Aortic Regurgitation

Aortic regurgitation — a leaking aortic valve — occurs when the valve at the exit of the heart fails to close properly, allowing blood to flow backwards into the heart with every beat. To compensate, the heart pumps a larger volume, and over years this extra workload can gradually enlarge and weaken the heart muscle — often long before symptoms appear.

That is what makes aortic regurgitation deceptive: the heart compensates so well, for so long, that significant damage can accumulate silently. Expert assessment answers the two questions that matter — how severe is the leak, and how is your heart coping — and ensures treatment happens before the heart muscle is harmed, not after.

The aortic valve opens with every heartbeat to let blood flow from the heart to the body, then closes to stop it flowing back. In aortic regurgitation, the valve leaflets no longer seal — so a portion of each heartbeat leaks backwards into the main pumping chamber (the left ventricle).

The heart adapts by enlarging to handle the extra volume. This compensation is effective for years — but it is borrowed time: left too long, the heart muscle stretches beyond recovery, and function may not fully return even after the valve is fixed. The purpose of specialist monitoring is to act before that point.

Aortic regurgitation is graded as mild, moderate or severe on echocardiography. It can also develop acutely — suddenly, due to infection or an aortic tear — which is a medical emergency, quite different from the chronic form this page describes.

Common causes include:

• Bicuspid aortic valve — being born with two valve leaflets instead of three; the most common cause in younger patients, and often associated with enlargement of the aorta itself
• Age-related valve degeneration
• Enlargement of the aortic root — if the aorta widens (due to high blood pressure, genetics or connective tissue conditions), it can pull the valve leaflets apart so they no longer meet
• Previous infection of the valve (endocarditis) or rheumatic fever
• In combination with aortic stenosis — many calcified valves both narrow and leak

Because the aorta itself is involved in many cases, proper assessment of aortic regurgitation always includes imaging of the aorta — not just the valve.

Chronic aortic regurgitation is typically silent for years. When symptoms do develop, they include:

• Breathlessness on exertion — the most common first symptom, progressing to breathlessness on lying flat or at night
• Fatigue and declining exercise capacity
• Palpitations or a forceful, pounding heartbeat — some patients are aware of their heartbeat in bed at night
• Chest discomfort, less commonly

Crucially, the onset of symptoms is a late sign in aortic regurgitation — by the time breathlessness appears, the heart is often already struggling. This is why regular imaging surveillance, rather than waiting for symptoms, is the cornerstone of managing significant regurgitation.

Your first appointment lasts up to 30 minutes and includes:

1. A detailed symptom and exercise capacity assessment — including the subtle changes patients adapt to
2. A review of previous echocardiograms — the trend over time matters as much as any single scan
3. A physical examination — aortic regurgitation produces characteristic findings, including a distinctive murmur and pulse
4. A resting ECG performed in clinic
5. A clear plan — precise grading of the leak, assessment of the heart's size and function, imaging of the aorta, and a monitoring or treatment strategy

• Echocardiogram — the cornerstone test: grading the severity of the leak and, critically, measuring the size and pumping function of the left ventricle, which drive treatment timing
• Cardiac MRI — the gold standard for quantifying the leak precisely and measuring heart volumes when echo findings are borderline or uncertain
• CT or MRI of the aorta — measuring the aortic root and ascending aorta, essential in bicuspid valve disease and whenever the aorta may be enlarged
• Exercise testing — objectively unmasking symptoms and reduced capacity in patients who report feeling well
• Blood tests — including NT-proBNP, a marker of heart strain that supports timing decisions
• Coronary angiography — checking the heart's arteries before any valve intervention, performed by me personally

Most patients complete their assessment within one to two weeks.

Mild and moderate regurgitation requires monitoring rather than intervention — typically echocardiograms every one to three years depending on severity, with good blood pressure control to reduce the load on the valve.

Severe regurgitation is managed with structured surveillance, and valve intervention is recommended when symptoms develop or when imaging shows the heart beginning to enlarge or weaken — even without symptoms. Acting on these imaging thresholds, before irreversible muscle damage, is the central principle of modern valve care.

Valve intervention for aortic regurgitation is most commonly surgical — either valve replacement or, in suitable anatomy, valve repair; if the aorta is enlarged, it can be treated in the same operation. Surgery for aortic regurgitation has excellent outcomes when timed correctly. Transcatheter (TAVI-type) approaches are established for stenosis and are an evolving option in selected regurgitation cases — typically patients at high surgical risk with suitable anatomy; as a TAVI specialist, I can advise whether this applies to you.

Every case is discussed at a specialist Heart Team meeting of cardiologists and cardiac surgeons, and I will explain the reasoning behind your recommendation openly — including why intervention may be advised even though you feel well.

• Aortic valve disease is my subspecialty — Consultant Interventional and Structural Cardiologist with dedicated expertise across the aortic valve, including TAVI
• PhD from King's College London, structural intervention fellowship at San Raffaele Hospital, Milan, and over 100 peer-reviewed publications in valve and coronary disease
• The complete pathway under one consultant — from murmur assessment and precise grading through surveillance, Heart Team discussion and follow-up after intervention
• Rapid access — same-week appointments at Heart Health Welbeck London (Marylebone), Cromwell Hospital (Kensington), The Wellington Hospital (St John's Wood), Bupa Health Care Canary Wharf, The Essex Cardiothoracic Centre (Basildon)
• Consultations in English and Turkish
• Recognised by all major private medical insurers; self-paying patients welcome

A leaking aortic valve harms silently — expert surveillance means acting before the heart is damaged, while outcomes are at their best. Contact my practice team to arrange a consultation at one of my London or Essex locations.

Contact Ms Amelia Garner (PA) on 020 3198 9826 or drozandemir.sec@outlook.com to arrange a consultation.