Aortic Valve Regurgitation – Diagnosis and Treatment

Diagnosis

Doctors diagnose aortic valve regurgitation by discussing symptoms, reviewing medical history, performing a physical exam, and using various tests.

When people visit the doctor with symptoms like shortness of breath, tiredness, chest pain, or swollen ankles, the doctor asks about their experiences and any family history of heart problems.

A healthcare provider listens to the chest with a stethoscope. If aortic regurgitation exists, the provider might hear a special sound known as a heart murmur.

This is an unusual whooshing or swishing sound caused by blood leaking backward through the aortic valve.

Here is a summary table of main checks for aortic valve regurgitation:

Check	What it Does	What it Helps Find
Physical exam	Listens for murmurs and checks pulse pressure	Hints at valve issues
Blood pressure test	Measures pressure in arteries	Wide pressure can signal regurgitation
Family and symptom history	Looks for patterns, risk factors	Guides next steps

If needed, the doctor often refers the patient to a cardiologist.

Main Tests Used to Diagnose Valve Issues

Doctors use several main tests to confirm aortic valve regurgitation and determine its severity:

• Echocardiogram (Echo):
  • This is the main test and uses sound waves to create images of the heart. It shows how well the aortic valve closes, how blood moves in the heart, and if there are problems in the valve or aorta. It clearly shows how much blood leaks backward.
  • Sometimes, doctors use a special type called a transesophageal echo, which provides a closer look from inside the body.
• Electrocardiogram (ECG or EKG):
  • This test records the heart’s electrical signals using sticky pads placed on the chest, arms, and legs. It reveals heart rhythm problems and changes linked with heart failure or damage from regurgitation.
• Chest X-ray:
  • X-rays show if the heart or aorta is enlarging or if fluid is building up in the lungs due to heart failure.
• Cardiac CT (Computed Tomography):
  • This scan combines X-rays to produce detailed pictures. Doctors use it if they suspect an aortic aneurysm or a tear called an aortic dissection, which can also affect the valve.
• Cardiac MRI (Magnetic Resonance Imaging):
  • This uses strong magnets to create pictures of the heart and aorta and helps track chronic aortic insufficiency or structural changes.
• Exercise and Stress Tests:
  • These tests check how the heart copes with activity and whether symptoms appear or worsen with effort. Doctors use these results to see if the valve leak limits heart function.
• Cardiac Catheterization:
  • Doctors insert a thin tube into a blood vessel and guide it to the heart. Dye makes arteries show up on X-ray images. This test is not always necessary but may be used if other tests are unclear or before surgery to check for blockages.

These tests also help identify related conditions, such as aortic stenosis (narrowing of the valve), bicuspid aortic valve (a valve with two flaps instead of three), damage from rheumatic fever, infections like endocarditis, or other causes like high blood pressure and inherited disorders.

Stages of Valve Problems and Their Meanings

After completing tests and exams, doctors classify aortic regurgitation into stages. Staging considers the amount of blood leaking, changes in the valve, blood flow patterns through the heart and lungs, and the presence of symptoms.

Stages of valve disease:

• Stage 1: At Risk
  • People do not have valve disease yet but have one or more risk factors, such as a family member with valve problems, high blood pressure, rheumatic fever, or a history of infective endocarditis.
• Stage 2: Mild or Moderate Valve Trouble
  • The valve leak is seen on tests, but the person does not have any symptoms. The structure of the valve may be changing, but it has not yet caused damage to blood flow or the heart.
• Stage 3: Bad Leak, No Symptoms
  • The leak is serious, with major backward flow of blood across the valve, but the person still feels normal. The heart may start getting bigger as it works harder, but there are no physical signs of heart failure yet.
• Stage 4: Severe with Symptoms
  • The leak is severe, and the person now shows signs such as tiredness, trouble breathing, or swelling. At this stage, the heart may struggle to keep up with the body’s needs, and heart failure can develop.

Treatment

Medicines and Ongoing Monitoring

Many people with aortic valve regurgitation take medicines to control symptoms and slow down complications. These drugs can:

• Lower blood pressure
• Make the heart work more efficiently
• Help manage swelling or buildup of fluid

Doctors might use several types of medicines, such as:

Medicine Type	Purpose
Diuretics	Reduce swelling
Blood pressure drugs	Lower strain on the heart
Vasodilators	Make it easier for blood to flow

Lifestyle changes, such as exercise, not smoking, and a heart-healthy diet, are also important.

Surgical Interventions and Procedural Approaches

When the condition is more serious or symptoms worsen, doctors may recommend surgery or procedures.

The main goals are to repair or replace the aortic valve. The doctor decides what is best based on symptoms, age, health, and whether another heart surgery is already planned.

Common options include:

• Aortic Valve Repair: Surgeons may fix the valve by separating valve flaps, reshaping or removing extra tissue, or patching up holes. Catheter methods can sometimes be used for leaks in replacement valves.
• Valve Replacement: The surgeon removes the damaged valve and places a new one. Replacements can be mechanical (last longer, but require lifelong blood thinners) or biological (from animal or human tissue, which may need to be replaced over time).

Type of Surgery	Features
Open-heart valve replacement	Requires chest incision, longer recovery
Minimally invasive (TAVR)	Smaller cuts, shorter hospital stay
Ross procedure	Uses patient’s own lung valve to replace the aortic

Doctors may choose minimally invasive procedures when possible to help with faster healing. Some people may need valve surgery at the same time as other heart surgery, like for a blocked artery.

Habits and Home Strategies

Managing Heart Valve Regurgitation During Pregnancy

Pregnancy places extra demands on the heart, so people with aortic valve regurgitation need special care.

If the valve problem is mild or managed well, most can go through pregnancy with doctor guidance. Some might need more frequent monitoring, extra tests, or changes in medications.

Patients should discuss all medicines with a provider, as not all drugs are safe during pregnancy.

For those with a severe heart valve problem, the risks to both parent and baby can be much higher. In these cases, a doctor might advise avoiding pregnancy.

Key tips for managing during pregnancy:

• Schedule regular visits with heart and obstetric care teams.
• Track symptoms and report any shortness of breath, swelling, or chest pain.
• Discuss medications and confirm which are safe during pregnancy.
• Get enough rest and practice good sleep habits.
• Follow a balanced diet and avoid foods high in salt or unhealthy fats.
• Avoid using tobacco or alcohol.

Below is a sample schedule for monitoring during pregnancy:

Trimester	Cardiology Visit	Echocardiogram	Medication Review
First	Yes	Yes	Yes
Second	Yes	Maybe	Yes
Third	Yes (maybe more)	Yes	Yes

Consultation frequency may change based on the severity of symptoms and overall health.

Working with the care team helps create a plan that supports both heart health and a healthy pregnancy. Attending all appointments and maintaining open communication with care providers is important.

If symptoms worsen or new problems occur, contacting the health team right away is critical for safety.

Getting Ready for Your Visit

Steps You Can Take Before the Appointment

• Check for Pre-visit Instructions: When scheduling, ask if there are any steps to follow before you arrive. For example, you might need to skip food or drinks before certain blood tests.

• Record Your Symptoms: Write down any health changes or issues you’ve had, even if they don’t seem directly linked to heart valve problems. Note when they started.

• Review Your Medical Details: List key health facts, such as any heart disease in your family, past illnesses, and any recent major changes in your life.

• List All Medications and Supplements: Include the names and dosages of any medicine, vitamins, or herbal supplements you use.

• Bring Support: Having a friend or family member with you can make it easier to remember the doctor’s advice and instructions.

• Prepare Questions: It’s helpful to have a list ready. Some examples to consider:

  • What might be causing my symptoms?

  • Could something else be responsible for my symptoms?

  • What tests are needed?

  • What treatments are suggested?

  • Are there other treatments I should consider?

  • Will surgery be needed, and which surgeon is best?

  • How do I manage other health issues together?

  • Are there activities or foods to avoid?

  • Should I see another specialist?

Note: Never hesitate to write down any other concerns you may have.

Questions Your Doctor May Ask

The medical team will likely ask many questions about your symptoms and history. Being prepared will help the appointment run more smoothly. Typical questions include:

• When did you first notice your symptoms?
• How often do you experience these symptoms?
• How severe are your symptoms?
• Has anything helped your symptoms get better?
• What seems to make your symptoms worse?
• Do you have a history of heart disease in your family?

If you have this information ready, you can save time and ensure your doctor has everything needed to recommend the right tests and treatments.