Topic Reviews A-Z
Aortic Regurgitation - Treatment
Acute aortic regurgitation carries a very high mortality if prompt surgical intervention in the form of aortic valve replacement (AVR) is not undertaken.
Treatment of pulmonary edema and afterload reduction can help relieve symptoms and buy the patient some time before surgery is performed. Nitroprusside is the treatment of choice since it reduces both preload and afterload with great efficacy. Dobutamine may be needed if the patient remains hypotensive with a low cardiac output. The use of intraaortic balloon counterpulsation is not commonly used in acute aortic regurgitation as it is in acute mitral regurgitation. If the acute aortic regurgitation is due to infective endocarditis, at least seven days of intravenous antibiotics are often given before valve replacement.
In patients with mild to moderate chronic aortic regurgitation, no specific treatment is required. These patients should be monitored yearly to assess the progression of the disease. Antibiotic prophylaxis is recommended to prevent bacterial endocarditis.
Patients with moderate to severe aortic regurgitation that are symptomatic should undergo AVR if they fall into NYHA class III-IV heart failure. Those that are in NYHA class II should receive an exercise stress test to assess the endurance and exercise capacity. They should be treated with diuretics and afterload reducers (commonly ACE inhibitors) until AVR is indicated.
If moderate to severe aortic regurgitation is present but the patient is asymptomatic, AVR is not clearly indicated. Afterload reducers are given and frequent echocardiographic assessment is recommended to monitor LV dysfunction. The ideal time for AVR is late enough in the course of the disease to justify the risk-benefit ratio of surgery, yet early enough to prevent potential irreversible myocardial damage from occurring. The LV ejection fraction has been shown to correlate best with surgical outcome.