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Treatments and drugs
By Mayo Clinic staffTreatment of aortic valve regurgitation depends on how severe your regurgitation is, your signs and symptoms, and whether the regurgitation is affecting your heart function. If you have aortic valve regurgitation, your doctor will evaluate your heart with regular echocardiograms to determine whether damage to your heart is getting worse.
Observation
Some people, especially those with mild regurgitation, don't need treatment. However, even if you don't have signs and symptoms of aortic valve regurgitation, schedule regular evaluations with your doctor. Observation isn't the same as ignoring the condition. Actively observing the stability or the progression of the condition is important so that you can receive the right treatment at the right time.
Medications
Medication can't eliminate aortic valve regurgitation. However, your doctor may prescribe certain medications to reduce the severity of aortic valve regurgitation, control blood pressure, and try to prevent or treat fluid buildup.
Surgery
Once signs and symptoms of aortic valve regurgitation develop, you'll usually need surgery. However, if aortic valve regurgitation is weakening your heart, you may need surgery even if you feel well. While the heart is generally good at counteracting problems caused by a leaky aortic valve, the problem is that if the valve isn't fixed or replaced in time, the strength of your heart may decline so much that it's permanently weakened. You can avoid that by having surgery at the appropriate time.
The overall function of your heart and the amount of regurgitation help to determine when surgery is necessary. Surgical procedures include:
- Valve repair. Aortic valve repair is surgery to preserve the valve and to improve its function. Occasionally, surgeons can modify the original valve (valvuloplasty) to eliminate backward blood flow. You don't need long-term medications to prevent blood clots (anticoagulation therapy) after a valvuloplasty.
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Valve replacement. In many cases, the aortic valve has to be replaced to correct aortic valve regurgitation. Your surgeon removes your aortic valve and replaces it with a mechanical valve or a tissue valve. Mechanical valves, made from metal, are durable, but they carry the risk of blood clots forming on or near the valve. If you receive a mechanical aortic valve, you'll need to take an anticoagulant medication, such as warfarin (Coumadin), for life to prevent blood clots. Tissue valves — which may come from a pig, cow or human cadaver donor — often need to be replaced. Another type of tissue valve replacement that uses your own pulmonary valve (autograft) is sometimes possible.
Traditionally, aortic valve replacement has been performed with open-heart surgery. A less invasive approach — transcatheter aortic valve implantation — delivers the new valve through a catheter via the femoral artery in your leg (transfemoral) or the left ventricular apex of your heart (transapical). For now, this procedure is usually limited to individuals who have a narrowed aortic valve (aortic stenosis) rather than aortic regurgitation and are considered at high-risk for surgical complications. In the future, however, transcatheter aortic valve implantation may be an option for treatment of aortic regurgitation.
Aortic valve regurgitation can be eliminated with surgery, and you can usually resume normal activities within a few months. The prognosis following surgery is generally good.
- Aortic regurgitation. American Heart Association. http://www.americanheart.org/print_presenter.jhtml?identifier=4448. Accessed June 20, 2011.
- Rakel RE, et al. Valvular heart disease. In: Rakel RE. Textbook of Family Medicine. 8th ed. Philadelphia, Pa.: Saunders Elsevier. 2011. http://www.mdconsult.com/books/page.do?eid=4-u1.0-B978-1-4377-1160-8..10027-2--s0310&isbn=978-1-4377-1160-8&uniqId=258746827-3. Accessed June 12, 2011.
- O'Gara P, et al. Valvular heart disease. In: Fauci AS, et al. Harrison's Online. 17th ed. New York, N.Y.: The McGraw-Hill Companies. 2008. http://www.accessmedicine.com/content.aspx?aID=2902425&searchStr=aortic+valve+insufficiency. Accessed June 18, 2011.
- Bashore TM, et al. Heart disease. In: McPhee SJ, et al. Current Medical Diagnosis & Treatment. 50th ed. New York, N.Y.: The McGraw-Hill Companies. 2011. http://www.accessmedicine.com/content.aspx?aID=3896&searchStr=aortic+valve+insufficiency. Accessed June 18, 2011.
- Congestive heart failure. American Heart Association. http://www.americanheart.org/presenter.jhtml?identifier=4585. Accessed June 20, 2011.
- How the healthy heart works. American Heart Association. http://www.heart.org/HEARTORG/Conditions/CongenitalHeartDefects/AboutCongenitalHeartDefects/How-the-Healthy-Heart-Works_UCM_307016_Article.jsp. Accessed June 12, 2011.
- Gaasch WH. Pathophysiology and clinical features of chronic aortic regurgitation in adults. http://www.uptodate.com/home/index.html. Accessed June 20, 2011.
- Gaasch WH. Course and management of chronic aortic regurgitation in adults. http://www.uptodate.com/home/index.html. Accessed June 20, 2011.
- Your guide to a healthy heart. National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health/public/heart/other/your_guide/healthyheart.pdf. Accessed June 21, 2011.
- Otto CM. Acute aortic regurgitation in adults. http://www.uptodate.com/home/index.html. Accessed June 20, 2011.
- Khawaja MZ, et al. Transcatheter aortic valve implantation for stenosed and regurgitant aortic valve bioprostheses. Journal of the American College of Cardiology. 2010;55:97.
- Grogan M (expert opinion). Mayo Clinic, Rochester, Minn. July 6, 2011.
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