Observations on the Optimum Time for Operative Intervention for Aortic Regurgitation

A recent echocardiographic study of symptomatic patients who had aortic valve replacement for isolated aortic regurgitation indicated that patients in whom preoperative left ventricular end-systolic dimension (LVD[SYS]) exceeded 55 mm or fractional shortening (%FS) was less than 25% were at high risk of developing congestive heart failure and dying after an otherwise successful operation. Because indices of left ventricular systolic function might identify asymptomatic patients with aortic regurgitation who might benefit from earlier operation, 37 such patients were evaluated with serial echocardiograms (mean follow-up 34 months). Fourteen patients (38%) subsequently developed symptoms and were recommended for operation (SUBSQ OP). Twenty-three patients (62%) remain asymptomatic during follow-up (NON OP). LVD(SYS) and %FS were the most sensitive measurements for distinguishing on initial examination the patients who subsequently required operation from those who have not (LVD[SYS] 53.0 mm SUBSQ OP vs 44.3 mm NON OP, p = 0.001; %FS 28.8% SUBSQ OP vs 33.9% NON OP,p = 0.002). During serial studies, the maximum rate of change in end-systolic dimension exceeded 7 mm per year in only one patient. Four of five patients (80%) with end-systolic dimension greater than 55 mm developed symptoms and came to operation during a