Medically reviewed by Dr Nabila Laskar, Consultant Cardiologist (GMC 7040901). Aortic regurgitation occurs when the aortic valve does not close completely, allowing blood to leak back from the aorta into the left ventricle with each heartbeat. It is one of the more common valve conditions and, when significant, places a volume overload on the left ventricle that over time can affect its function.
Causes include aortic root dilatation, where the enlargement of the aorta causes the valve leaflets to separate and fail to close properly. This is the most common cause in developed countries and may be associated with high blood pressure, connective tissue disorders such as Marfan syndrome, or a bicuspid aortic valve. Degenerative valve disease, previous rheumatic fever, endocarditis (infection of the valve), and inflammatory conditions such as ankylosing spondylitis can also cause or contribute to regurgitation.
Mild to moderate aortic regurgitation is frequently asymptomatic for many years. As the condition progresses and the left ventricle compensates by enlarging and thickening, breathlessness on exertion, fatigue, palpitations, and reduced exercise tolerance may develop. Classic signs include a wide pulse pressure (a large difference between systolic and diastolic blood pressure) and a collapsing or "water hammer" pulse felt at the wrist.
Echocardiography is the primary tool for both diagnosing aortic regurgitation and grading its severity. It measures the volume and fraction of blood leaking back with each beat, assesses left ventricular dimensions, and tracks any aortic root dilatation. Serial echocardiograms are the mainstay of monitoring, with frequency depending on severity. The timing of any intervention is guided largely by trends in left ventricular size and function and the development of symptoms.
Mild to moderate aortic regurgitation with preserved left ventricular function and no symptoms is managed with regular surveillance echocardiograms. Blood pressure management is important to reduce regurgitant volume. Significant aortic regurgitation that has caused symptoms, or that has led to left ventricular enlargement beyond specific thresholds, is managed surgically with aortic valve replacement or repair, depending on anatomy and underlying cause.
Frequency depends on severity. Mild regurgitation may require echo surveillance every three to five years, moderate regurgitation every one to two years, and severe regurgitation more frequently as clinical and echocardiographic thresholds for intervention are approached.
Yes, it can progress, which is why regular echocardiographic surveillance is important. The rate of progression varies between individuals and underlying causes.
No. Aortic stenosis is narrowing of the valve, restricting outflow. Aortic regurgitation is leaking of the closed valve, allowing backflow. Both are diagnosed by echocardiogram and both may require intervention when significant, but their mechanisms, symptoms, and timing of intervention differ.
Not until specific thresholds are reached. Mild and moderate cases are monitored rather than immediately treated. Intervention is considered when symptoms develop or when left ventricular dimensions or function reach defined echocardiographic thresholds.