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aortic regurgitation

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Aortic valve insufficiency

Alternative Names
aortic insufficiency

The aortic valve is a flap-like opening located between the left side of the heart and the aorta, the main artery of the heart. This valve opens so that blood can flow out of the aorta, but closes so that blood cannot flow back in. Sometimes this valve does not close tightly and blood flows backwards into the left side of the heart. This is called aortic regurgitation (AR).

What is going on in the body?
The heart is divided into two halves, right and left. Each side has a pumping chamber, called a ventricle. The left-sided pumping chamber or left ventricle (LV) receives blood from the lungs. During a heartbeat, the left heart chamber squeezes, generating enough pressure to open the aortic valve. Blood from the left side is then pumped into the aorta and out into the body for general circulation. As the left heart chamber empties, the aortic valve closes.

In normal hearts, the valve seals shut and no blood is allowed to flow back into the left side. But when the aortic valve is abnormal, blood does flow backwards. This causes blood to flow into the left heart chamber from two sources. The first source is from the lungs, which is normal. The second source is from the backflow of blood across the leaky aortic valve. When the heart receives this excess amount of blood, the left side must work harder, causing it to become very big and very stressed. This can happen slowly over time, but can get worse rather quickly.

What are the signs and symptoms of the condition?
This is a condition that usually progresses slowly over years. Many people do well despite moderate to severe regurgitation of the aortic valve.

Symptoms may not appear until the left heart chamber is quite stressed. Common symptoms include: What are the causes and risks of the condition?
There are many causes of aortic regurgitation. Some of the more common ones include:
  • congenital heart defects affecting the structure of the aortic valve that are present at birth
  • infective endocarditis, an infection in the valves or lining of the heart
  • high blood pressure
  • cystic medial necrosis, a weakening of the tissue that makes up the artery wall
  • Marfan's syndrome, an inherited disease that causes a structural weakening of skeletal, ocular and cardiovascular tissues
  • aortic dissection, a tear in the aorta that allows blood to flow between the inner and outer layers and separate them
  • ankylosing spondylitis
  • Reiter's syndrome, an arthritic disorder that affects adult males
  • syphilis, a sexually transmitted disease caused by a type of bacteria
  • rheumatic fever, a disease that can result in a type of arthritis in the joints and heart problems
This condition can result in damage to the left heart chamber as it dilates and works harder. In acute cases caused by bacterial endocarditis, there is an increased risk of death if heart valve surgery isn't done right away.

What can be done to prevent the condition?
Nothing can be done to prevent a person from being born with a malfunctioning aortic valve. But other cases can be prevented by treating any underlying disease that could develop into AR.

How is the condition diagnosed?
First, a doctor will do a physical examination. He or she will check the person's pulse and listen to the heart for murmurs and other sounds that might indicate AR. The doctor also may do one or more of these tests: What are the long-term effects of the condition?
The aortic valve may begin to leak or leak more if a person has a heart infection or aortic dissection. This can result in the function of the left heart chamber deteriorating quickly within a few weeks or months.

Chronic regurgitation usually progresses slowly and ends in surgery or with severe congestive heart failure.

What are the risks to others?
There are no risks to others.

What are the treatments for the condition?
Heart medications may help reduce the severity of the regurgitation. It can postpone or avoid surgery in people who don't have symptoms. Valve replacement surgery may be needed for some people when there are signs that the left heart chamber isn't working well.

What are the side effects of the treatments?
All medications have side effects. A doctor can give the person a list of side effects based on the medications prescribed.

All surgery brings a risk of infection, bleeding, and death.

What happens after treatment for the condition?
For people who have heart valve surgery, the size of the left heart chamber usually decreases and its function improves. But, the level of improvement depends on how much damage was done to the left side before surgery.

If a person does not have symptoms and his or her left heart chamber works well, he or she can remain on medication for a long time.

How is the condition monitored?
People with AR need to have regular checkups so that the doctor can: People who have received artifical valves need to be monitored closely to prevent blood clots.

Author: Eric Berlin, MD
Reviewer: HealthAnswers Australia Medical Review Panel
Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia
Last Updated: 1/10/2001
Potential conflict of interest information for reviewers available on request



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