Aortic regurgitation

What is aortic regurgitation?

Aortic regurgitation, or “AR,” is a condition in which the aortic valve leaks. The aortic valve is 1 of the 4 valves in the heart. It is between the left ventricle and the aorta, which is the large blood vessel that carries blood to the rest of the body.

When the heart valves work normally, they keep blood flowing in only 1 direction. Normally, little or no blood can leak backward. But if the valves are not working properly, blood can go back in the direction it came from.

Normally, the aortic valve keeps blood flowing from the left ventricle to the aorta. When the aortic valve leaks, it lets blood flow back into the left ventricle. Over time, this can lead to problems.

What causes AR?

In general, ΑR is caused by either:

• A diseased or damaged aortic valve
• Widening of the first part of the aorta (the part that surrounds the aortic valve).

What are the symptoms of AR?

Early on, most people have no symptoms. They find out that they have ΑR when their doctor or nurse hears a heart murmur on a routine exam. A heart murmur is an extra sound in the heartbeat that doctors or nurses hear when they listen to the heart with a stethoscope.

When ΑR causes symptoms, they can include:

• Trouble breathing with exercise or other physical activity
• Chest pain

Is there a test for AR?

Yes. Your doctor or nurse will ask about your symptoms, do an exam, and order 1 or more tests.

The test done most often to check for AR is an echocardiogram, or “echo.” This test uses sound waves to create a picture of the heart as it beats. It shows the size of the heart chambers, how well the heart pumps, and how well the heart valves work (figure 2). Your doctor might repeat this test over time to check whether your condition changes.

You might have a test called an electrocardiogram, or “ECG.” This test measures the electrical activity in your heart.

Some people with ΑR will also have:

• A chest X-ray – This can show the size and shape of your heart and aorta.
• An imaging test, such as an MRI – This can show more detail about how much the aortic valve is leaking, and the size and shape of your heart and aorta.

To get more information about your heart, your doctor might order a test called cardiac catheterization, or “cardiac cath”. For cardiac cath:

• A doctor puts a thin tube into a blood vessel in your leg or arm.
• Then, they move the tube through the aorta, through the aortic valve (figure 1), and into the left ventricle of your heart. When the tube is in your heart and blood vessels, they take measurements.
• With the tip of the tube in the aorta, above the aortic valve, the doctor puts a dye into the tube. The dye shows up on X-ray, and can show how much the aortic valve is leaking.
• The doctor might also use a tube to put dye in the arteries in your heart. This can show if any of them are narrowed or blocked.

How is AR treated?

Treatment depends on your symptoms and how severe they are, and what’s causing your AR. If your ΑR is mild or you have no symptoms, you might not need treatment. But your doctor will monitor your symptoms to see if and when they get worse.

Severe AR that causes symptoms, or is causing changes in the heart’s size or how well it works, needs treatment. The main treatment is surgery to replace the aortic valve. During surgery, the doctor will remove the diseased valve and replace it with a valve that works normally. In some cases, the doctor will also fix a widened part of the aorta during surgery.

In some cases, a procedure to put in a new aortic valve without surgery might be an option. This is called “transcatheter aortic valve implantation,” or “TAVI,” or “transcatheter aortic valve replacement,” or “TAVR.”

Other treatment depends on your situation. It might include heart medicines or treatment for high blood pressure.

Can I play sports?

It depends on your ΑR and symptoms, the size of your aorta, and your other conditions. You and your doctor will discuss the level of physical activity that is right for you.

Do I need to take antibiotics before I go to the dentist?

In general, no. In the past, doctors recommended that people with ΑR take antibiotics before going to the dentist or having certain medical or dental procedures. But now, only people with certain heart conditions need antibiotics before going to the dentist or having some procedures. Most people with ΑR do not need antibiotics for those times. But people with a valve replacement do need antibiotics in these situations.

What if I want to get pregnant?

If you want to get pregnant, talk with your doctor before you start trying. They might recommend treatment for your AR before you get pregnant. They will also make sure that any medicines you take are safe to take during pregnancy.