An asymptomatic 48-year-old man with severe chronic aortic regurgitation has an LVEF of 56%, LV end-systolic diameter of 54 mm, and LV end-diastolic diameter of 68 mm on serial echocardiography. What is the appropriate recommendation?
- A Refer for surgical valve replacement ✓
- B Start vasodilator therapy and reassess in 6 months
- C Continue observation with annual echocardiography alone
- D Refer for transcatheter edge-to-edge repair
Correct answer: A. Refer for surgical valve replacement
Explanation
Asymptomatic severe chronic aortic regurgitation warrants surgery once resting LVEF falls to 55 percent or below, or LV end-systolic diameter exceeds 50 mm (or 25 mm/m2 body surface area), even before symptoms develop, because irreversible LV dysfunction follows if intervention is delayed. This patient crosses the end-systolic threshold at 54 mm. Vasodilators are used only to improve haemodynamics in symptomatic patients who are poor surgical candidates, and transcatheter repair is not an established option for the aortic valve.
Reference: Braunwald's Heart Disease, 12th ed.
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