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Aortic Regurgitation

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Aortic regurgitation is a condition in which blood leaks back through the aortic valve. This is because the valve does not close properly. With each heartbeat, more blood than usual enters the left ventricle and so it needs to work harder. Mild regurgitation may not cause symptoms. More severe regurgitation can cause symptoms and may lead to heart failure. Medication can help to ease symptoms. Surgery to replace the valve may be needed.

The heart has four chambers - two atria and two ventricles. The walls of these chambers are mainly made of special heart muscle. During each heartbeat both of the atria squeeze (contract) first to pump blood into the ventricles. Then both ventricles contract to pump blood out of the heart into the arteries. There are one-way valves between the atria and ventricles, and between the ventricles and the large arteries coming from the heart. The valves make sure that when the atria or ventricles contract, the blood flows in the correct direction.

Cross-section diagram of a normal heart

The aortic valve lies between the left ventricle and the aorta. When the left ventricle relaxes, the aortic valve closes and the mitral valve opens. This allows more blood into the ventricle, ready for the next heartbeat.

Aortic regurgitation is sometimes called aortic incompetence or a leaky aortic valve. In aortic regurgitation the valve does not close properly. Therefore, blood leaks back (regurgitates) into the left ventricle from the aorta.

In some cases, aortic regurgitation occurs at the same time as aortic stenosis. See separate leaflet called Aortic Stenosis for more details.

The main causes include the following:

Rheumatic fever

Rheumatic fever is a condition that sometimes occurs during an infection with a germ (bacterium) called the streptococcus. Your body makes antibodies to the bacterium to clear the infection. However, in some people the antibodies also attack various parts of the body, in particular the heart valves. Inflammation of a valve may develop which can cause permanent damage and lead to thickening and scarring years later.

Abnormal widening of the base of the aorta

If the root of the aorta becomes abnormally wide, the cusps of the valve cannot meet and the valve becomes leaky. The tissue at the base of the aorta can be affected by various conditions such as: Marfan's syndrome, ankylosing spondylitis, rheumatoid arthritis, reactive arthritis, relapsing polychondritis, syphilis.

Other causes:

  • If the leak is small you are not likely to have any symptoms.
  • If the backflow of blood becomes worse the left ventricle has to work harder with each heartbeat to pump the extra blood back into the aorta. The wall of the ventricle may then enlarge and may also become thickened (hypertrophied). Symptoms can then include:
    • Dizziness.
    • Chest pain (angina) when you exert yourself. This occurs because of reduced blood flow to the coronary arteries.
    • Forceful heartbeats which you may feel as the sensation of having a 'thumping heart' (palpitations).
  • If the backflow of blood is severe the left ventricle may not function properly and you can develop heart failure. This causes shortness of breath, tiredness and fluid retention in various tissues of the body.
  • Heart failure may become severe and life-threatening. See separate leaflet called Heart Failure for more details.
  • Infection of the valve (endocarditis) is an uncommon complication. (Abnormal valves are more prone than normal valves to infection.) Unless promptly treated, endocarditis can cause serious illness.

If the backflow of blood is mild and you have no symptoms then you may not need any treatment. If you develop symptoms or complications, various medicines may be advised to ease the symptoms. Surgery may be advised if symptoms become worse.


Medication may be advised to help ease symptoms of heart failure if heart failure develops. For example:

  • 'Water' tablets (diuretics) usually help if you are breathless. They make the kidneys produce more urine. This gets rid of excess blood and fluid which may build up in the lungs or other parts of the body with heart failure.
  • Angiotensin-converting enzyme (ACE) inhibitors are medicines which help to reduce the amount of work the heart does and to ease symptoms of heart failure.


Surgical options include repair of the aortic valve or replacement of the valve. Valve replacement surgery may be with a mechanical or a tissue valve. Mechanical valves are made of materials which are not likely to react with your body, such as titanium. Tissue valves are made from treated animal tissue, such as valves from a pig. If you need surgery, a surgeon will advise on which is the best option for your situation.

Surgical treatment has greatly improved the outlook in most people with more severe regurgitation. The outlook is good if the valve is treated before the heart becomes badly damaged.

Antibiotics to prevent endocarditis

Antibiotics used to be offered to all people with heart valve disease before dental treatment and some surgical procedures to prevent the development of infection of the valve (endocarditis). However, the National Institute for Health and Care Excellence (NICE) issued guidance in 2008 which advised that people at risk of endocarditis only need to take antibiotics if they actually have an infection at the time that dental or surgical procedures are undertaken.

Dental health

Good oral and dental hygiene are also thought to be important in helping to prevent infective endocarditis. In particular, if you have any condition which increases your risk of developing infective endocarditis (see above), you should not let any dental problems such as a dental abscess or gum disease go untreated. These dental conditions increase the chance of germs (bacteria) getting into the bloodstream.

The outcome will depend on the underlying cause and the severity of aortic regurgitation. The outcome is generally poor if there is no treatment but is good with available modern treatments.

Further help & information

Original Author:
Dr Tim Kenny
Current Version:
Peer Reviewer:
Dr Adrian Bonsall
Document ID:
4710 (v43)
Last Checked:
Next Review:
The Information Standard - certified member
See also: Aortic Regurgitation written for professionals
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