Other times, there are four projections called the quadricuspid valve.
  Having a parent or sibling with double valves increases the risk of this condition. However, you may have bicuspid valve even if you do not have a family history of this condition.
• Narrowing of the aortic valve is called aortic stenosis: As we age, calcium deposits can build up in the aortic valve. The buildup causes the aortic valve to harden and narrow. It prevents the valve from opening properly. Aortic stenosis may also prevent the valve from closing properly.
• Inflammation of the inner lining of the heart’s chambers and valves: This life-threatening condition is also called endocarditis. It is usually caused by an infection. It may damage the aortic valve.
• Rheumatic fever: This condition was once a common childhood disease in the United States. Strep throat can cause this. Rheumatic fever can cause the aortic valve to harden and narrow, resulting in blood leakage. If you have irregular heart valves due to rheumatic fever, it is called rheumatic heart disease.
• Other health conditions: Other rare conditions can cause the aorta to enlarge and damage the aortic valve. These include a connective tissue disease called Marfan syndrome. Some immune system conditions, such as lupus, can also lead to aortic valve regurgitation.
• Rupture or injury of the body’s main artery: The main artery of the body is the aorta. Traumatic chest injury can damage the aorta and cause aortic regurgitation. A tear in the inner layer of the aorta, called aortic dissection, can also occur in the same way.

Risk factors

Things that increase the risk of aortic valve regurgitation include:

• Older age.
• Heart problems present at birth are also called congenital heart defects.
• History of infections that may affect the heart.
• Certain conditions run in families that can affect the heart, such as Marfan syndrome.
• Other types of heart valve disease, such as aortic valve stenosis.
• Hypertension.

This can occur without any known risk factors.

Complications

Complications of aortic valve regurgitation may include:

• Feeling faint or dizzy.
• Heart failure.
• Some heart infections, such as endocarditis.
• Heart rhythm problems called arrhythmias.
• Death.

Prevention

If you have any heart disease, get regular health check-ups.

If you have a parent, child, or sibling with bicuspid aortic valve, you should have an imaging test called an echocardiogram. This can check for aortic valve regurgitation. Early diagnosis of heart valve diseases such as aortic valve insufficiency is important. Doing this may make the condition easier to treat.

Also take steps to prevent conditions that may increase the risk of aortic valve regurgitation. For example:

• If you have a severe sore throat, get a medical check-up. Untreated strep throat can lead to rheumatic fever. Strep throat is treated with bacteria-fighting medications called antibiotics.
• Check your blood pressure regularly. Have your blood pressure checked at least every two years starting from the age of 18. Some people need more frequent check-ups.

Diagnosis

To diagnose aortic valve regurgitation, a member of your healthcare team will examine you. You’ll usually be asked questions about your symptoms and health history. You may also be asked about your family’s health history.

Your blood pressure is usually checked using a cuff placed around your arm. A device called a stethoscope is used to listen to your heart. Your healthcare provider may hear an irregular sound called a heart murmur.

You may be referred to a doctor trained in heart diseases, called a cardiologist.

Tests

Tests may be done to check your heart health and find out the cause of aortic valve regurgitation. Tests may include:

• Echocardiogram: Sound waves are used to create pictures of the beating heart. This test shows how blood flows through the heart and heart valves. It can show the aortic valve and aorta. An echocardiogram can help you understand how severe your aortic regurgitation is.
  There are different types of echocardiograms. If a standard test does not provide enough information, you may have a test called a transesophageal echocardiogram. This type creates pictures of the heart from inside the body. It provides a detailed look at the aorta and aortic valve.
• Electrocardiogram (ECG or EKG): ECG measures the electrical activity of the heart. It shows how fast or how slow your heart is beating. Adhesive patches are placed on the chest and sometimes on the arms and legs. Wires connect the electrodes to a computer that displays the results.
• Chest x-ray: A chest x-ray can show whether the heart or aorta is enlarged. It can also help determine the condition of the lungs.
• CT scan of the heart: This test, also called cardiac CT, uses a series of X-rays to create a detailed image of the heart. You lie down on a table inside a donut-shaped machine. A CT scan can also help confirm a tear in the aorta.
• Exercise tests or stress tests: These tests usually involve walking on a treadmill or riding a stationary bike while your heart is checked. Exercise tests show how the heart responds to physical activity. Tests can show whether valve disease symptoms occur during exercise. If you cannot exercise, you can take medications that affect the heart, such as exercise.
• Cardiac MRI: This test uses a magnetic field and radio waves to create detailed pictures of the heart, including the aorta and aortic valve.
• Heart catheterization: This test is not always used to find aortic valve regurgitation. This may only be done if other tests cannot diagnose the condition or determine how serious it is. Cardiac catheterization may be performed before valve replacement surgery to check for blockages.
  In cardiac catheterization, the doctor inserts a long, thin, flexible tube called a catheter into a blood vessel, usually in the groin or wrist. It is directed to the heart. The dye flows from the catheter into the arteries in the heart. The dye helps arteries appear more clearly on X-ray images and videos.

Stages of heart valve disease

After the test confirms the diagnosis of heart valve disease, your healthcare team can tell you the stage of the disease. Staging helps determine the most appropriate treatment.

The stage of heart valve disease depends on many things, including symptoms, severity of disease, structure of the valve or valves, and blood flow in the heart and lungs.

Heart valve disease is divided into four basic groups:

• Stage A: At risk. There are risk factors for heart valve disease.
• Stage B: Gradual. Valve disease is mild or moderate. There are no heart valve symptoms.
• Stage C: Asymptomatic severe. There are no heart valve symptoms, but valve disease is serious.
• Stage D: Symptomatic severe. Heart valve disease is serious and causes symptoms.

Treatment

Treatment of aortic valve regurgitation depends on:

• How serious the situation is.
• Symptoms if any.
• Whether the situation is getting worse or not.

The goal of treatment for aortic valve regurgitation is to relieve symptoms and prevent complications.

If your symptoms are mild or have no symptoms, you may only need regular checkups. You may need regular echocardiograms to check the health of your aortic valve. Heart-healthy lifestyle changes are also often recommended.

medicines

If you have aortic valve regurgitation, you may be given the following medications:

• Treat symptoms.
• Reduce the risk of complications.
• Lower blood pressure.

Surgery or other procedures

Surgery may be required to repair or replace the diseased valve, especially if the condition and symptoms are severe. Heart valve surgery may be needed even if aortic regurgitation is not severe or there are no symptoms.

The decision to repair or replace a damaged aortic valve depends on:

• Your symptoms.
• Your age and general health.
• Whether you need heart surgery to correct another heart condition.

If you are having another heart surgery, surgeons may perform aortic valve surgery at the same time.

Surgery to repair or replace the aortic valve may be done as open heart surgery. This involves an incision, also called an incision, on the chest. Sometimes surgeons can perform minimally invasive heart surgery to replace the aortic valve.

Aortic valve regurgitation surgery includes:

• Aortic valve repair: To repair the aortic valve, surgeons may separate the valves that connect together (also known as tuberosities). They can reshape or remove excess valve tissue so that the valves can close tightly. Or they may cover holes in a valve. A catheter procedure may be performed to insert a plug or device into the leaky replacement aortic valve.
• Aortic valve replacement: The surgeon removes and replaces the damaged valve. The part to be replaced may be a mechanical valve or a valve made from cow, pig or human heart tissue. Tissue valve is also called biological tissue valve.
  Sometimes surgeons can perform minimally invasive heart surgery to replace the aortic valve. This procedure is called transcatheter aortic valve replacement (TAVR). Smaller incisions are used than those used in open heart surgery.
  Sometimes the aortic valve is replaced with your own lung valve, also called a pulmonary valve. Your pulmonary valve is replaced with a valve of biological lung tissue taken from a deceased donor. This more complex surgery is called the Ross procedure.
  Biological tissue valves deteriorate over time. They may eventually need to be replaced. People with mechanical valves need lifelong blood-thinning medications to prevent blood clots. Inform your healthcare team about the benefits and risks of each type of valve.

Lifestyle and home remedies

While lifestyle changes cannot prevent or treat your condition, your healthcare team may recommend that you practice some heart-healthy habits. These may include:

• Eat a heart-healthy diet: Enjoy a variety of fruits and vegetables, low-fat or fat-free dairy, poultry, fish and whole grains. Avoid saturated and trans fats, excess salt and sugar.
• Maintain a healthy weight: Aim to maintain a healthy weight. If you are overweight or obese, your healthcare team may recommend that you lose weight. Ask what target weight is healthy for you.
• Exercise regularly: Aim to add about 30 minutes of physical activity, such as brisk walks, to your daily fitness routine. Ask your care team for advice before you start exercising, especially if you are considering playing competitive sports.
• Do not smoke or use tobacco: If you smoke, quit. Ask your care team about resources to help you quit smoking. Joining a support group may be helpful.
• Control high blood pressure: Uncontrolled high blood pressure increases the risk of serious health problems. If you are 18 or older, have your blood pressure checked at least every two years. If you have risk factors for heart disease or are over 40, you may need more frequent checkups.
• Get a cholesterol test: Get your first cholesterol test when you’re in your 20s, and then get another test at least every 4 to 6 years. Some people may need to start testing earlier or have more frequent check-ups.
• Manage diabetes: If you have diabetes, tight blood sugar control can help keep your heart healthy.
• Get good sleep habits: Poor sleep may increase the risk of heart disease. Adults should aim to get 7 to 9 hours of sleep per day. Go to bed and wake up at the same time every day, including weekends. If you have trouble sleeping, talk to your healthcare team about strategies that may help.

Pregnancy and aortic valve insufficiency

Those who have heart valve disease, including aortic valve insufficiency, during pregnancy need careful and regular check-ups. If you have a serious heart valve condition, you may be told not to become pregnant to reduce the risk of complications.