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Aortic Regurgitation

Understanding the heart

The heart has four chambers – two atria and two ventricles. The walls of these chambers are mainly made of special heart muscle. During each heartbeat both of the atria contract first to pump blood into the ventricles. Then both ventricles contract to pump blood out of the heart into the arteries. There are one-way valves between the atria and ventricles, and between the ventricles and the large arteries coming from the heart. The valves make sure that when the atria or ventricles contract, the blood flows in the correct direction.

What is the aortic valve and what is aortic regurgitation?

The aortic valve lies between the left ventricle and the aorta. The aorta is the main artery that takes blood from the heart to the body. The aortic valve has three flaps (cusps). Blood flows through the valve when the left ventricle contracts at the early part of the heartbeat. When the left ventricle relaxes, the aortic valve closes and the mitral valve opens to allow more blood into the ventricle, ready for the next heartbeat.

Aortic regurgitation is sometimes called aortic incompetence or a leaky aortic valve. In aortic regurgitation the valve does not close properly. Therefore, blood leaks back (regurgitates) into the left ventricle from the aorta.

What are the causes of aortic regurgitation?

The main causes include the following:

Rheumatic fever

Rheumatic fever is a condition that sometimes occurs during an infection with a bacterium (germ) called the streptococcus. Your body makes antibodies to the bacterium to clear the infection. However, in some people the antibodies also attack various parts of the body, in particular the heart valves. Inflammation of a valve may develop which can cause permanent damage and lead to thickening and scarring years later.

Congenital causes

Various heart problems present at birth may include aortic regurgitation.

Abnormal widening of the base of the aorta

If the root of the aorta becomes abnormally wide, the cusps of the valve cannot meet and the valve becomes leaky. The tissue at the base of the aorta can be affected by various conditions such as: Marfan’s syndrome, ankylosing spondylitis, rheumatoid arthritis, Reiter’s syndrome, relapsing polychondritis, syphilis.

Endocarditis

This is an infection of the valve. See separate leaflet called ‘Endocarditis – Infective’.

What are the symptoms of aortic regurgitation?

  • If the leak is small you are not likely to have any symptoms.
  • If the backflow of blood becomes worse the left ventricle has to work harder with each heartbeat to pump the extra blood back into the aorta. The wall of the ventricle may then enlarge and may also become thickened (hypertrophied). Symptoms can then include:
    • Dizziness.
    • Chest pain (angina) when you exert yourself. This occurs because of reduced blood flow to the coronary arteries.
    • Forceful heartbeats which you may feel as palpitations.
  • If the backflow of blood is severe the left ventricle may not function properly and you can develop heart failure. This causes shortness of breath, tiredness, and fluid retention in various tissues of the body. See separate leaflet called ‘Heart Failure’.

What are the possible complications of aortic regurgitation?

  • Heart failure may become severe and life-threatening.
  • Endocarditis is an uncommon complication. This is an infection of the valve. (Abnormal valves are more prone to infection than normal valves.) Unless promptly treated, endocarditis can cause serious illness.

How is aortic regurgitation diagnosed?

  • A doctor may hear a heart murmur or other abnormal noises when listening with a stethoscope. Murmurs and noises are due to blood passing through abnormal valves, or to abnormal movement of valves. There are typical murmurs and noises which occur with aortic regurgitation. Sometimes this is detected on a routine examination if you have no symptoms, and the regurgitation is mild.
  • An electrocardiogram (ECG) can show that the left ventricle is thickened or enlarged.
  • An echocardiogram (ultrasound scan of the heart) can confirm the diagnosis.

What are the treatments for aortic regurgitation?

If the backflow of blood is mild and you have no symptoms then you may not need any treatment. If you develop symptoms or complications, various medicines may be advised to ease the symptoms. Surgery may be advised if symptoms become worse.

Medication

Medication may be advised to help ease symptoms of heart failure if heart failure develops. For example:

  • Diuretics (water tablets) usually help if you are breathless. They make the kidneys produce more urine. This gets rid of excess blood and fluid which may build up in the lungs or other parts of the body with heart failure.
  • Angiotensin-converting enzyme (ACE) inhibitors are medicines which help to reduce the amount of work the heart does and to ease symptoms of heart failure.

Valve replacement surgery

This may be with a mechanical or a tissue valve. Mechanical valves are made of materials which are not likely to react with your body, such as titanium. Tissue valves are made from treated animal tissue, such as valves from a pig. If you need surgery, a surgeon will advise on which is the best option for your situation.

Surgical treatment has greatly improved the outlook in most people with more severe regurgitation. Surgery to replace the valve has a very good success rate. The outlook is good if the valve is treated before the heart becomes badly damaged.

Antibiotics to prevent endocarditis

Antibiotics used to be offered to all people with heart valve disease before dental treatment and some surgical procedures to prevent the development of endocarditis. However, the National Institute for Health and Clinical Excellence (NICE) issued guidance in 2008 which advised that people at risk of endocarditis only need to take antibiotics if they actually have an infection at the time that dental or surgical procedures are undertaken.

Further sources of help and information

British Heart Foundation

Greater London House, 180 Hampstead Road, London, NW1 7AW
Tel (Heart Help Line): 0300 330 3311 Web: www.bhf.org.uk

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