Aortic Regurgitation

In aortic regurgitation, some blood that has already been pumped out of the heart and into the aorta leaks backward into the heart.

A leak may develop gradually (over months or years) or quickly (over hours or days).

Causes

In people with aortic stenosis or aortic sclerosis, valves may not close completely, resulting in aortic regurgitation.

Aortic regurgitation may result when the aorta enlarges, often because of high blood pressure. When the aorta is enlarged, the valve may not close completely. As a result, blood leaks backward through the valve into the heart.

Aortic regurgitation may occur quickly if a tear in the lining of the aorta (aortic dissection) or a bulge that forms in a weakened area of the aorta (aortic aneurysm) affects the aortic valve. Infection of the heart valves (endocarditis) may also cause aortic regurgitation to occur quickly.

Symptoms and Diagnosis

If regurgitation develops gradually, it may cause no symptoms, or symptoms may develop slowly. Usually, symptoms do not appear until years after the regurgitation started. At first, people may tire more easily or feel short of breath during physical activity. If regurgitation worsens, people also feel short of breath during rest. This worsening means that heart failure is developing.

If regurgitation occurs quickly, symptoms may develop quickly and become severe. People may feel short of breath and as if their heart is racing. Severe heart failure may develop quickly. Death may occur without warning.

Doctors usually suspect the diagnosis on the basis of abnormal heart sounds, abnormalities in the pulse, and the results of a chest x-ray. However, echocardiography is much more accurate. Echocardiography can usually detect aortic regurgitation and the heart damage that may result from regurgitation. Usually, no other tests are needed.

Treatment and Outlook

If regurgitation develops gradually, most people do not need treatment at first. But when regurgitation becomes moderate to severe, even if it does not cause symptoms, most people are given a drug to reduce the amount of work the heart has to do. The drug may be an angiotensin-converting enzyme (ACE) inhibitor or a calcium channel blocker. These drugs may postpone the development of symptoms and thus the need for valve replacement. However, if symptoms develop or if echocardiography detects substantial heart damage (even if no symptoms are present), the aortic valve is replaced.

If regurgitation occurs quickly, the aortic valve is usually replaced as soon as possible. If the cause is endocarditis or aortic dissection, the valve may be repaired instead.

Without treatment, aortic regurgitation tends to worsen over time. The outlook is worse for older people, partly because many of them also have coronary artery disease. If heart failure develops, the outlook is also worse. After heart valve replacement, people over 75 tend to continue to have heart problems (including heart failure) and are more likely to die.