Contemporary Overview of Aortic Regurgitation in Young Individuals: Insights From Real-Life Evidence

Aortic regurgitation (AR) in young adults (aged 18-44 years) is often under- or misdiagnosed and is not always benign. As in older populations, prognosis depends on the severity of regurgitation, the underlying cause, early left ventricular dysfunction, and the chosen intervention strategy. Prompt diagnosis and timely treatment improve outcomes, yet the optimal timing for surgery in asymptomatic chronic AR remains uncertain. Recent studies have proposed new thresholds for left ventricular structural and functional assessment to better evaluate the impact of AR on prognosis and guide intervention timing. Echocardiography remains the primary imaging modality, but a multimodality approach is essential to accurately assess AR severity and subtle left ventricular changes. Transesophageal echocardiography with 3-dimensional imaging is crucial for evaluating valve repair feasibility, particularly when valve-sparing root repair, reintervention, or transcatheter procedures are considered. Additional tools such as cardiac magnetic resonance, global longitudinal strain, and biomarkers may further enhance disease monitoring. Assessment can be challenging, especially with eccentric jets or complex valve anatomy, and current surgical cut-offs remain debated. Aortic valve repair is preferred in young patients, including those with concomitant proximal aortic aneurysm, but it remains underutilized. Here, we propose a treatment algorithm for severe AR in young adults, integrating the underlying cause, valve anatomy, and left ventricular function, with a special focus on multimodality imaging to guide monitoring and therapeutic strategies.