Aortic Regurgitation

Question 1

Valve Hemodynamics

Mild Aortic Regurgitation

Answer 1

1. Jet width <25% of LVOT
2. Vena contracta <0.3 cm
3. Regurgitant volume <30 mL/beat
4. Regurgitant fraction <30%
5. ERO <0.10 cm2

Question 2

Valve Hemodynamics

Moderate Aortic Regurgitation

Answer 2

1. Jet width 25%–64% of LVOT
2. Vena contracta 0.3–0.6 cm
3. Regurgitant volume 30–59 mL/beat
4. Regurgitant fraction 30% to 49%
5. ERO 0.10–0.29 cm2

Question 3

Valve Hemodynamics

Severe Aortic Regurgitation

Answer 3

1. Jet width ≥65% of LVOT
2. Vena contracta >0.6 cm
3. Holodiastolic flow reversal in the proximal abdominal aorta
4. Regurgitant volume ≥60 mL/beat
5. Regurgitant fraction ≥50%
6. ERO ≥0.3 cm2

Question 4

Recommendations for Timing of Intervention for Chronic AR

Answer 4

1. In symptomatic patients with severe AR (Stage D), aortic valve surgery is indicated regardless of LV systolic function.
2. In asymptomatic patients with chronic severe AR and LV systolic dysfunction (LVEF ≤55%) (Stage C2), aortic valve surgery is indicated if no other cause for systolic dysfunction is identified.
3. In patients with severe AR (Stage C or D) who are undergoing cardiac surgery for other indications, aortic valve surgery is indicated.
4. In asymptomatic patients with severe AR and normal LV systolic function (LVEF >55%), aortic valve surgery is reasonable when the LV is severely enlarged (LVESD >50 mm or indexed LVESD >25 mm/m2)
5. In patients with moderate AR (Stage B) who are undergoing cardiac or aortic surgery for other indications, aortic valve surgery is reasonable.
6. In asymptomatic patients with severe AR and normal LV systolic function at rest (LVEF >55%; Stage C1) and low surgical risk, aortic valve surgery may be considered when there is a progressive decline in LVEF on at least 3 serial studies to the low–normal range (LVEF 55% to 60%) or a progressive increase in LV dilation into the severe range (LV end-diastolic dimension [LVEDD] >65 mm) .
7. In patients with isolated severe AR who have indications for SAVR and are candidates for surgery, TAVI should not be performed.