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What is Aortic Valve Regurgitation: Symptoms, Causes, Diagnosis, and Treatment

Definition and Overview

Aortic valve regurgitation is a cardiac defect that prevents the aortic valve from closing properly. As a result, a certain amount of blood that was just pumped out of the heart’s left ventricle leaks back to it. The condition, which is also known as aortic valve incompetence and aortic insufficiency, is more common in men than in women and mostly affects people over the age of 65.

When blood circulates in the body, it follows a one-way path through the heart. It flows through the left atrium and then down to the left ventricle before it is pumped to the aorta through the aortic valve, which closes after each heartbeat. If the aortic valve does not close all the way, oxygen-rich blood flows backwards into the left ventricle, forcing the heart to work harder to compensate for the blood leak. In many cases, the condition is asymptomatic; in others, patients experience chest pain and shortness of breath. If left untreated, the condition can cause the ventricular walls to thicken and the heart muscles can be permanently damaged. This increases the risk of heart failure.

Aortic valve regurgitation can be mild, moderate or severe. It can also develop suddenly (acute) or progress over a period of years or even decades (chronic) without patients even noticing it. Patients with less serious conditions usually experience very few symptoms and many of them do not require treatment. However, if the condition is severe, surgery is often needed to either repair or replace the aortic valve.

Causes of Condition

Chronic aortic valve regurgitation occurs when the aortic valve is damaged due to congenital aortic valve defects, rheumatic fever, or enlargement of the aorta.

The condition can also suddenly develop if caused by the following:

  • A heart infection (endocarditis) - An infection of the heart’s inner lining can be caused by bacteria or fungi, which can travel through the bloodstream.

  • Ageing – Ageing causes structural changes to cardiac structures, which can result in the weakening of the heart valves.

  • Aortic dissection – A condition in which the inner layer of the aorta is torn, causing its inner and middle layers to separate.

  • Problems with the replacement aortic valve

  • Radiation treatment to the chest area

  • Trauma to the heart valve or aorta

  • Untreated syphilis

Patients suffering from acute aortic valve regurgitation often suffer from more serious symptoms than those whose condition has slowly progressed over several years.

Key Symptoms

In many cases, aortic valve regurgitation develops very slowly, which gives the heart ample time to make adjustments and compensate for the blood leak. As such, most patients do not experience any symptoms; some are not even aware that they have the condition until they are diagnosed when they undergo certain tests for unrelated conditions.

However, if the condition occurs or develops suddenly (acute), classic signs and symptoms of heart problems can be observed. These include:

  • Chest pain

  • Shortness of breath, especially when doing exercises or lying down

  • Fatigue

  • Swollen ankles and feet

  • Fainting

  • Arrhythmia

  • Heart murmur

Who to See and Types of Treatments Available

Patients with symptoms mentioned above can consult their family doctor or a general physician (GP) for initial tests and assessment. If a heart problem is suspected, they will be referred to a cardiologist, a doctor that specialises in the diagnosis, treatment, and management of all heart-related conditions.

To diagnose aortic valve regurgitation, doctors usually begin by reviewing the patient’s medical history and their symptoms. Patients are asked when they first noticed the symptoms and treatment that they have received so far. They also undergo a physical examination in which a stethoscope is used to listen to their heartbeat. Patients with aortic valve regurgitation present with a heart murmur, a whooshing or swishing sound that indicates a blood flow problem.

To make a diagnosis and to rule out other heart conditions that share similar symptoms, the following tests may be performed:

  • Echocardiogram - Considered the most important imaging test in the diagnosis of many heart-related conditions including aortic valve regurgitation. It uses sound waves to determine the causes and severity of the condition. It is also useful in determining the best treatment method for the patient.

  • Cardiac catheterisation - A catheter-based procedure that can be used for both diagnostic and therapeutic purposes. It uses a long thin tube that is inserted into an artery or vein in the arm, groin, or neck and threaded through the blood vessels to the heart.

  • Cardiac MRI - Another non-invasive imaging test that produces a clear picture of the heart, helping doctors to easily assess its function and structure.

  • Chest x-ray - A standard diagnostic test used to determine the cause of specific symptoms including chest pain and shortness of breath.

  • Electrocardiogram - Used to measure the electrical activity of the heart. It is a useful diagnostic tool for patients suffering from arrhythmia.

Aortic valve regurgitation treatment

  • Mild aortic valve regurgitation, which is characterised by small amounts of blood leak, usually does not require treatment. In most cases, doctors advise watchful waiting and perform periodic tests to ensure that the condition is not progressing.

  • Moderate aortic valve regurgitation is also generally handled well and not associated with serious symptoms. Although it can cause the heart to enlarge a little in some cases, the amount of blood leak is usually not a cause for concern. However, the condition must be monitored over time.

  • Severe aortic valve regurgitation – If patients are showing signs of heart failure, aortic valve repair or replacement is generally recommended. Both procedures can be performed through open-heart surgery or minimally invasive techniques.

Patients are also usually prescribed with medicines that aim to reduce blood pressure. Those who have undergone valve replacement surgery must also take medicines to prevent infection and the formation of blood clots around the artificial valve.

References:

  • Roles of your four heart valves. American Heart Association. http://www.heart.org/HEARTORG/Conditions/More/HeartValveProblemsandDisease/Roles-of-Your-Four-Heart-ValvesUCM450344_Article.jsp.

  • Heart valve disease. National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health/dci/Diseases/hvd/hvd_all.html.