What the leak does
A small leak often does essentially nothing: the heart absorbs it, and many people live with trivial or mild regurgitation for decades without consequence [3][4]. A severe leak is different — the heart must pump the leaked blood twice, the workload rises, and over years the left heart can enlarge, the rhythm can tip into atrial fibrillation, and breathlessness and fatigue creep in [1][3].
The two kinds — and why the difference decides everything
Primary (degenerative) regurgitation is a problem of the valve itself: its leaflets or supporting cords have stretched, thickened or snapped, so the door no longer meets in the middle [1][2].
Secondary (functional) regurgitation is a problem of the heart around the valve: a weakened, enlarged ventricle pulls a structurally normal valve out of shape [1][2]. The distinction matters more than the severity grade, because in primary disease fixing the valve fixes the problem, while in secondary disease the first target is the heart muscle itself — medication and heart-failure care — with valve intervention for selected patients [1][2].
How it is assessed
The echocardiogram is the central test: it shows the leak, grades it, finds its mechanism and watches the chambers behind it [1][3]. Mild and moderate leaks are usually simply monitored with scheduled echoes. The signals that move the conversation on are a severe leak, new symptoms, a dilating ventricle or new atrial fibrillation [1][2].
If treatment is ever needed
For severe primary regurgitation, surgery to repair the valve — keeping your own tissue — is preferred where the anatomy allows, as we cover in detail in our repair-versus-replacement article [1][2]. For selected patients who are not fit for surgery, a catheter-delivered clip that pinches the leaflets together can reduce the leak [1][2]. Which road, and whether any road at all, is a Heart Team decision made with you [1][2].
