Heart Valve Regurgitation

Many people first hear the term regurgitation from an echocardiography report, for example one that says mild mitral regurgitation or trivial tricuspid regurgitation. Regurgitation means a valve does not close tightly, so some blood flows back into the previous chamber of the heart. Other terms often used are insufficiency or a leaky valve. The types of leakage in each valve and how they happen are covered on the Valve Regurgitation / Insufficiency page.

Understanding the Degree of Leakage

Doctors assess the leak using several measurements at once, such as the width and direction of the backward jet, the volume of blood that leaks, and the size of the heart chambers. The results are grouped as trivial (very mild), mild, moderate, and severe. Trivial to mild leakage in the tricuspid and pulmonary valves is often found in healthy people and is considered normal (physiological). The Framingham study found small leaks like these in many adults without heart disease.

What Determines the Next Step

A single word describing the degree is not enough. Your doctor also looks at which valve is leaking, its cause, whether the ventricle or atrium is starting to enlarge, the strength of the heart's pumping, the pressure in the lung blood vessels, and your symptoms. This is why two people with the same degree of leakage may need different plans. For example, a moderate leak that has been stable for years means something different from a moderate leak with a left ventricle that keeps enlarging.

Monitoring and Timing of Treatment

The 2020 ACC/AHA guidelines suggest echocardiography intervals according to the degree: roughly every 3 to 5 years for mild leakage, every 1 to 2 years for moderate leakage, and every 6 to 12 months for severe leakage without symptoms. The goal is to find the right time for valve repair or replacement, before the ventricle becomes permanently damaged. If new symptoms appear, you do not need to wait for your scheduled checkup.

Living with a Leaky Valve

Most people with mild to moderate leakage can go about their activities, work, and exercise as usual. The things to look after are well-controlled blood pressure, clean teeth and mouth, and a planned pregnancy. Keep your old echocardiography reports, because changes over time help your doctor assess how the leak is progressing.

An echocardiography report usually lists the name of the valve and the degree of leakage. To confirm the degree, the doctor does not rely on a single measurement but combines several measurements, following the 2017 recommendations of the American Society of Echocardiography. The size and strength of the left ventricle and the lung pressure are also recorded, because both determine the timing of treatment.

If the result is on the border between moderate and severe, or the images are unclear, the doctor may add echocardiography through the esophagus or a cardiac MRI. Stress echocardiography helps if you feel short of breath but the leak at rest does not appear severe. Bring your previous test reports to every checkup, because changes over time are often more meaningful than a single result.

Discuss your echocardiography results with a cardiologist, especially if they state moderate or severe leakage, or if you do not yet know when your next checkup should be. Trivial or mild leakage without symptoms is usually nothing to worry about, but still ask whether a repeat test is needed. Go to the emergency room right away if severe shortness of breath comes on suddenly or you faint.

• Your echocardiography report mentions moderate or severe leakage
• Shortness of breath or tiring quickly during activities that used to feel easy
• Palpitations with an irregular rhythm
• Leg swelling or rapid weight gain
• You are past the checkup date your doctor recommended