When Is the Best Time to Operate for Aortic Regurgitation?

Abstract

Selecting the best time to operate for aortic regurgitation is a dilemma. The concept that operating after congestive heart failure has developed is too late has perhaps been overemphasized, as has the concept that irreversible left ventricular dysfunction frequently develops during the asymptomatic period. In the follow-up of patients with asymptomatic aortic regurgitation, prime attention should be given to the clinical parameters of symptoms, physical findings, electrocardiographic changes, and the appearance of the plain chest radiograph. Further studies are not needed in patients who are truly asymptomatic with a normal heart size. In most patients, especially those in the 30-to 65-year age group, the onset of mild dyspnea on exertion is the key. Measurements of left ventricular dimensions by echocardiography or radionuclide imaging is a useful supplement when early left ventricular dysfunction is suspected clinically. The decision to operate must be individualized, because of the importance of factors such as age, anatomic and etiological nature of the aortic valve disease, presence of hypertension and coronary artery disease, and attitude of the patient toward surgery and long-term anticoagulation. (Cardiol Rev 1993;1:5, 301-310)