Surgical Correction of Aortic Regurgitation

Aortic regurgitation hemodynamically amounts essentially to an aorticoventricular fistula. While it is not strictly accurate to classify this condition as one of the forms of arteriovenous fistula, the clinicopathological analogies implied in such a connotation may be very helpful in understanding the notoriously rather extreme variations in the clinical course of aortic insufficiency. Thus it may enable one to appreciate readily that a small to moderate-sized fistula might be compatible with a prolonged life of normal activity while a larger one would initiate a rapidly progressive "downhill" course. This would tend to explain the differing attitudes of cardiologists with respect to the disease. Some of them consider it to be a relatively benign lesion even in the face of progressive (and sometimes extreme) enlargement of the heart, while others are most disturbed by the mere finding of a basal diastolic murmur and a low diastolic blood pressure level, frequently in