Guide to Aortic Regurgitation

What is Aortic Regurgitation (aka Aortic Insufficiency)?

Aortic regurgitation occurs when the heart's aortic valve doesn't close tightly. The aortic valve connects the heart’s left side to the aorta, the body’s main artery. In aortic regurgitation, the leaky aortic valve allows blood that was just pumped out of the heart's main pumping chamber (left ventricle) to leak back into it.

The leakage of blood can prevent the heart from efficiently pumping blood out to the rest of your body. When the body does not get enough blood, the heart has to work harder to make up for it, which can put a strain on it that causes further problems.

What Causes Aortic Regurgitation?

There are a variety of causes of aortic regurgitation, ranging from congenital heart defects (heart problems that are present from birth) to complications of infectious illnesses. Major causes include:

Congenital heart defects
Deterioration of the valve with age
Endocarditis, which is an infection of the heart valve
Rheumatic fever, a complication of untreated strep infections
Rare diseases such as Marfan syndrome that can damage the aortic valve
Trauma (damage to the aorta near the site of aortic valve)
Enlargement of the aorta because of high blood pressure

Aortic valve regurgitation can develop suddenly or over decades. When it develops over years it is called chronic aortic regurgitation. When it develops suddenly, it is called acute aortic regurgitation.

Acute aortic regurgitation can be caused by:

Complications from a replacement (prosthetic) aortic valve
Trauma to the heart valve or aorta itself
Endocarditis
Aortic dissection, which means that the inner layer of the aorta separates from the middle layer

What are the signs and symptoms of Aortic Regurgitation?

Signs and symptoms of aortic regurgitation include:

Fatigue and weakness with increase in activity level
Shortness of breath with exertion or when lying on one’s back
Chest pain (angina), discomfort or tightness, often increasing during exercise
Swollen ankles and feet (edema)
Heart palpitations — sensations of a rapid, fluttering heartbeat
Irregular pulse (arrhythmia)
Heart murmur
Fainting

The signs and symptoms of aortic valve regurgitation are the result of the heart having to work harder to pump blood out to the body. In response to this need, the left ventricle of the heart may enlarge and thicken. At first, these adaptations help the left ventricle pump blood with more force. But eventually these changes weaken the left ventricle — and the heart overall in time

How is Aortic Regurgitation diagnosed?

People with aortic regurgitation may have no signs or symptoms for many years, and they may even be unaware that they have this condition until a doctor hears a heart murmur at a routine physical.

Echocardiography (an ultrasound of the heart) is the gold standard in diagnosing aortic regurgitation. After the condition has been diagnosed by echocardiography, a catheterization may be performed to monitor pressures inside the heart as well as to check for additional coronary artery disease.

How is Aortic Regurgitation Treated?

People without symptoms or with mild symptoms from aortic regurgitation should have regular check-ins with their cardiologist to monitor for changes in their condition. Once aortic valve regurgitation becomes severe, a procedure is often required to repair or replace the aortic valve.

Aortic valve repair or replacement for chronic severe aortic regurgitation is typically used for:

Those with active symptoms
People without symptoms who have left ventricular dysfunction (as seen by cardiac testing)
People with aortic regurgitation who have to undergo another cardiac surgery
People with preserved ventricular function but a left ventricular end-systolic dimension more than 50 to 55 mm or end-diastolic dimension more than 70 to 75 mm

Aortic valve repair or replacement can be done through a traditional “open” surgical operation (in which cardiac surgeons make an incision down the middle of the chest), a minimally invasive surgical operation (in which cardiac surgeons make smaller incisions, sometimes between the ribs), or as a transcatheter procedure (in which a cardiac surgeon or an interventional cardiologists accesses the aortic valve by passing instruments through the bloodstream). Transcatheter aortic valve replacement is commonly referred to as TAVR (pronounced like “Ta-ver”).

People with aortic regurgitation should have detailed counseling about physical activity. Exercises to AVOID include:

Isometric exercise
Weight lifting
Heavy exertional activities involving strenuous arm work

These should be specifically prohibited because of the increase in peripheral vascular resistance that occurs with arm exercise.

In contrast, rhythmic, low-resistance, large muscle group exercise such as bicycling are encouraged.

My doctor tells me that I have Aortic Regurgitation, what should I do now?

If you have no or mild symptoms from your aortic regurgitation, you should follow up with your cardiologist regularly to monitor for any changes.

A cardiologist can help determine the severity level for your aortic regurgitation. If you are having symptoms, you should also consult with a cardiac surgeon to evaluate your surgical treatment options.

Our team of cardiac surgeons are here to help with your specific case of aortic regurgitation, whether you want to discuss options, create a plan of action, or receive a second opinion.

Next Steps

If you have heart disease and need help, we’re here for you. To get started today, call (212) 305-2633 or use our appointment request form.