Aortic valve insufficiency is a form of valvular heart disease. It occurs when the aortic valve does not function properly. This may cause the heart to work harder and can lead to heart failure.

Aortic valve insufficiency, which healthcare professionals also call aortic regurgitation, is a type of heart valve disease. It occurs when the aortic valve does not close efficiently. This causes blood to leak backward into the left ventricle, which is one of the chambers in the heart.

In the United States, aortic valve insufficiency affects 4.9–10% of people. The chance of developing aortic valve insufficiency increases with age. About 2% of people over age 70 have this condition.

This article explores what aortic valve insufficiency is, as well as its symptoms, causes, diagnosis, treatments, and outlook.

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The aortic valve is one of the four valves in the heart. It regulates the flow of blood from the left ventricle into the aorta, which is the main artery in the body that distributes oxygenated blood from the heart to the rest of the body.

The valve opens to let blood from the left ventricle move into the aorta. It closes so blood does not flow back in the wrong direction.

However, in aortic valve insufficiency, the valve does not close properly. This allows blood to flow back into the left ventricle. The heart then needs to work harder due to the blood leak. Over time, the ventricle walls may thicken and pump less efficiently.

Aortic valve insufficiency may develop slowly over decades or occur suddenly. It may also range from mild to severe.

Some people with mild aortic valve insufficiency may have few, if any, symptoms. Some may not experience symptoms for a long time.

When symptoms do develop, they may include:

Aortic valve insufficiency has several possible causes. It may occur due to a congenital heart abnormality, which is a heart problem a person has from birth. Various other factors can also damage the valve and lead to aortic valve insufficiency, including:

  • endocarditis
  • aorta abnormalities
  • untreated syphilis
  • blunt chest trauma
  • complications after surgical procedures

Anyone can develop aortic valve insufficiency, but certain risk factors may weaken the valve and increase the risk. Risk factors include:

A person can speak with a healthcare professional about their individual risk factors for developing aortic valve insufficiency.

Typically, a healthcare professional performs a physical exam to diagnose aortic valve insufficiency. This may include:

  • medical history review
  • symptom review
  • use of a stethoscope to listen to a person’s heart sounds

Healthcare professionals may use some of the following diagnostic tests to confirm aortic valve insufficiency:

  • ECG: This test measures the electrical activity of the heart. It can detect an abnormal heart rate.
  • Echocardiogram: This test uses sound waves to create images of the heart in motion. Doctors use it to view the aorta and the aortic valve.
  • Transesophageal echocardiogram (TEE): This is an optional way to perform an echocardiogram. It involves inserting a small transducer attached to a tube through the mouth into the esophagus (food pipe). The transducer produces the sound waves to create the images. Because the esophagus is close to the upper heart chambers, a TEE creates clear images of the heart valves.
  • Stress tests: These tests involve monitoring the heart while a person exercises. This helps doctors determine whether a person has symptoms of aortic valve insufficiency during physical activity.
  • Other imaging tests: These may include MRI and CT scans.

Treatment may depend on the severity of symptoms and whether the condition occurred suddenly or over time.

For mild aortic valve insufficiency that does not have symptoms, doctors may recommend monitoring every 12–24 months.

Depending on the severity of symptoms, doctors may recommend additional treatments such as medications and surgery.


Healthcare professionals may recommend treating high blood pressure with medications such as diuretics, beta-blockers, and ACE inhibitors.

They may also suggest medications to reduce blood clotting and stroke risk, such as anticoagulants.


Symptomatic severe aortic valve insufficiency usually requires surgery. The exact indications on when to perform surgery may vary. But 2020 guidelines from the American Heart Association indicate that outcomes are best when doctors perform surgery before left ventricle ejection fraction (LVEF) decreases to less than 55%.

LVEF is a measurement of how much blood the left ventricle of the heart pumps out with each contraction.

Different surgical options are available to replace or repair the aortic valve. In some cases, a surgeon may be able to repair the valve. But in other cases, the damage may be too severe, and a person will need valve replacement surgery.

In many cases, valve replacement involves open heart surgery. However, another potential option is transcatheter aortic valve implantation, which involves a doctor inserting a catheter into the groin to reach the heart instead of performing open heart surgery.

Learn more about what surgical options are available to replace a heart valve.

The outlook for aortic valve insufficiency typically depends on whether a person has symptoms. People who are asymptomatic often have a favorable outlook unless their condition progresses quickly.

Complications, such as a decrease in LVEF, are one factor that can affect outlook. People with aortic valve insufficiency may experience a decrease in LVEF, which increases the likelihood of complications and worsening symptoms.

Once someone with aortic valve insufficiency has symptoms, complications may include pulmonary edema and congestive heart failure. At this stage, without surgery to repair the valve, the 4-year survival rate is about 30%.

However, surgery to repair or replace the valve often improves the survival rate. Research suggests that even in people who have symptoms and an LVEF of 35% or less, valve replacement surgery can improve survival rates.

Aortic valve insufficiency is a form of valvular heart disease. It develops when the aortic valve does not close tightly, causing blood to flow back into the left ventricle. It may develop due to a heart infection, an injury, or damage to the aortic valve from a heart condition present at birth.

Some people with mild aortic valve insufficiency do not have many symptoms. When symptoms occur, they may include shortness of breath, chest pain, and fatigue. Treatment may include medications to manage high blood pressure and blood clots and surgical repair or replacement of the aortic valve.

A person should speak with a healthcare professional to learn more about their risk of developing aortic valve insufficiency and which treatments may be best for their situation.