Leaky valve can’t improve on its own

Dear Dr. Roach: I’ve had a leaky aortic valve for approximately six years. I recently had an echocardiogram using Doppler. The last test I received was three years ago, which came back with a reading of mild-tomoderate aortic regurgitation. It initially started out as mild, then increased to mild-to-moderate in 2019. My test results for 2022 came back as a mild decrease in the severity of aortic insufficiency: The result stated that there was just a “trace” of transvalvular regurgitation. I am 69 and slim. The changes I’ve made over the threeyear period include eating more vegetables and fruits, along with fish three times a week. I’ve increased my cardio training to six days a week and continued weight training three times a week. Can the valve improve on its own without any medication or surgery?

G.D.

Answer: The aortic valve is the structure in between the heart’s left ventricle and the aorta, the largest blood vessel that provides the blood supply to the entire body. If the valve doesn’t open all the way, it’s called aortic stenosis, but if there is leakage backward through the valve, from the aorta back into the left ventricle, it is called aortic regurgitation, or aortic insufficiency.

Most people with aortic insufficiency have a long period of time (many years) with no symptoms at all, and an echocardiogram every three to five years is reasonable in people with mild aortic insufficiency. A few percentage of people each year will progress to more severe valve leakage. In addition to monitoring the echocardiogram, we look for a development of symptoms, the most important of which are angina (chest pain or discomfort, especially with exercise) and heart failure (shortness of breath, especially with exercise). This also includes symptoms such as being unable to lie down flat, or waking up at night gasping for breath and needing to sit up.

Valves generally do not improve on their own. What’s most important is that your valve is not worsening quickly and that you are able to do your exercises without symptoms. Your healthy eating and exercise may not be improving your valve, but it is very healthy for your arteries and other body systems.