Aortic Regurgitation

(Aortic Insufficiency)

Aay-or-tick Ree-gur-jit-TAY-shun

Definition

Aortic regurgitation is a heart condition in which the valve between the left ventricle (lower left heart chamber) and the aorta (the major blood vessel leaving the heart) malfunctions. This valve defect allows the pumped out blood to leak back into the heart. As a result, the left ventricle must work harder to pump more blood than normal. This increased work gradually causes the left ventricle to enlarge. There are two main types of aortic regurgitation:

Acute aortic regurgitation —symptoms develop rapidly, and in severe cases, prompt surgery may be lifesaving
Chronic aortic regurgitation —symptoms develop over the course of many months or years

Aortic Valve Regurgitation

Causes

Possible structural causes of aortic regurgitation:

The aortic valve itself is deformed and malfunctions.
A heart deformity or disturbance near the valve affects the valve’s functioning.

Risk Factors

A risk factor is something that increases your chance for getting a disease or condition.

Acute Aortic Regurgitation

Risk factors for developing acute aortic regurgitation include:

Infections of the heart such as:
- Rheumatic fever
- Infectious endocarditis
Aortic dissection —separation of the inner layer of the aorta from the middle layer
Trauma, such as an accident

Chronic Aortic Regurgitation

Risk factors for developing chronic aortic regurgitation include:

Bicuspid aortic valve—a congenital (existing at birth) deformity in which the aortic valve has two cusps rather than three
Other types of congenital heart disease
Infections of the heart such as:
- Rheumatic fever
- Infectious endocarditis
Diseases that cause widening of the aortic root (the part of the aorta attached to the ventricle) such as:
- Marfan syndrome
- High blood pressure
Collagen vascular diseases, such as systemic lupus erythematosus
Aortic aneurysm
Sex: male
Age: Over age 50

Symptoms

In acute aortic regurgitation, symptoms come on quickly since the heart has not had the time to compensate or enlarge. In chronic aortic regurgitation, symptoms develop more gradually and may not be noticed for years until the condition worsens.

In both cases, symptoms may include:

Shortness of breath
Fatigue, especially after physical activity
Fluid retention in certain parts of the body, such as the ankles
Heart arrhythmias (abnormal heart beats)
Angina (chest pain from insufficient blood supply)
Hypotension (low blood pressure)

Diagnosis

The doctor will ask about your symptoms and medical history, and perform a physical exam. In particular, the doctor will use a stethoscope to listen for a murmur (an abnormal heart sound). If you have a certain type of heart murmur, the doctor may suspect that you have aortic regurgitation and may recommend further tests, such as:

Electrocardiogram (EKG, ECG)—a test that records the heart's electrical activity using electrodes attached to the surface of the chest. In severe aortic regurgitation, the EKG may show abnormal electrical activity.
Chest x-ray —an x-ray to determine the approximate size and shape of the heart. In aortic regurgitation, the chest x-ray may show enlargement of the lower left ventricle, or in some cases, enlargement of the aorta.
Echocardiogram —a test that uses high-frequency sound waves (ultrasound) to examine the size, shape, and motion of the heart. It can detect leaking of the valves and abnormal thickening of the heart muscle. This test can also examine the functioning of the left ventricle.
Cardiac catheterization —a tube inserted into the heart through an artery (usually in the groin) to detect problems with the heart's structure, function, and blood supply
Radionucleotide ventriculogram (nuclear scan)—measures how well the left ventricle is pumping as well as the amount of blood being pumped out of the ventricle with each heartbeat

Treatment

In the case of severe acute aortic regurgitation, especially due to trauma, immediate surgery may be needed.

For chronic aortic regurgitation, the proper timing of medical therapy versus surgical treatment depends on several factors. These include:

When you develop symptoms and how severe they are
The degree of heart damage and level of heart function
Your age
The risks associated with the treatment

Treatment for aortic regurgitation may include:

Medications

If aortic regurgitation is not causing symptoms and heart function remains normal, you may be treated with medications that lower blood pressure to reduce the pressure against which the heart pumps. Medication may also be given to treat chest pain, to treat irregular heartbeats, to prevent infection of damaged or artificial valves, and to prevent blood clots. If you have heart failure, you may be treated with medications that help your heart to pump more effectively.

Surgery

Surgery is usually performed for severe acute aortic regurgitation or when the timing is right for chronic aortic regurgitation. If you have chronic aortic regurgitation, your doctor will follow your symptoms and heart function closely in order to determine the best surgical timing for you. Surgery involves replacing the aortic valve.

Prevention

Prompt treatment of strep infections can prevent rheumatic fever, which is a risk factor for developing heart valve problems like aortic regurgitation. If you have an abnormal valve, you are at higher risk of developing valve infections. You should talk with your doctor to understand in what circumstances you may need to take antibiotics to decrease your risk of valve infection. For instance, you may need antibiotics before undergoing certain dental procedures or surgeries.

RESOURCES:

American Heart Association
http://www.americanheart.org

Heart Information Network
http://www.heartinfo.org

CANADIAN RESOURCES:

Canadian Cardiovascular Society
http://www.ccs.ca/home/index_e.aspx

Canadian Family Physician
http://www.cfpc.ca/cfp/

References:

Aortic regurgitation. American Heart Association website. Available at: http://www.americanheart.org/presenter.jhtml?identifier=4448 . Accessed on December 5, 2002.

Aortic valve disease: aortic regurgitation. The Merck Manual website. Available at: http://www.merck.com/pubs/mmanual/ . Accessed on December 15, 2002

Cheitlin M. Surgery for chronic aortic regurgitation: when should it be considered? Am Fam Physician . 2001;64(10).

Tarasoutchi F, et al. Symptoms, left ventricular function, and timing of valve replacement surgery in patients with aortic regurgitation. Am Heart J . 1999;138:477-485.

Last reviewed September 2009 by David N. Smith, MD
Last Updated: 9/30/09