When the heart squeezes, the left ventricle (the lower left chamber) contracts, pushing blood out into the aorta, the main artery that takes blood to the body. The aortic valve is located between the left ventricle and the aorta and prevents blood from leaking back in between beats.
Aortic regurgitation or insufficiency occurs when the aortic valve doesn't completely close and allows some blood to leak back into the heart. Aortic regurgitation can be trivial, mild, moderate or severe.
Aortic regurgitation often doesn't cause symptoms in infants or children. As the child gets older, abnormal signs and symptoms may appear, including fatigue, a heart murmur (an extra heart sound when a doctor listens with a stethoscope), or, rarely, chest pain, fainting or arrhythmias.
At CHOP's Cardiac Center, we usually diagnose aortic regurgitation after a primary care doctor detects a heart murmur and refers a child to us. Diagnosis may require some or all of these tests:
- Pulse oximetry: a painless way to monitor the oxygen content of the blood
- Chest X-ray
- Echocardiogram (also called "echo" or cardiac ultrasound): ultrasound waves create an image of the heart and can show the size, shape and movement of the heart's valves and chambers as well as the flow of blood through the heart
- Electrocardiogram (ECG): a record of the electrical activity of the heart
- Exercise stress test
- Cardiac MRI: a three-dimensional image shows the heart's abnormalities
- Cardiac catheterization: a thin tube is inserted into the heart through a vein and/or artery in either the leg or through the umbilicus ("belly button")
If the regurgitation is trivial or mild, treatment isn't usually necessary. Doctors will monitor the patient with regular checkups, and might even prescribe some medications if the regurgitation is moderate or severe. The following options are used to treat more severe cases of aortic regurgitation:
Surgery to repair or replace the aortic valve is often necessary in severe cases. Depending on the age, gender and particular needs of your child, as well as the valve anatomy, surgeons may attempt to repair the valve, or at least improve its function, with a surgery called a valvuloplasty.
Another option to treat aortic regurgitation includes the use of mechanical (artificial) valves as replacement valves. If this is the case, your child may need to stay on blood-thinning medicines for the rest of his or her life to lower the risk of developing blood clots.
Yet another option is the Ross Procedure. In this operation, the aortic valve is replaced with the patient's pulmonary valve. The pulmonary valve is then replaced with one from a donated organ. This procedure allows the patient's own pulmonary valve (now in the aortic position) to grow with the child and blood thinners are not required.
Because of enormous strides in medicine and technology, today most children with heart conditions go on to lead healthy, productive lives as adults. Aortic regurgitation can cause health problems in adults, though, so people with this condition will need to be monitored by a cardiologist regularly for the rest of their lives.
Through 18 years
Children with aortic regurgitation require regular checkups with a pediatric cardiologist. Some children must remain on medicine and limit physical activity. Our pediatric cardiologists follow patients until they are young adults and coordinate care with the primary care physicians.
Aortic regurgitation can cause health problems in adults. It is very important that adults with this condition are monitored by a cardiologist regularly for the rest of their lives. The Cardiac Center will help with the transition to an adult cardiologist.
The Philadelphia Adult Congenital Heart Center, a joint program of The Children's Hospital of Philadelphia and Penn Medicine, meets the unique needs of adults who were born with heart defects.