What to know about aortic regurgitation

What is aortic regurgitation?

The aortic valve is one of four valves found in the heart. It is the final valveTrusted Source oxygenated blood passes through before traveling to other parts of the body.

In a healthy heart, the blood travels in a unilateral or one-way direction through the aortic valve. After the blood flows out, the valve leaflets (flaps made of collagen) close over the valve opening. This allows the heart to effectively and efficiently pump oxygenated blood to all parts of the body.

Aortic regurgitation, also known asTrusted Source aortic insufficiency, is a type of valvular heart disease. When it occurs, the compromised valve allows oxygenated blood to flow back into the left ventricle, which is one of the lower chambers of the heart.

The leaky valve causes the heart to work harder to provide oxygenated blood to the body. It can also cause the walls of the left ventricle to thicken, making it even harder for the heart to pump blood.

Over time, the heart may not be able to provide enough oxygenated blood to meet the body’s needs.

Aortic regurgitation symptoms

Often, aortic regurgitation does not causeTrusted Source symptoms for a long period of time when it occurs.

When symptoms do occur, they can include:

• trouble breathing or feeling like it is hard to catch a breath during physical exertion
• shortness of breath when lying down
• palpitations
• chest pain
• coughing and shortness of breath that occurs mainly at night
• lightheadedness or fainting

In some cases, doctors may note changes in a person’s pulse rate or the development of heart murmurs.

The American Heart AssociationTrusted Source also notes that the condition may cause swollen feet or ankles.

Causes of aortic regurgitation

Aortic regurgitation can occur due toTrusted Source dysfunctions in several parts of the aortic valve that may be present from birth, including:

• aortic valve leaflets
• aortic root, which is where the aorta and heart connect
• annulus, which is a fibrous ring between the aortic root and left ventricle
• ascending aorta, or the first part of aorta starting at the base of the left ventricle

Other possible causes that can lead to aortic regurgitation include:

• infective endocarditis
• senile valvular calcifications, in which deposits of calcium build up on the valve as a person ages
• rheumatic heart disease
• trauma
• prosthetic valve dysfunction, which describes surgically placed, synthetic valves that do not work properly
• traumatic and nontraumatic rupture of the ascending aorta with aortic cusp prolapse (when the lower flaps of the aortic valve are displaced into the left ventricle when the heart beats)
• abnormal space between a prosthetic valve and the opening of the valve
• certain medications, such as dopamine agonists like bromocriptine
• myxomatous valve degeneration, which affects the structure of the aortic valve
• congenital valve abnormalities
• age-related widening of the aorta
• enlargement of the aortic annulus
• aortic dissection
• high blood pressure
• Whipple disease
• brittle bone disease
• Crohn’s disease
• rheumatologic disorders, such as systemic lupus erythematosus, ankylosing spondylitis, and psoriatic arthritis
• iatrogenic aortic regurgitation, which is a rare, severe form of aortic regurgitation due to percutaneous aortic balloon valvuloplasty

Diagnosing aortic regurgitation

During diagnosis, a healthcare professional will evaluate a person’s personal and family medical history. They will also review any symptoms a person is experiencing that may point to aortic regurgitation.

They will also likely performTrusted Source a physical examination, which will likely include listening to the heart with a stethoscope. They will check for changes in heart rate as well as listen for murmurs, both of which could indicate aortic regurgitation.

The primary tool used for diagnosis is echocardiography. This form of ultrasound scan provides a large amount of information about the aortic leaflets and the surrounding structures. For example, a doctor may evaluate each valve for regurgitation and narrowing.

Types and stages of aortic regurgitation

Aortic regurgitation falls into two categoriesTrusted Source: acute and chronic.

Acute aortic regurgitation typically comes on suddenly and requires emergency surgical correction. Chronic aortic regurgitation comes on gradually. It may eventually require surgical intervention.

Healthcare professionals in the United States typically use the 2017 American Society of Echocardiography guidelines to separate aortic regurgitation into different types. The identified types include:

• Type 1 — in which the valves function normally but dilation (widening) or openings cause the leaks
• Type 2 — in which excessive leaflet tissue causes aortic cusp prolapse
• Type 3 — in which several underlying causes result in restriction of movement of the aortic leaflets

Chronic aortic regurgitation breaks down into four stages:

• Stage A — people at risk of developing the condition
• Stage B — people with mild to moderate, progressive aortic regurgitation
• Stage C — people with severe, asymptomatic aortic regurgitation
• Stage D — people with severe, symptomatic aortic regurgitation

A doctor will recommend appropriate treatment based on the type and stage of aortic regurgitation as well as the underlying cause.

Aortic regurgitation treatment

Treatment will vary basedTrusted Source on the underlying cause of the condition as well as the type and stage.

In some cases, a person may need to take medications. For example, people with an infection may require antibiotics. If a person has high blood pressure, a doctor may prescribe medications, such as angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor blockers, or dihydropyridine calcium channel blockers.

Surgical intervention to repair or replace the aortic valve is another option. In some cases, a person may need emergency surgery.

Summary

Aortic regurgitation occurs when the leaflets that close the valve do not function properly, allowing blood to flow backward into the left ventricle of the heart. This can damage the heart tissue and, over time, lead to a poorly functioning heart.

The condition may be asymptomatic at first, but it can cause chest pain, trouble breathing, and fainting.

Treatment can involve medications to treat underlying conditions as well as surgical repair or replacement of the valve.