Aortic Valve Regurgitation: Leaky Valve Symptoms, Causes & Treatment

Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026

Quick Answer: What Is Aortic Valve Regurgitation?

Aortic valve regurgitation is a heart valve disease in which the aortic valve does not close tightly, so blood leaks backward into the left ventricle, leaving you tired and short of breath [1]. It can develop suddenly or over many years, often without symptoms [1]. Over time the heart weakens, and severe cases often need surgery to repair or replace the valve [1].

What the research says

• "Silent" aortic regurgitation is not as harmless as once thought. A 2026 meta-analysis of 27 studies (4,720 patients with asymptomatic moderate or severe regurgitation, average follow-up 3.9 years) found a death rate of 1.75 per 100 person-years — more than double that of the general population — and earlier valve replacement or repair was associated with lower mortality (pooled hazard ratio 0.33, 95% CI 0.30–0.37). The authors caution that study quality and heterogeneity limit interpretation. (Naser et al., Heart, 2026) [3]

• For people too high-risk for surgery, purpose-built TAVR valves did better than off-label ones. A meta-analysis of 34 studies (2,162 patients with pure native aortic regurgitation) found 30-day mortality of 3% with dedicated devices versus 9% with off-label devices, device success of 93% versus 82%, and 1-year mortality of 6% versus 24%. (Samimi et al., JACC Cardiovasc Interv, 2025) [4]

Aortic Valve Regurgitation at a Glance

Feature	Summary
Definition	A heart valve disease in which the aortic valve doesn't close tightly, letting blood leak backward into the left ventricle [1]
Speed of onset	Over many years (most common) or suddenly (usually from valve infection) [1]
Key symptoms	Shortness of breath, fatigue, irregular heartbeat, fainting, chest pain, palpitations, swollen ankles and feet [1]
Main causes	Bicuspid valve at birth, aortic stenosis, endocarditis, rheumatic fever, Marfan syndrome/lupus, aorta tear or chest injury [1]
Risk factors	Older age, congenital heart defects, heart infections, inherited conditions, other valve disease, high blood pressure [1]
Complications	Fainting, heart failure, endocarditis, arrhythmias, death [1]
Staging	Stage A (at risk) → B (progressive) → C (severe, no symptoms) → D (severe with symptoms) [2]
Treatment	Checkups and echocardiograms, medicines, valve repair or replacement (mechanical/biological/TAVR/Ross) [2]
Lifestyle care	Heart-healthy diet, weight, ~30 min daily exercise, no tobacco, blood pressure and cholesterol control, diabetes management, 7–9 hours of sleep [2]

What Is Aortic Valve Regurgitation?

Aortic valve regurgitation — also called aortic regurgitation — is a type of heart valve disease. The valve between the heart's lower left chamber and the body's main artery doesn't close tightly. As a result, some of the blood pumped out of the heart's main pumping chamber, the left ventricle, leaks backward [1].

Here is how the heart's plumbing normally works: a typical heart has two upper chambers (the right and left atria) that receive incoming blood and two lower, more muscular chambers (the right and left ventricles) that pump blood out. The four heart valves act as gates at the chamber openings, keeping blood flowing in the right direction. Each valve has flaps — also called cusps or leaflets — that open and close once during each heartbeat.

The aortic valve sits between the left ventricle and the aorta — the body's main artery. In regurgitation, that valve doesn't close properly, and the leaked blood has a compounding effect:

• The left ventricle holds more blood than it should.

• The chamber gets larger and thickens to handle the extra volume [1].

• At first, this is helpful — the larger left ventricle maintains good blood flow with more force.

• Over time, however, the heart becomes weak — and the leakage can prevent the heart from doing a good enough job of pumping blood to the rest of the body [1].

What are the seven warning signs of aortic valve regurgitation?

Most often, aortic valve regurgitation develops over time — and you may have no symptoms for years. Some people don't even realize they have the condition. But sometimes it happens suddenly, usually caused by an infection of the valve [1].

As the regurgitation becomes worse, symptoms may include:

• Shortness of breath with exercise or when lying down [1]

• Tiredness and weakness, especially when being more active than usual [1]

• Irregular heartbeat

• Lightheaded feeling or fainting

• Chest pain, discomfort, or tightness — often getting worse during exercise [1]

• Palpitations — feelings of a rapid, fluttering heartbeat [1]

• Swollen ankles and feet

When to See a Doctor

Call a member of your healthcare team right away if you have symptoms of aortic valve regurgitation [1].

Watch for heart failure, too — a condition in which the heart can't pump blood as well as it should. The first symptoms of aortic valve regurgitation are sometimes related to heart failure [1]. Make an appointment if you have:

• Fatigue that doesn't get better with rest

• Shortness of breath

• Swollen ankles and feet

What causes aortic valve regurgitation?

Any condition that damages the aortic valve can cause aortic valve regurgitation [1]. The main causes include:

Cause	How It Damages the Valve
Heart valve disease present at birth	Some people are born with an aortic valve that has only two cusps (or connected cusps) instead of the typical three — a bicuspid valve. Rare variants include a unicuspid valve (one cusp) and a quadricuspid valve (four cusps). Having a parent or sibling with a bicuspid valve raises your risk — but it can occur with no family history [1]
Aortic stenosis	Calcium deposits build up on the aortic valve as you age, stiffening and narrowing it. The narrowing prevents the valve from opening properly — and can also prevent it from closing properly, causing leaks [1]
Endocarditis	Inflammation of the inner lining of the heart's chambers and valves, usually caused by an infection. A life-threatening condition that can damage the aortic valve (and the usual culprit behind sudden regurgitation) [1]
Rheumatic fever	Once a common childhood illness in the United States, caused by strep throat. It can make the aortic valve stiff and narrow — and in turn cause blood to leak. A heart valve problem from rheumatic fever is called rheumatic heart disease [1]
Other health conditions	Rare conditions that make the aorta bigger and damage the valve, including Marfan syndrome (a connective tissue disease present at birth) and immune system conditions such as lupus
Tear or injury of the aorta	A traumatic chest injury can damage the aorta and cause regurgitation — and so can an aortic dissection (a tear in the aorta's inner layer) [1]

For deeper reading on related conditions, see our guides on aortic valve disease and aortic dissection.

Six Risk Factors

• Older age

• Congenital heart defects (heart conditions present at birth)

• History of infections that can affect the heart

• Inherited conditions that can affect the heart, such as Marfan syndrome [1]

• Other types of heart valve disease, such as aortic valve stenosis [1]

• High blood pressure

One important caveat: aortic valve regurgitation can also happen without any known risk factors.

What are the complications of aortic valve regurgitation?

Aortic valve regurgitation can lead to fainting or lightheadedness, heart failure, heart infections such as endocarditis, arrhythmias and death [1].

• Fainting or feeling lightheaded

• Heart failure

• Heart infections, such as endocarditis

• Arrhythmias (heart rhythm conditions)

• Death

How is aortic valve regurgitation diagnosed?

Diagnosis starts with a physical exam: your healthcare team member asks about your symptoms, health history, and family health history. Your blood pressure is checked with a cuff (usually on the arm), and a stethoscope listens to your heart. A whooshing or swishing sound called a heart murmur may be heard — a sound made by rapid, choppy blood flow through the heart [2]. You may then be referred to a cardiologist, a doctor trained in heart diseases [2].

Seven Diagnostic Tests

Test	What It Shows
Echocardiogram	Sound waves make pictures of the beating heart and show how blood flows through the heart and valves, including the aortic valve and aorta; helps tell how severe the regurgitation is. A transesophageal echocardiogram creates pictures from inside the body for a detailed look when a standard test isn't enough [2]
Electrocardiogram (ECG or EKG)	Records the heart's electrical signals and shows how fast or slowly the heart is beating; sensor patches go on the chest and sometimes the arms and legs [2]
Chest X-ray	Can show if the heart or aorta is enlarged and helps check the condition of the lungs [2]
CT scan of the heart (cardiac CT)	A series of X-rays makes a detailed image of the heart; can also help confirm a tear in the aorta [2]
Exercise or stress tests	Walking on a treadmill or riding a bike while the heart is checked; shows how the heart reacts to activity and whether symptoms occur during exercise; medicine can mimic exercise for those who can't [2]
Cardiac MRI	Magnetic fields and radio waves make detailed pictures of the heart, including the aorta and aortic valve [2]
Cardiac catheterization	Not always used; done when other tests can't diagnose the condition or determine severity, or before valve replacement surgery to check for blocked blood vessels. A long, thin catheter is placed in a blood vessel (usually groin or wrist), guided to the heart, and dye is released to make the arteries visible on X-ray images and video [2]

The Four Stages of Valve Disease

After testing confirms the diagnosis, your team may assign a stage to help determine the most appropriate treatment. Staging depends on symptoms, disease severity, valve structure, and blood flow through the heart and lungs.

Stage	Name	What It Means
A	At risk	Risk factors for heart valve disease are present [2]
B	Progressive	Valve disease is mild or moderate; no symptoms [2]
C	Asymptomatic severe	Valve disease is severe but still no symptoms [2]
D	Symptomatic severe	Valve disease is severe and causing symptoms [2]

What are the treatment options for aortic valve regurgitation?

Treatment depends on how serious the condition is, the symptoms (if any), and whether the condition is getting worse. The goals are to ease symptoms and prevent complications [2].

If symptoms are mild or absent, you may only need regular health checkups — including regular echocardiograms to monitor the aortic valve's health — plus heart-healthy lifestyle changes. Note that surgery may be needed even if the regurgitation isn't severe or when there are no symptoms [2]. The repair-or-replace decision depends on your symptoms, age and overall health, and whether you need surgery for another heart condition (the aortic valve can be operated on at the same time) [2].

Medications

Medicines may be given to:

• Treat symptoms

• Lower the risk of complications

• Lower blood pressure

Aortic Valve Repair

Surgeons may repair the valve by:

• Separating valve flaps (cusps) that have connected [2]

• Reshaping or removing excess valve tissue so the cusps can close tightly [2]

• Patching holes in a valve [2]

• Using a catheter treatment to place a plug or device in a leaking replacement valve [2]

Aortic Valve Replacement

The surgeon removes the damaged valve and replaces it with one of two types:

Valve Type	What to Know
Mechanical valve	Man-made; people with mechanical valves need blood thinners for life to prevent blood clots [2]
Biological tissue valve	Made from cow, pig, or human heart tissue; tissue valves break down over time and may someday need to be replaced [2]

Surgical approaches include:

• Open-heart surgery — a cut (incision) in the chest.

• Minimally invasive heart surgery — smaller cuts; sometimes surgeons can place a tissue valve inside a damaged valve through a procedure called TAVR (transcatheter aortic valve replacement), also known as TAVI (transcatheter aortic valve implantation). TAVR uses smaller incisions than open-heart surgery [2].

• The Ross procedure — a more complicated surgery in which the aortic valve is replaced with your own lung valve (pulmonary valve), and the pulmonary valve is replaced with a biological tissue valve from a deceased donor [2].

Ask your healthcare team about the benefits and risks of each valve type to choose the best option for you.

Pregnancy and Aortic Valve Regurgitation

Careful, regular checkups are needed for those with heart valve disease — including aortic valve regurgitation — during pregnancy [2]. Discuss plans and medicine safety with your healthcare team before becoming pregnant.

Which heart-healthy habits help with aortic valve regurgitation?

An important honesty note first: lifestyle changes can't prevent or treat the condition itself [2] — but your healthcare team will likely recommend these heart-healthy habits:

1. Eat a heart-healthy diet. Enjoy fruits and vegetables, low-fat or fat-free dairy, poultry, fish, and whole grains. Stay away from saturated and trans fats, and excess salt and sugar.

2. Stay at a healthy weight. If you're overweight or have obesity, your team may recommend losing weight — ask what goal weight is healthy for you.

3. Get regular exercise. Aim for about 30 minutes of physical activity (such as brisk walks) daily [2]. Ask your team before starting exercise, especially competitive sports.

4. Don't smoke or use tobacco. If you smoke, quit — ask your team about quitting resources; a support group may help.

5. Control high blood pressure. Uncontrolled high blood pressure raises the risk of serious health problems. Get checked at least every two years from age 18 — more often if you have heart disease risk factors or are over 40 [2].

6. Get a cholesterol test. The American Heart Association recommends testing between ages 9 and 11, again between 17 and 21, and then at least every 4 to 6 years — earlier or more often for some people [2].

7. Manage diabetes. Tight blood sugar control helps keep the heart healthy.

8. Practice good sleep habits. Poor sleep may raise heart disease risk. Adults should aim for 7 to 9 hours of sleep daily [2] and consistent bed and wake times — talk with your team if sleep is a problem.

How can aortic valve regurgitation be detected early through screening?

If you have any type of heart disease, get regular health checkups to help prevent complications.

One family tip that matters: if you have a parent, child, or sibling with a bicuspid aortic valve, you should have an imaging test called an echocardiogram to check for a bicuspid valve or valve regurgitation [1]. Finding heart valve disease as early as possible may make it easier to treat [1].

Also take steps to prevent conditions that raise risk:

• Get a health checkup if you have a severe sore throat. Untreated strep throat can lead to rheumatic fever; strep throat is treated with antibiotics [1].

• Check your blood pressure regularly — at least every two years starting at age 18, with more-frequent checks for some people [1].

Frequently Asked Questions

What is aortic valve regurgitation?

Aortic valve regurgitation (aortic regurgitation) is a heart valve disease in which the aortic valve doesn't close tightly. Each heartbeat pumps blood out of the left ventricle into the aorta — and some of it leaks backward into the ventricle, making the heart less efficient and often causing tiredness and shortness of breath.

Can you have aortic valve regurgitation without symptoms?

Yes — most often the condition develops over years without any symptoms, and many people don't realize they have it. Symptoms such as shortness of breath, fatigue, and swollen ankles tend to appear as the leak worsens. Sometimes it appears suddenly, usually from a valve infection.

What causes a leaky aortic valve?

Any condition that damages the valve can cause it: a bicuspid valve present at birth (two flaps instead of three), aortic stenosis from age-related calcium buildup, endocarditis (a valve infection), rheumatic fever from strep throat, conditions like Marfan syndrome or lupus that enlarge the aorta, and aorta tears or chest injuries.

Is aortic valve regurgitation serious?

Aortic valve regurgitation can be — the leaked blood makes the left ventricle larger and thicker, and while that initially helps the heart pump harder, over time the heart becomes weak. Untreated complications include heart failure, arrhythmias, fainting, heart infections, and even death. That is why regular checkups and echocardiograms matter, even without symptoms.

How is aortic valve regurgitation diagnosed?

A physical exam may reveal a heart murmur — a whooshing sound from rapid, choppy blood flow. Confirmation comes from tests such as the echocardiogram (the key test for severity), ECG, chest X-ray, cardiac CT, exercise/stress tests, cardiac MRI, and cardiac catheterization. Disease is then staged from Stage A (at risk) to Stage D (severe with symptoms).

When does a leaky aortic valve need surgery?

Surgery to repair or replace the valve is often needed once the condition becomes severe — and may be recommended even without symptoms. The decision depends on your symptoms, age, overall health, and whether you need other heart surgery. Repair options include separating fused cusps, reshaping tissue, and patching holes; replacement options include mechanical and biological valves, TAVR/TAVI, and the Ross procedure.

What is the difference between mechanical and biological valve replacements?

A mechanical valve is man-made and lasts longer, but requires blood thinners for life to prevent clots. A biological (tissue) valve is made from cow, pig, or human tissue and doesn't need lifelong blood thinners, but wears out over time and may need replacement someday. Your team will weigh the benefits and risks of each.

What are the symptoms of a leaky aortic valve?

Symptoms often appear slowly and can include shortness of breath with activity or when lying flat, tiredness, a pounding heartbeat, chest discomfort and swollen ankles. Sudden severe shortness of breath or chest pain needs emergency care, so call 911.

Can aortic valve regurgitation be treated with medicine?

Medicines such as blood pressure drugs can ease strain on the heart and help symptoms, but they cannot fix the leaking valve. Severe leaks usually need valve repair or replacement.

How often do I need an echocardiogram for aortic regurgitation?

It depends on how severe the leak is. Mild leaks may only need a check every few years, while moderate or severe leaks need more frequent imaging. Your cardiologist will set the schedule.

Conclusion

The main lessons from this guide are:

• Aortic valve regurgitation is a slow leak: the aortic valve fails to close tightly, and backward-flowing blood gradually enlarges and thickens the left ventricle — helpful at first, but eventually weakening the heart.

• Silence is the signature: most people have no symptoms for years, which makes regular checkups — especially echocardiograms for those with a family bicuspid valve — essential. The warning signs (shortness of breath, fatigue, swollen ankles, chest pain, palpitations) deserve immediate attention.

• Treatment options are real and effective: from watchful monitoring and medicines to valve repair and replacement, including minimally invasive TAVR. Severe cases often need surgery — and getting there early makes it easier to treat.

We hope this complete guide has given you a clear understanding of aortic valve regurgitation — how the leak develops, why it weakens the heart over time, and the full range of treatments available. Since regurgitation is one of the two main forms of aortic valve disease, our aortic valve disease guide explains the broader picture, and our aortic dissection guide covers one of its rarer causes.

Disclaimer: This article is for informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. If you are experiencing a medical emergency — including sudden chest pain or fainting — call 911 or your local emergency number immediately.

Related Reading

Aortic Stenosis: Narrowed Heart Valve Symptoms, Causes & Treatment explains narrowing of the aortic valve and how it is treated.

Echocardiogram: Types, What to Expect, Results and Risks describes the heart ultrasound used to measure a leaky valve.

Aortic Valve Replacement: What It Is, Who Needs It and How Recovery Works covers aortic valve replacement types, recovery and risks.

Endocarditis: Symptoms, Causes, Types, Diagnosis, Treatment and When to Seek Emergency Care — What You Need to Know explains heart valve infection, a cause of sudden valve leaks.

References

1. Mayo Clinic. Aortic valve regurgitation — Symptoms & causes. Accessed October 12, 2026. https://www.mayoclinic.org/diseases-conditions/aortic-valve-regurgitation/symptoms-causes/syc-20353129

2. Mayo Clinic. Aortic valve regurgitation — Diagnosis & treatment. Accessed October 12, 2026. https://www.mayoclinic.org/diseases-conditions/aortic-valve-regurgitation/diagnosis-treatment/drc-20353135

3. Naser JA, Massad F, Al-Abcha A, et al. Natural history of asymptomatic moderate or severe aortic regurgitation: a systematic review and meta-analysis. Heart. 2026;112(12):646-657. PMID 41249036. https://doi.org/10.1136/heartjnl-2025-326643

4. Samimi S, Hatab T, Kharsa C, et al. Meta-analysis of dedicated vs off-label transcatheter devices for native aortic regurgitation. JACC Cardiovasc Interv. 2025;18(1):44-57. PMID 39570231. https://doi.org/10.1016/j.jcin.2024.08.042