Aortic valve prolapse; Aortic insufficiency; Heart valve - aortic regurgitation; Valvular disease - aortic regurgitation; AI - aortic insufficiency
Aortic regurgitation is a heart valve disease in which the aortic valve does not close tightly. This allows blood to flow from the aorta (the largest blood vessel) into the left ventricle (a chamber of the heart).
Any condition that prevents the aortic valve from closing completely can cause this problem. When the valve does not close all the way, some blood comes back each time the heart beats.
When a large amount of blood comes back, the heart must work harder to force out enough blood to meet the body's needs. The left lower chamber of the heart widens (dilates) and the heart beats very strongly (bounding pulse). Over time, the heart becomes less able to supply enough blood to the body.
In the past, rheumatic fever was the main cause of aortic regurgitation. The use of antibiotics to treat strep infections has made rheumatic fever less common. Therefore, aortic regurgitation is more commonly due to other causes. These include:
Aortic insufficiency is most common in men between the ages of 30 and 60.
The condition often has no symptoms for many years. Symptoms may come on slowly or suddenly. They may include:
Signs may include:
Aortic regurgitation may be seen on tests such as:
A chest x-ray may show swelling of the left lower heart chamber.
Lab tests cannot diagnose aortic insufficiency. However, they may help rule out other causes.
You may not need treatment if you have no symptoms or only mild symptoms. However, you will need to see a health care provider for regular echocardiograms.
If your blood pressure is high, you may need to take blood pressure medicines to help slow the worsening of aortic regurgitation.
Diuretics (water pills) may be prescribed for symptoms of heart failure.
In the past, most people with heart valve problems were given antibiotics before dental work or an invasive procedure, such as colonoscopy. The antibiotics were given to prevent an infection of the damaged heart. However, antibiotics are now used much less often.
You may need to limit activity that requires more work from your heart. Talk to your provider.
Surgery to repair or replace the aortic valve corrects aortic regurgitation. The decision to have aortic valve replacement depends on your symptoms and the condition and function of your heart. There is increasing interest in a minimally invasive procedure in which a replacement valve is implanted via catheter. This is similar to a procedure traditionally done in people with aortic stenosis. This option may become more common in the future.
You may also need surgery to repair the aorta if it is enlarged.
Surgery can cure aortic insufficiency and relieve symptoms, unless you develop heart failure or other complications. People with angina or congestive heart failure due to aortic regurgitation do poorly without treatment.
Complications may include:
Contact your provider if:
Blood pressure control is very important if you are at risk for aortic regurgitation.
Bonow RO, Nishimura RA. Aortic Regurgitation. In: Libby P, Bonow RO, Mann DL, Tomaselli GF, Bhatt DL, Solomon SD, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 12th ed. Philadelphia, PA: Elsevier; 2022:chap 73.
Carabello BA. Valvular heart disease. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 66.
Leon MB, Mack MJ. Transcatheter Aortic Valve Replacement. In: Libby P, Bonow RO, Mann DL, Tomaselli GF, Bhatt DL, Solomon SD, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 12th ed. Philadelphia, PA: Elsevier; 2022:chap 74.
Writing Committee Members, Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Thorac Cardiovasc Surg. 2021;162(2):e183-e353. PMID: 33972115 pubmed.ncbi.nlm.nih.gov/33972115/.BACK TO TOP
Review Date: 1/9/2022
Reviewed By: Michael A. Chen, MD, PhD, Associate Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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