Aortic Valve Regurgitation - Symptoms, Causes & Surgery

By Adam Pick, Patient & Author of The Patient's Guide To Heart Valve Surgery
Aortic Valve Regurgitation Overview As I personally experienced, 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 blood that was just pumped out of your heart to leak back into it. According to the Mayo Clinic, the leakage of blood may prevent your heart from efficiently pumping blood out to the rest of your body. If your heart isn't working efficiently, you may feel fatigued and short of breath. Aortic valve regurgitation can develop suddenly or over decades. It has a variety of causes, such as rheumatic fever. Once aortic valve regurgitation becomes severe, surgery is usually required to repair or replace the aortic valve. Aortic valve regurgitation is also called aortic insufficiency or aortic incompetence.

Signs And Symptoms Of Aortic Valve Regurgitation Most often aortic valve regurgitation develops gradually, and your heart compensates for the problem. You may have no signs or symptoms for many years, and you may even be unaware that you have this condition. However, as aortic valve regurgitation progresses, signs and symptoms usually appear and may include: Fatigue and weakness, especially when you increase your activity level Shortness of breath, especially with exertion or when you lie flat Chest pain, discomfort or tightness, often increasing during exercise Fainting Rapid or irregular pulse Heart palpitations sensations of a rapid, fluttering heartbeat Swollen ankles and feet

Causes Of Aortic Valve Regurgitation

Aortic valve regurgitation disrupts the way blood normally flows through your heart and its valves. Any condition that damages the aortic valve can cause regurgitation. Causes of aortic valve regurgitation may be: A congenital heart defect. You may have been born with an aortic valve that has one leaflet (unicuspid valve) or two leaflets (bicuspid valve) rather than the normal three leaflets. Deterioration of the valve with age. The aortic valve opens and shuts tens of thousands of times a day, every day of your life. Aortic valve regurgitation may result from age-related wear and tear on the valve. 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, leading to aortic valve regurgitation later in life. Other causes. Other, rarer conditions that can damage the aortic valve and lead to regurgitation include Marfan syndrome (a disease of connective tissue), ankylosing spondylitis (a spine disorder) and syphilis (a sexually transmitted disease). Damage to the aorta near the site of the aortic valve, such as damage from trauma to your chest or from a tear in the aorta, also can cause backward flow of blood through the valve. Aortic valve regurgitation is most common in men between the ages of 30 and 60. However, women and those older or younger can be affected too.

Treatment of Aortic Valve Regurgitation

Treatment of aortic valve regurgitation depends on the degree of the regurgitation, your signs and symptoms, and whether the regurgitation is affecting your heart function. If signs and symptoms of aortic valve regurgitation develop, you may need surgery. However, many patients are asymptomatic. The overall function of your heart and the amount of regurgitation help to determine when surgery is necessary. Surgical procedures include aortic valve repair and aortic valve replacement

Aortic Regurgitation
What is aortic regurgitation? The aortic valve is between the heart's left ventricle (lower chamber that pumps blood to the body) and the aorta (the large artery that receives blood from the heart's left ventricle and distributes it to the body). Regurgitation means the valve doesn't close properly, and blood can leak backward through it. This means the left ventricle must pump more blood than normal, and will gradually get bigger because of the extra workload. Aortic regurgitation can range from mild to severe. Some people may have no symptoms for years. But as the condition worsens, symptoms will appear. These can include

fatigue (especially during times of increased activity) shortness of breath edema (retention of fluid) in certain parts of the body such as the ankles heart arrhythmias (abnormal heartbeats) angina pectoris (chest pain or discomfort caused by reduced blood supply to the heart muscle)

What causes aortic regurgitation?

Aortic regurgitation can be caused by several things. It may be due to a bicuspid aortic valve. This is a congenital (existing at birth) deformity of the valve. In it, the valve has two cusps (flaps) rather than the normal three cusps. It can also be found in other kinds of congenital heart disease. Aortic regurgitation can also be caused by infections of the heart, such as rheumatic fever or infective endocarditis. Diseases that can cause the aortic root (the part of the aorta attached to the ventricle) to widen, such as the Marfan syndrome or high blood pressure, are other causes. What should be done? Patients with mild aortic regurgitation who have few or no symptoms need to see their physician regularly. As conditions worsen, medications may be used. These drugs can help regulate the heart rhythm, rid the body of fluids to control edema, and/or help the left ventricle pump better. Serious cases may require surgical treatment. This involves replacing the diseased valve with an artificial one. People with aortic regurgitation are at increased risk for developing an infection of the heart valve or lining of the heart (endocarditis). In the past, the American Heart Association has recommended that patients with aortic regurgitation take a dose of antibiotics before certain dental or surgical procedures. However, our association no longer recommends antibiotics before dental procedures except for patients at the highest level of risk for bad outcomes from endocarditis, such as

patients with a prosthetic cardiac valve, patients who have had endocarditis before, patients with certain kinds of congenital heart disease, or heart transplant patients who develop a problem with a heart valve.

Also, the American Heart Association no longer recommends routine antibiotics to prevent endocarditis in patients undergoing gastrointestinal (GI) or genitourinary (GU) tract procedures.