Aortic regurgitation may also be referred to as aortic insufficiency or a leaky aortic valve. The aortic valve is one of four heart valves and sits between the aorta (the main artery in your body) and the left lower chamber of your heart. It is the “front door” of the heart. Aortic regurgitation is a structural heart disease where the valve does not close tightly or completely, causing blood to flow backwards. Because there is backward flow of blood, your heart may have to work harder to compensate. This ineffective way of pumping blood can cause thickening of the heart muscle and may eventually lead to heart failure. Aortic regurgitation can occur in your native valve (the valve you were born with) or after undergoing a valve replacement. When aortic regurgitation occurs in the situation of a patient who has already had a valve replacement, it can mean that the valve has degenerated over time and needs to be replaced again.
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What to watch for
This condition is rated on a scale of 1-4 in severity and is typically diagnosed by echocardiogram (ultrasound of the heart). With mild leaking, patients may not experience any symptoms. Patients with more severe leaking may have an audible heart murmur, palpitations, chest pain, shortness of breath, fatigue, difficulty lying flat, or swelling in the lower extremities (feet, ankles, legs). In more severe cases patients may experience dizziness or even fainting.
Causes and Treatment
Aortic regurgitation can be caused by several structural and non-structural related conditions. One main cause is having a congenital abnormality, or a condition that you are born with which causes you to be at higher risk of developing aortic regurgitation (having a bicuspid aortic valve, diseases of the aorta or aortic sinuses). It can also be caused by bacterial infections of the heart tissue (endocarditis), suffering trauma to your chest or from a calcified or narrowed valve (may also be called aortic stenosis).
In mild cases no treatment may be necessary. Your primary doctor or cardiologist may order repeat echocardiograms to monitor over time. When the leaking is severe and causing symptoms or evidence of other concerning changes to the structure of your heart, having the valve repaired or replaced is often recommended.
In cases where aortic valve repair or replacement is recommended you will be referred to a heart valve disease specialist. This may be an interventional cardiologist, a cardiothoracic surgeon, or both. For some patients, less invasive options like transcatheter replacement may be an option. Your provider may recommend additional tests, diagnostic procedures, or imaging studies to help determine the best approach for your specific situation.
