Management of Chronic Aortic Regurgitation

Aortic regurgitation may be the most treacherous of the valvular lesions due to subtlety of symptoms and physical findings and due to difficulty in timing surgical intervention to prevent permanent cardiac dysfunction. Cardiac imaging (eg, echocardiography or magnetic resonance) is critical to quantify the degree of regurgitation and to detect significant left ventricular dysfunction or dilation. Stress testing can be useful in timing surgical intervention in borderline cases. Medical therapy consists of afterload reduction, diuresis, and inotrope administration. Surgical therapy today consists of aortic valve repair in a minority of cases or aortic valve replacement in the remainder. Percutaneous means to replace the aortic valve are in development. Cardiac decompensation may require cardiac transplantation.