Aortic regurgitation

Aortic regurgitation (AR) can be caused by primary disease of the aortic valve leaflets or dilation of the aortic root. It may develop acutely (acute AR) or over decades (chronic AR).

Chronic AR may be asymptomatic for years until overt symptoms of congestive heart failure develop. Initial symptoms can include palpitations and uncomfortable awareness of the pounding heart when lying on the left side.

Acute AR is a medical emergency, presenting with sudden onset of pulmonary oedema and hypotension or cardiogenic shock. May also present as myocardial ischaemia or aortic root dissection.

Echocardiography is the best non-invasive test to diagnose and grade the severity of AR.

Vasodilator therapy improves haemodynamics and delays the need for aortic valve replacement/repair (AVR) in asymptomatic patients with chronic severe AR.

AVR is indicated in symptomatic patients or asymptomatic patients with LV ejection fraction (EF) ≤55%.

AVR could also be considered for asymptomatic patients with severe AR and LVEF >55% and if LV end-systolic diameter is >50 mm (>25 mm/m²).

Aortic regurgitation (AR) is the diastolic leakage of blood from the aorta into the left ventricle. It occurs due to inadequate coaptation of valve leaflets resulting from either intrinsic valve disease or dilation of the aortic root. It can remain asymptomatic for decades before patients present with irreversible myocardial damage.