[When should one operate for asymptomatic chronic aortic insufficiency?]

In the presence of symptomatic aortic insufficiency, the indication for surgery is accepted. On the other hand, when the patient is asymptomatic, there is hesitation between intervening too early because of the operative risk and complications of valvular prostheses, and operating too late because of the progressive spontaneous risk of aortic parietal complications, sudden death or irreversible left ventricular dysfunction. Before any discussion, it is logical to verify the asymptomatic character of the patient with a stress test. On knowing the severity of the aortic insufficiency, which is usually confirmed by Doppler echocardiography, the decision is based partly on the left ventricular effects and the ascending aortic diameters, and partly on the operative risk modified by age and associated pathologies. In this article, drawing on the data in the literature we set out to discuss the operative indications in asymptomatic chronic aortic insufficiency.