Chronic aortic regurgitation. Role of medical therapy and optimal timing for surgery.
Aortic valve replacement should be performed once significant symptoms develop. Lacking important symptoms, operation should also be performed in patients with aortic regurgitation who manifest consistent and reproducible evidence of either LV contractile dysfunction at rest or extreme LV dilation. Noninvasive imaging techniques should play a major role in this evaluation. An important clinical decision, such as recommending aortic valve replacement in the asymptomatic patient, should not be based on a single echocardiographic or radionuclide angiographic measurement alone. When these data consistently indicate impaired contractile function at rest or extreme LV dilation on repeat measurements, however, operation is indicated in the asymptomatic patient. This strategy should reduce the likelihood of irreversible LV dysfunction in these patients and enhance long-term postoperative survival.
Bonow
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Division of Cardiology, Northwestern University Medical School, Chicago, Illinois, USA.
D001022:Aortic Valve Insufficiency / Q000150:complications / Q000401:mortality / Q000628:therapy*; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D002908:Chronic Disease; D004232:Diuretics / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D019918:Heart Valve Prosthesis Implantation; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000627:therapeutic use*; D018487:Ventricular Dysfunction, Left / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology
D002316:Cardiotonic Agents; D004232:Diuretics; D014665:Vasodilator Agents