About Aortic regurgitation (AR)

Your heart has four chambers, and each one has a valve that allows blood to exit. The aortic valve is one of these valves. With each heartbeat, the blood should move freely through the heart and the valve should then shut tightly until the next heartbeat.

With aortic regurgitation (AR), sometimes called aortic insufficiency (AI), the aortic valve does not close completely. This allows some of the blood to flow backward into the main chamber (the left ventricle) each time the heart beats. The leak caused by this condition may prevent the heart from correctly distributing blood to the rest of your body.

The likelihood of developing AR increases with age. It can develop suddenly or gradually over a long period of time. Once it becomes severe, surgery is often required to repair or replace the aortic valve.

According to one study, about 5% of the population has AR of any severity. Less than 1 percent of the total population has severe AR. About 2% to 3% of people over age 60 have severe AR.

There are several potential causes of AR, including:

Congenital heart valve disease. Most aortic valves have three cusps. Some people are born with an aortic valve that only has two cusps or fused cusps rather than three separate cusps. These heart defects put you at risk for developing AR at some time in your life.

Infection of the heart’s tissue (endocarditis). This condition is usually caused by an infection that starts somewhere else in the body. Germs or bacteria travel in the blood to the heart and cause it harm. The valves are especially vulnerable.

Rheumatic fever. When strep throat is not properly treated, it can turn into rheumatic fever, which can damage the aortic valve. This is a common cause of severe AR among older adults.

Other diseases. Other rare conditions can enlarge the aorta and aortic valve and lead to AR, including Marfan syndrome, a connective tissue disease. Some autoimmune conditions, such as lupus, can also lead to AR.

Tear or injury to aorta. A traumatic chest injury or aortic tear can also cause AR.

Most often, AR develops gradually. You may have no signs or symptoms for years. In some cases, AR comes on suddenly, usually as a result of an infection of the valve.

Symptoms may include:

• Chest pain, discomfort, or tightness (often worsening during exercise)
• Fatigue or weakness (especially when you increase your activity level)
• Shortness of breath (with exercise or when you lie down)
• Swelling in the ankles/feet
• Rapid, fluttering heartbeat (palpitations)
• Irregular pulse (arrhythmia)
• Heart murmur
• Lightheadedness or fainting

With AR, as blood leaks back into the heart’s main pumping chamber, the left ventricle holds more blood, possibly causing it to enlarge and thicken. At first, the larger left ventricle helps maintain good blood flow with more force. But eventually these changes weaken your heart.

With a weaker heart, you may experience fainting or lightheadedness, or heart rhythm problems (arrhythmias).

The most serious potential complication of AR is heart failure, which is when your heart muscle weakens and can’t pump blood properly to your body. Heart failure can then lead to complications with your other organs.

AR can also raise your risk of getting endocarditis, an infection of the inner lining of the heart.

Even if you don’t have symptoms, your doctor may be able to detect AR by listening to your heart with a stethoscope. Typically, your doctor would hear a whooshing sound in between beats if you have valve problems. The whooshing sound means there is abnormal flow of blood through the valve.

To confirm a diagnosis, your doctor may order one or more of the following tests:

Echocardiogram. With this test, sound waves are aimed at your heart to create a video of its beats. This can help doctors find AR and determine how serious it is

Electrocardiogram (ECG or EKG). In this test, wires (electrodes) attached to pads on your skin measure the electrical activity of your heart, which can detect enlarged chambers of your heart, heart disease, and abnormal heart rhythms

Chest X-ray. This can often tell if your heart or aorta is enlarged, possibly because of AR. It can also show if your lungs have been affected by AR

Cardiac catheterization. With this test, your doctor inserts a flexible tube called a catheter through an artery and into your heart. Your doctor may use a special dye and an X-ray “movie” to get a more detailed look at your heart’s valves and chambers

Cardiac MRI. This test uses a magnetic field and radio waves to create detailed pictures of your heart, including the aorta and aortic valve

Exercise tests or stress tests. These tests help your doctors see if you have signs and symptoms of AR during physical activity, and help determine the severity of your disease

Treatment depends on the severity of the condition, whether you’re having symptoms, and if your condition is getting worse.

Mild AR may not require any treatment. In this case, you would be monitored over time. Your doctor may also recommend healthy lifestyle changes. Medications may be prescribed to lower blood pressure.

In more serious cases, aortic valve repair or replacement may be the best option. In general, valve repair may be preferred, but if it is not possible, heart valve replacement may be required.

Aortic valve repair and replacement is usually done through traditional open-heart surgery. This involves an incision in the chest and opening of the chest bone (sternotomy). Your doctor removes the aortic valve and replaces it with a mechanical valve or a valve made from animal tissue. During the procedure, you will receive anesthesia and be connected to a heart-lung bypass machine to keep blood moving through your body. After the procedure, doctors wire the chest bone back together and close the incision.

Some people with AR may not be candidates for open-heart aortic valve replacement surgery due to other health problems that would make the procedure too risky.