Management of aortic valve disease in the presence of left ventricular dysfunction

The development of heart failure in patients with aortic valve disease is associated with increased mortality, unless aortic valve replacement is performed. There is an especially high risk of death among patients with low ejection fraction. The heart failure must be treated and the patient's condition stabilized before surgery is performed. A delay in surgery, on the other hand, may lead to irreversible cardiac dysfunction and culminate in heart failure. Initial management must include an evaluation of the severity of the lesion and the functional state of the left ventricle. It is possible to achieve both of these goals simultaneously with echocardiography and pharmacologic challenge.