What is aortic regurgitation?
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, also known as aortic valve regurgitation or aortic valve 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 symptoms
Aortic valve regurgitation often doesn't cause symptoms in infants or children. As the child grows, however, abnormal signs and symptoms may appear, including fatigue or a heart murmur (an extra heart sound when a doctor listens to the child’s heart with a stethoscope). In rare cases, a leaky aortic valve may cause chest pain, fainting or arrhythmias.
Testing and diagnosis for aortic regurgitation
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")
Treatments for aortic regurgitation
In cases of trivial or mild aortic regurgitation, treatment isn't usually necessary. Doctors will monitor the patient with regular checkups and may prescribe some medications if the regurgitation is moderate or severe. The following options are used to treat more severe cases of aortic regurgitation:
Repairing or replacing the leaky aortic valve is often necessary in severe cases. Depending on your child’s age, needs and valve anatomy, physicians may attempt to repair the valve or improve its function with a procedure called a valvuloplasty.
Artificial valve surgery
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 their life to lower the risk of developing blood clots.
A third option is the Ross Procedure, an operation in which 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.
Outlook for aortic regurgitation
Due to the enormous strides in medicine and technology in recent years, most children with heart conditions today go on to lead healthy, productive lives as adults.
Aortic valve 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 medication and limit physical activity. At Children’s Hospital of Philadelphia (CHOP), our pediatric cardiologists follow patients until they are young adults and coordinate care with 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. CHOP’s Cardiac Center can help with the transition to an adult cardiologist.
The Philadelphia Adult Congenital Heart Center, a joint program of CHOP and Penn Medicine, meets the unique needs of adults who were born with heart defects.
Reviewed by Shobha S. Natarajan, MD