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Aortic valve regurgitation

Aortic valve regurgitation — or aortic regurgitation — is a condition that occurs when your heart's aortic valve doesn't close tightly. Aortic valve regurgitation allows some of the blood that was just pumped out of your heart's main pumping chamber (left ventricle) to leak back into it.

The leakage may prevent your heart from efficiently pumping blood to the rest of your body. As a result, you may feel fatigued and short of breath.

Aortic valve regurgitation can develop suddenly or over decades. Once aortic valve regurgitation becomes severe, surgery is often required to repair or replace the aortic valve.

Symptoms Causes Risk factors Complications Prevention

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:

  • Fatigue and weakness, especially when you increase your activity level
  • Shortness of breath with exertion or when you lie down
  • Swollen ankles and feet (edema)
  • Chest pain (angina), discomfort or tightness, often increasing during exercise
  • Lightheadedness or fainting
  • Irregular pulse (arrhythmia)
  • Heart murmur
  • Sensations of a rapid, fluttering heartbeat (palpitations)

When to see a doctor

Contact your doctor right away if signs and symptoms of aortic valve regurgitation develop. Sometimes the first indications of aortic valve regurgitation are those of its major complication, congestive heart failure. See your doctor if you have fatigue, shortness of breath, and swollen ankles and feet.

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

  • Congenital heart valve disease. You may have been born with an aortic valve that has only two leaflets (bicuspid valve) or fused leaflets rather than the normal three separate leaflets. This puts you at risk of developing aortic valve regurgitation at some time in your life.
  • Endocarditis. The aortic valve may be damaged by endocarditis — an infection inside your heart that involves heart valves.
  • 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. Many older adults in the United States were exposed to rheumatic fever as children, although they may not have developed rheumatic heart disease.
  • Disease. Other rare conditions can enlarge the aortic valve and lead to regurgitation, including Marfan syndrome, a connective tissue disease.
  • 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.

How your heart works

Heart valves open like a one-way gate. The leaflets of the aortic valve are forced open as the left ventricle contracts and blood flows into the aorta. When the blood has gone through the valve and the left ventricle has relaxed, the leaflets close to prevent the blood that has just passed into the aorta from flowing back into the left ventricle.

A defective heart valve is one that fails to either open or close fully. When a valve doesn't close tightly, blood can leak backward. This backward flow through a valve is called regurgitation.

In aortic valve regurgitation, some blood leaks back into the left ventricle instead of flowing onward to the rest of your body after being pumped into the aorta. This forces the left ventricle to hold more blood, possibly causing it to enlarge and thicken.

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.

Your risk of aortic valve regurgitation is greater if you've been affected by any of the following:

  • Aortic valve damage. Inflammation associated with certain conditions, such as endocarditis or rheumatic fever, can damage your aortic valve. Also, a narrowing of the aortic valve (aortic stenosis) can be associated with leaking.
  • High blood pressure (hypertension). High blood pressure may stretch the root of the aorta where the aortic valve sits. The valve leaflets may no longer meet, resulting in leakage.
  • Congenital heart valve disease. If you were born with a malformed aortic valve, your chances of having aortic valve regurgitation increase.
  • Disease. Certain conditions, including Marfan syndrome and ankylosing spondylits, may cause the aortic root (where the aorta attaches to the ventricle) to widen, resulting in a leaky aortic valve.
  • Age. By middle age, you can develop some aortic valve regurgitation caused by natural deterioration of the valve.

Any heart valve problem puts you at risk of an infection of the heart's inner lining (endocarditis). If the aortic valve is leaky, it's more prone to infection than is a healthy valve.

When it's mild, aortic valve regurgitation may never cause a serious threat to your health. But when it's severe, aortic valve regurgitation may lead to heart failure. Heart failure is a serious condition in which your heart is unable to pump enough blood to meet your body's needs.

For any heart condition, see your doctor regularly so he or she can monitor you and possibly catch aortic valve regurgitation before it develops or in the early stages, when it's more easily treatable. Also, be aware of conditions that contribute to developing aortic valve regurgitation, including:

  • 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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