Aortic Valve Regurgitation

Symptoms

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Most often, aortic valve regurgitation develops gradually, and your heart compensates for the problem. You may have no signs or symptoms for years, and you may even be unaware that you have the condition.

However, as aortic valve regurgitation worsens, signs and symptoms may include:

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• Fatigue and weakness, especially when you increase your activity level

• Shortness of breath with exercise or when you lie down

• Swollen ankles and feet

• Chest pain (angina), discomfort or tightness, often increasing during exercise

• Lightheartedness or fainting

• Irregular pulse (arrhythmia)

• Heart murmur

• Sensations of a rapid, fluttering heartbeat (palpitations)

 

Causes

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Your heart has four valves that keep blood flowing in the correct direction. These valves include the mitral valve, tricuspid valve, pulmonary valve and aortic valve. Each valve has flaps (cusps or leaflets) that open and close once during each heartbeat. Sometimes, the valves don't open or close properly, disrupting the blood flow through your heart and potentially impairing the ability to pump blood to your body.

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In aortic valve regurgitation, the valve between the lower left heart chamber (left ventricle) and the main artery that leads to the body (aorta) doesn't close properly, which causes some blood to leak backward into the left ventricle. This forces the left ventricle to hold more blood, possibly causing it to enlarge and thicken.

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At first, left ventricle enlargement helps because it maintains adequate blood flow with more force. But eventually these changes weaken the left ventricle — and your heart overall.

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Any condition that damages a valve can cause regurgitation. Causes of aortic valve regurgitation include:

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Congenital heart valve disease. You may have been born with an aortic valve that has only two cusps (bicuspid valve) or fused cusps rather than the normal three separate cusps. In some cases a valve may only have one cusp (unicuspid) or four cusps (quadricuspid), but this is less common. These congenital heart defects put you at risk of developing aortic valve regurgitation at some time in your life. If you have a parent or sibling with a bicuspid valve, it increases the risk that you may have a bicuspid valve, but it can also occur if you don't have a family history of a bicuspid aortic valve.

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Age-related changes to the heart. Calcium deposits can build up on the aortic valve over time, causing the aortic valve's cusps to stiffen. This can cause the aortic valve to become narrow, and it may also not close properly.

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Endocarditis. The aortic valve may be damaged by endocarditis — an infection inside your heart that involves heart valves.

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Rheumatic fever. Rheumatic fever — a complication of strep throat and once a common childhood illness in the United States — can damage the aortic valve. Rheumatic fever is still prevalent in developing countries but rare in the United States. Some older adults in the United States were exposed to rheumatic fever as children, although they may not have developed rheumatic heart disease.

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Other diseases. Other rare conditions can enlarge the aorta and aortic valve and lead to regurgitation, including Marfan syndrome, a connective tissue disease. Some autoimmune conditions, such as lupus, also can lead to aortic valve regurgitation.

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Trauma. Damage to the aorta near the site of the aortic valve, such as damage from injury to your chest or from a tear in the aorta, also can cause backward flow of blood through the valve.

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Risk factors

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Risk factors of aortic valve regurgitation include:

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• Older age

• Certain heart conditions present at birth (congenital heart disease)

• History of infections that can affect the heart

• Certain conditions that can affect the heart, such as Marfan syndrome

• Other heart valve conditions, such as aortic valve stenosis

• High blood pressure

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Complications

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Aortic valve regurgitation can cause complications, including:

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• Heart failure

• Infections that affect the heart, such as endocarditis

• Heart rhythm abnormalities

• Death

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Prevention

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For any heart condition, see your doctor regularly so he or she can monitor you and possibly catch aortic valve regurgitation or other heart condition before it develops or in the early stages, when it's more easily treatable. If you have been diagnosed with a leaking aortic valve (aortic valve regurgitation) or a tight aortic valve (aortic valve stenosis), you'll probably require regular echocardiograms to be sure the aortic valve regurgitation doesn't become severe.

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Also, be aware of conditions that contribute to developing aortic valve regurgitation, including:

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• Rheumatic fever. If you have a severe sore throat, see a doctor. Untreated strep throat can lead to rheumatic fever. Fortunately, strep throat is easily treated with antibiotics.

• High blood pressure. Check your blood pressure regularly. Make sure it's well-controlled to prevent aortic regurgitation.

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Diagnosis

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To diagnose aortic valve regurgitation, the doctor may review your signs and symptoms, discuss your and your family's medical history, and conduct a physical examination. Your doctor may listen to your heart with a stethoscope to determine if you have a heart murmur that may indicate an aortic valve condition.

Your doctor may order several tests to diagnose your condition, and determine the cause and severity of your condition. Tests may include:

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Echocardiogram. Sound waves directed at your heart from a wandlike device (transducer) held on your chest produces video images of your heart in motion. This test can help doctors closely look at the condition of the aortic valve and the aorta. It can help doctors determine the cause and severity of your condition, and see if you have additional heart valve conditions. Doctors may also use a 3-D echocardiogram.

Doctors may conduct another type of echocardiogram called a transesophageal echocardiogram to get a closer look at the aortic valve. In this test, a small transducer attached to the end of a tube is inserted down the tube leading from your mouth to your stomach (esophagus).

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Electrocardiogram (ECG). In this test, wires (electrodes) attached to pads on your skin measure the electrical activity of your heart. An ECG can detect enlarged chambers of your heart, heart disease and abnormal heart rhythms.

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Chest X-ray. This enables your doctor to determine whether your heart is enlarged — a possible indicator of aortic valve regurgitation — or whether you have an enlarged aorta. It can also help doctors determine the condition of your lungs.

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Exercise tests or stress tests. Exercise tests help doctors see whether you have signs and symptoms of aortic valve disease during physical activity, and these tests can help determine the severity of your condition. If you are unable to exercise, medications that have similar effects as exercise on your heart may be used.

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Cardiac MRI. Using a magnetic field and radio waves, this test produces detailed pictures of your heart, including the aorta and aortic valve. This test may be used to determine the severity of your condition.

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Cardiac catheterization. This test isn't often used to diagnose aortic valve regurgitation, but it may be used if other tests aren't able to diagnose the condition or determine its severity. Doctors may also conduct cardiac catheterization prior to valve replacement surgery to see if there are obstructions in the coronary arteries, so they can be fixed at the time of the valve surgery.

In cardiac catheterization, a doctor threads a thin tube (catheter) through a blood vessel in your arm or groin to an artery in your heart and injects dye through the catheter to make the artery visible on an X-ray. This provides your doctor with a detailed picture of your heart arteries and how your heart functions. It can also measure the pressure inside the heart chambers.

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Treatment

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Treatment of aortic valve regurgitation depends on the severity of your condition, whether you're experiencing signs and symptoms, and if your condition is getting worse.

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If your symptoms are mild or you aren't experiencing symptoms, your doctor may monitor your condition with regular follow-up appointments. Your doctor may recommend that you make healthy lifestyle changes and take medications to treat symptoms or reduce the risk of complications.

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You may eventually need surgery to repair or replace the diseased aortic valve. In some cases, your doctor may recommend surgery even if you aren't experiencing symptoms. If you're having another heart surgery, doctors may perform aortic valve surgery at the same time. In some cases, you may need a section of the aorta (aortic root) repaired or replaced at the same time as aortic valve surgery if the aorta is enlarged.

If you have aortic valve regurgitation, consider being evaluated and treated at a medical center with a multidisciplinary team of cardiologists and other doctors and medical staff trained and experienced in evaluating and treating heart valve disease. This team can work closely with you to determine the most appropriate treatment for your condition.

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Surgery to repair or replace an aortic valve is usually performed through a cut (incision) in the chest. In some cases, doctors may perform minimally invasive heart surgery, which involves the use of smaller incisions than those used in open-heart surgery.

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Surgery options include:

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Aortic valve repair. To repair an aortic valve, surgeons may conduct several different types of repair, including separating valve flaps (cusps) that have fused, reshaping or removing excess valve tissue so that the cusps can close tightly, or patching holes in a valve.

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Aortic valve replacement. Aortic valve replacement is often needed to treat aortic valve regurgitation. In aortic valve replacement, your surgeon removes the damaged valve and replaces it with a mechanical valve or a valve made from cow, pig or human heart tissue (biological tissue valve).

Biological tissue valves degenerate over time and may eventually need to be replaced. People with mechanical valves will need to take blood-thinning medications for life to prevent blood clots. Your doctor will discuss with you the benefits and risks of each type of valve and discuss which valve may be appropriate for you.

Doctors may also conduct a catheter procedure to insert a replacement valve into a failing biological tissue valve that is no longer working properly. Other procedures using catheters to repair or replace aortic valves to treat aortic valve regurgitation continue to be researched.