Key result
Untreated severe asymptomatic AR linked to advanced LV remodeling and eventual HF.
Why the study?
There is no clear consensus on whether to perform early aortic valve replacement or wait for symptom onset or LV remodeling in asymptomatic patients with hemodynamically significant AR not meeting guideline criteria.
What is the optimal management strategy (early intervention vs watchful waiting) for asymptomatic patients with severe aortic regurgitation who do not meet guideline criteria for surgery?
What is the optimal management strategy (early intervention vs watchful waiting) for asymptomatic patients with severe aortic regurgitation who do not meet guideline criteria for surgery?
This case report highlights the clinical dilemma of managing asymptomatic severe aortic regurgitation when guideline-defined echocardiographic criteria for intervention are not met.
Underscores management uncertainty for asymptomatic severe AR below surgical thresholds; leaves open optimal intervention timing in prospective studies.
Aortic regurgitation (AR) is the third most common valvular disease, which more often affects younger people, mostly men. Untreated severe AR leads to advanced left ventricular (LV) remodeling, which results in LV systolic dysfunction, which consequently leads to the heart failure. There is no clear consensus for the management of asymptomatic patients with hemodynamically significant AR who do not meet guideline-defined echocardiographic criteria. In these patients, there is a debate about the optimal therapeutic approach, that is, whether to replace the aortic valve in an early, asymptomatic phase, or wait for the symptom onset and/or systolic dysfunction and LV enlargement in order to intervene. Through this case, we present the approach to the patient from his first visit to the doctor, as well as the diagnostic process that led to the diagnosis of severe AR and pericarditis, which turned out to be the case of the patient's symptoms, as well as the dilemma in the further treatment of the patient.
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Bušić et al. (2024) studied this question. Untreated severe asymptomatic aortic regurgitation can lead to advanced left ventricular remodeling and eventual heart failure if not managed appropriately.
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