Medical Treatment of Aortic Regurgitation

Aortic regurgitation has no medical treatment. The only true treatment is surgery.

Medicines are only useful in patients with high arterial pressure and in those operated on with ventricular dysfunction in which it has not improved after surgery. The most useful ones are the so called ACE inhibitors (captopril, enalapril, lisinopril, etc) and AT2 antagonists (losartán, valsartán, telmisartán, etc).

It’s important to state that no effect of these or other pills has been proven to delay surgery.

In patients with Marfan syndrome beta-blockers may slow down the growth of the aorta and reduce the risk of complications; their use is therefore recommended. AT2 antagonists may also offer a clinical benefit but this is not proven yet; they are also commonly prescribed if well tolerated (they reduce the arterial pressure).

Patients with Marfan or similar syndromes and those with aorta diameters close to surgical indication are advised against strenuous physical activity and isometric, contact or competition sports.

Source: Guidelines on the management of valvular heart disease (version 2012) The Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS)

European Heart Journal  doi:10.1093/eurheartj/ehs109

Every normal heart consists of heart muscle and four valves. Two valves are located between forechambers (atria) and pumping chambers (ventricles) as inlet valves, the other two are between ventricles and big arteries (aorta, pulmonary artery) as outlet valves of the pumping chambers. These valves regulate inflow into the heart and outflow into lungs of the body through coordinated opening and closing.

A disease may be caused by an inborn anomaly that gets worse with age. Some heart valve disease may only occur with wear due to increasing age or as a consequence of infections with bacteria.

Signs of heart valve disease may vary. The disease is often unrecognized for many years because the heart compensates the functional disturbance and patient does not experience any symptoms. If symptoms occur, decreased exercise tolerance is the most frequent. This may be felt as shortness of breath on physical exertion, increased fatigue, or simply “getting slower”. Chest pain may occur with some diseases, sometimes swelling of the ankles is noted. 

The valves that are most frequently affected are those of the left heart. The mitral valve is the inlet valve of the left ventricle, and the aortic valve the outlet valve. One can differentiate between two principal functional changes, narrowing during outflow (stenosis) or leak during the closed phase (regurgitation). Sometimes a combination of the 2 disturbances may exist. The exact type of valve dysfunction may be detected by ultrasound (echocardiogram). Once a certain level of functional impairment is reached medication is not sufficient to stabilize the heart, and an operation or intervention is necessary. Without surgery principally the situation will continue to get worse, and ultimately additional damage to the heart muscle will develop that will contribute to heart failure or death.