Aortic Valve Regurgitation

What is aortic valve regurgitation?

The aortic valve lies between the lower left chamber of the heart (left ventricle) and the aorta, the big blood vessel that carries blood to all the tissues of the body. The aortic valve has 3 flexible leaflets called cusps. The valve’s purpose is to prevent the backflow (regurgitation) of blood pumped from the heart.

Valve regurgitation occurs when the valve leaflets fail to close properly during the heart’s relaxation phase. This allows blood from the aorta to leak back into the left ventricle. The heart then needs to re-pump the regurgitated blood into the aorta with the next heartbeat. Over time, this extra workload on the left ventricle can cause the heart to enlarge and may lead to congestive heart failure.

There are 2 types of aortic valve regurgitation: acute and chronic. The acute type is a sudden event that may lead to death in a few hours. The chronic type progresses slowly but steadily until it begins to cause symptoms.

How does it occur?

Bacterial or fungal infections of the valve may cause perforations (holes) in the cusps. Holes in valve leaflets most often cause acute valve regurgitation. Aortic dissection, caused by bleeding into the wall of the aorta, can expand the aortic valve and cause it to leak. A chest injury can also cause the aortic valve to leak.

Chronic valve regurgitation is most often caused when the aorta near the valve slowly expands. Among the causes are diseases such as high blood pressure, Marfan’s syndrome, and certain forms of rheumatoid disease. Other causes include rheumatic fever, mild infections of the valve, and abnormalities of the valve that you were born with.

What are the symptoms?

In acute regurgitation, the heart is generally unable to keep up with the demand for blood, and blood pressure drops to a shock-like state. Fluids often collect in the lungs and other body tissues, making breathing difficult. People with this condition may quickly become very ill and need medical attention.

Chronic regurgitation rarely causes symptoms until the condition is severe. As time passes, the added workload on the left ventricle causes shortness of breath with exertion, discomfort when lying flat, and waking up at night very short of breath. Occasionally, there may be chest pain when you exert yourself.

How is it diagnosed?

Your doctor may see signs of heart enlargement during a physical exam. He or she will be able to hear a certain heart murmur through a stethoscope. 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 and standard electrocardiograms may show heart enlargement or heart muscle thickening. The best lab test is the echocardiogram, which uses ultrasound waves to record images of the heart. This method accurately measures the heart chamber size and muscle thickness. If the size of your left ventricle is increasing, you may need surgery. A special part of the ultrasound test, called the Doppler exam, measures the severity of the regurgitation.

How is it treated?

You should take antibiotics before dental procedures such as teeth cleaning. You will also need to take them before any tests or treatments that involve insertion of tubes or instruments into your body. The antibiotics prevent heart valve infection.

If you have few symptoms and mild enlargement of your heart, you may be treated with:

Medicines such as digitalis, which increases the pumping efficiency of the heart.
Diuretics, which are drugs that help rid your body of excess fluid.
Vasodilator drugs, which reduce blood pressure slightly and decrease the work of the heart.

The acute form of aortic valve regurgitation must be quickly treated, usually with valve replacement surgery. The risks of the operation are higher because it is an emergency. Death is almost certain without surgical repair. Fortunately, acute aortic valve regurgitation is far less common than the chronic variety.

If you have chronic aortic regurgitation, you may have no symptoms for a long time. When signs or symptoms of declining heart function appear, valve replacement surgery is the treatment of choice. Chronic aortic regurgitation can weaken the heart muscle. If tests such as the echocardiogram show that the muscle is starting to weaken, your doctor may recommend that you have surgery even if you don’t have symptoms.

What are the risks and benefits of surgery?

Untreated, severe aortic valve regurgitation leads to death. The risk of death from valve replacement surgery varies from 2% to 8%.

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

Mechanical valve replacements work well, but require lifelong blood-thinner medicine to keep blood clots from forming in the bloodstream. These drugs cause a small increase in the risk of bleeding. This is most serious when it causes bleeding in the brain. Follow-up care requires frequent visits to a doctor.

Bioprosthetic valves are either specially treated pig valves or valves made from other body tissue. They do not require long-term blood thinners but breakdown more often.

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

Information obtained from GE Medical Systems; authorization given to reproduce on HCNW web site 9/02.
Written by Donald L. Warkentin, MD
Published by McKesson Clinical Reference Systems.
Copyright © 1997-2002 McKesson Health Solutions LLC. All rights reserved.
This content is reviewed periodically and is subject to change as new health information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.