When to intervene in chronic aortic regurgitation

Symptomatic patients with chronic aortic regurgitation should undergo aortic valve replacement. Asymptomatic patients with normal left ventricular function are not surgical candidates, but aortic valve replacement should be performed in most patients with left ventricular dysfunction, even if symptoms are not yet present. The short-term administration of vasodilators is generally beneficial, but there is only meager evidence that the hemodynamic benefits are maintained; for this reason, the wide application of these agents should be postponed until well-designed clinical trials document a long-term benefit.