Aortic Regurgitation

What are heart valves?

There are four valves in the heart. They allow blood to be directed around the heart and when working normally ensure the blood flows in one direction. They open and close with every heartbeat – that’s 100,000 times a day! 

Heart valves

What is a murmur?

A murmur is the sound blood makes as it travels through a valve which is thickened or leaking.

What is the aortic valve? 

The aortic valve is the main outlet valve of the heart which allows blood to exit the heart with every heartbeat. Normal aortic valves have three leaflets. Around 1 in 200 people are born with an abnormal heart valve which has two leaflets, known as a bicuspid aortic valve. 

What is aortic regurgitation? 

Aortic regurgitation is a condition where the one-way aortic valve doesn’t close tightly and therefore becomes leaky. Blood exits the heart when the left ventricle (heart muscle) pumps. As the valve is leaky, when the heart relaxes blood is able to fall back into the heart.  

What causes aortic regurgitation? 

There are a number of causes of aortic regurgitation. It can be due to a problem with the valve or a problem with the aorta (main blood vessel leading away from the heart – if the aorta is stretched the valve leaflets are unable to close properly resulting in a leaky valve). Common causes are listed below: 

Valve related causes: 

• Bicuspid aortic valve (congenital abnormality) 
• Damage to the aortic valve following heart valve infection (endocarditis) 
• Valve degeneration (age related wear and tear) 
• Rheumatic fever 

Aorta-related causes: 

• Longstanding hypertension (high blood pressure) 
• Diseases affecting the elastic tissue of the arteries (e.g. Marfan’s syndrome, Ehlers Danlos) 
• Idiopathic dilatation (unexplained stretching of the aorta). 

What are my treatment options? 

Aortic regurgitation is a chronic (long term) condition. It can be graded into three categories: mild, moderate and severe. 

Mild or moderate aortic regurgitation do not usually cause symptoms or any strain on the heart. 

Regardless of the severity of aortic regurgitation, if you have no symptoms, it is likely that the Heart Valve Team will keep you under review with a clinic visit and echocardiogram (echo or cardiac ultrasound) intermittently as the valve disease can progress. Patients with aortic regurgitation are often followed up for many years without any symptoms. Follow up intervals will be determined by the Valve Team looking after you and depends on the severity and progression of your aortic regurgitation. Patients with mild aortic regurgitation usually do not require long-term monitoring. Occasionally on-going monitoring of this type of valve disease is not required and the Heart Valve Team will discuss the reasons for this with you.

If your aortic valve is severely leaky and you develop symptoms, or the heart becomes stretched or weakened, you may be referred for surgery. Most people with aortic regurgitation will not require any treatment and will just need regular monitoring of their condition.

Most people with aortic regurgitation will not require any treatment and will just require regular monitoring of their condition.

What tests will I need? 

Most people with aortic regurgitation will have an ECG and an echocardiogram. Other tests as outlined below may also be performed.

Electrocardiogram (ECG)

Stickers are placed on the chest and the electrical activity of the heart is recorded. 

Echocardiogram (Echo or cardiac ultrasound)

During this test an ultrasound probe is place on the chest and moving pictures of the heart are produced. The test takes around 30 minutes. 

Transoesophageal echocardiogram (TOE) 

This is a day case procedure similar to an endoscopy which takes place under sedation. A probe is passed into the gullet and detailed pictures of the heart are obtained using ultrasound.

Cardiac MRI scan 

This is a scan of the heart using a magnet to generate moving video images of the heart. A needle will be inserted into your vein in the arm prior to the test. You lie down in a tunnel for the scan which will take around 30-40 minutes. The scanner is noisy so you will be given ear plugs and head phones to protect your ears. The scan may not be suitable for those who are claustrophobic and if this is the case we can arrange other tests instead.

Lifestyle 

As with any type of heart disease, it is important that you follow a healthy diet and keep your weight within a normal range. 

Smoking

If you smoke, it is advisable that you stop. Your GP can guide you to support available to help you stop smoking. 

Exercise

For most patients there is no limitation for exercising, however if you have stretching of the aorta you are advised to avoid heavy lifting. You can discuss this with your healthcare professional. 

Pregnancy

If you are planning to get pregnant you should discuss this with your healthcare professional first and let them know immediately if you become pregnant.

Endocarditis 

Bacteria can enter the blood stream via many sources, most commonly the mouth and skin. In patients with abnormal valves these bacteria can attach to the heart valves causing infection known as endocarditis. 

It is therefore important to take good care of your teeth by brushing your teeth twice a day and visiting your dentist for regular check-ups (at least once a year). If you have toothache or an abscess it is important that you get treated for this quickly. Make sure you tell your dentist you have a heart valve condition.

It is therefore important to take good care of your teeth by brushing your teeth twice a day and visiting your dentist for regular check-ups (at least once a year). If you have toothache or an abscess it is important that you get treated for this quickly. Make sure you tell your dentist you have a heart valve condition.

Symptoms 

If you experience any new symptoms between clinic appointments then it is important that you let your healthcare professional know.

You can visit the Leeds Specialist Valve Service web page for more information