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Aortic Regurgitation

(Aortic Insufficiency)


Guy P. Armstrong

, MD, Waitemata District Health Board and Waitemata Cardiology, Auckland

Reviewed/Revised Nov 2023
Topic Resources

Aortic regurgitation is leakage of blood back through the aortic valve each time the left ventricle relaxes.

The aortic valve is in the opening between the left ventricle and the ascending aorta (the large artery leading from the heart). The aortic valve opens as the left ventricle contracts to pump blood into the aorta. When the aortic valve does not close completely, blood leaks backward from the aorta into the left ventricle as the left ventricle relaxes to fill with blood from the left atrium. The backward leakage of blood, termed regurgitation, increases the volume and pressure of blood in the left ventricle. As a result, the amount of work the heart has to do increases. To compensate, the muscular walls of the ventricles thicken (hypertrophy), and the chambers of the ventricles enlarge (dilate). Eventually, despite this compensation, the heart may be unable to meet the body's need for blood, leading to heart failure Heart Failure (HF) Heart failure is a disorder in which the heart is unable to keep up with the demands of the body, leading to reduced blood flow, back-up (congestion) of blood in the veins and lungs, and/or... read more Heart Failure (HF) , with fluid accumulation in the lungs.

Causes of Aortic Regurgitation

Aortic valve regurgitation may develop suddenly (acute) or gradually (chronic).

The most common causes of acute aortic regurgitation are

Valvular Regurgitation

The most common causes of chronic aortic regurgitation are

Rheumatic fever and syphilis used to be the most common causes of aortic regurgitation in North America and Western Europe, where both disorders are now rare because of the widespread use of antibiotics. In regions where antibiotics are not widely used, aortic regurgitation due to rheumatic fever or syphilis is still common.

About 1% of babies have a bicuspid aortic valve, but it commonly does not cause problems until adulthood.

Symptoms of Aortic Regurgitation

Mild aortic regurgitation causes no symptom other than a characteristic heart murmur (abnormal heart sound) that can be heard with a stethoscope each time the left ventricle relaxes. People with severe regurgitation may develop symptoms when heart failure results.

Heart failure Heart Failure (HF) Heart failure is a disorder in which the heart is unable to keep up with the demands of the body, leading to reduced blood flow, back-up (congestion) of blood in the veins and lungs, and/or... read more Heart Failure (HF) causes shortness of breath during exertion. Lying flat, especially at night, makes breathing difficult. Sitting up allows backed-up fluid to drain out of the upper part of the lungs, restoring normal breathing. About 5% of people with aortic regurgitation have chest pain due to an inadequate blood supply to the heart muscle (angina Angina Angina is temporary chest pain or a sensation of pressure that occurs while the heart muscle is not receiving enough oxygen. A person with angina usually has discomfort or pressure beneath the... read more ), especially at night.

The pulse, sometimes called a collapsing pulse, is momentarily strong, then disappears quickly because the blood leaks backward through the aortic valve into the heart, causing blood pressure to decrease sharply.

Diagnosis of Aortic Regurgitation

  • Physical examination

  • Echocardiography

The diagnosis is based on the results of a physical examination (such as the collapsing pulse and characteristic heart murmur) and confirmed by echocardiography Echocardiography and Other Ultrasound Procedures Ultrasonography uses high-frequency (ultrasound) waves bounced off internal structures to produce a moving image. It uses no x-rays. Ultrasonography of the heart (echocardiography) is one of... read more Echocardiography and Other Ultrasound Procedures . Echocardiography also shows the severity of the regurgitation and whether the heart muscle has been affected.

First-degree relatives (that is, parents, siblings, or children) of people with a bicuspid valve should also be tested because 20 to 30% will also have a bicuspid valve, which increases their risk of developing aortic regurgitation as they get older .

Aortic Valve Replacement

Treatment of Aortic Regurgitation

  • Valve repair or replacement

Treatment with medication is not especially effective in slowing the progression of heart failure and does not eliminate the need for timely valve repair or replacement.

Echocardiography is done periodically to determine how rapidly the left ventricle is enlarging, which will help doctors determine when surgery should be done. The damaged valve should be surgically repaired or replaced with an artificial valve before the left ventricle becomes irreversibly damaged.

People who have had a valve replacement are given antibiotics before surgical, dental, or medical procedures (see table ) to reduce the risk of infection of the heart valve.

Prognosis for Aortic Regurgitation

With treatment, the prognosis for people with mild to moderate aortic regurgitation is very good. When valve replacement is done before heart failure develops, long-term prognosis for people with moderate to severe aortic regurgitation is also good. However, the outlook for people with severe aortic regurgitation and heart failure is considerably poorer.

More Information

The following English-language resource may be useful. Please note that THE MANUAL is not responsible for the content of this resource.

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