The aortic valve is between the heart's left ventricle (lower chamber that pumps blood to the body) and the aorta (the large artery that receives blood from the heart's left ventricle and distributes it to the body). Regurgitation means the valve doesn't close properly, and blood can leak backward through it. This means the left ventricle must pump more blood than normal, and will gradually get bigger because of the extra workload. Aortic regurgitation can range from mild to severe. Some people may have no symptoms for years. But as the condition worsens, symptoms will appear. These can include

• fatigue (especially during times of increased activity)
• shortness of breath
• edema (retention of fluid) in certain parts of the body such as the ankles
• heart arrhythmias (abnormal heartbeats)
• angina pectoris (chest pain or discomfort caused by reduced blood supply to the heart muscle)

What causes aortic regurgitation?

Aortic regurgitation can be caused by several things. It may be due to a bicuspid aortic valve. This is a congenital (existing at birth) deformity of the valve. In it, the valve has two cusps (flaps) rather than the normal three cusps. It can also be found in other kinds of congenital heart disease. Aortic regurgitation can also be caused by infections of the heart, such as rheumatic fever or infective endocarditis. Diseases that can cause the aortic root (the part of the aorta attached to the ventricle) to widen, such as the Marfan syndrome or high blood pressure, are other causes.

What should be done?

Patients with mild aortic regurgitation who have few or no symptoms need to see their physician regularly. As conditions worsen, medications may be used. These drugs can help regulate the heart rhythm, rid the body of fluids to control edema, and/or help the left ventricle pump better.

Serious cases may require surgical treatment. This involves replacing the diseased valve with an artificial one.

People with aortic regurgitation are at increased risk for developing an infection of the heart valve or lining of the heart (endocarditis). In the past, the American Heart Association has recommended that patients with aortic regurgitation take a dose of antibiotics before certain dental or surgical procedures. However, our association no longer recommends antibiotics before dental procedures except for patients at the highest level of risk for bad outcomes from endocarditis, such as

• patients with a prosthetic cardiac valve,
• patients who have had endocarditis before,
• patients with certain kinds of congenital heart disease, or
• heart transplant patients who develop a problem with a heart valve.