eMedicine Specialties > Cardiology > Valvular Heart Disease

Aortic Regurgitation: Follow-up

Author: Robert J Hilkert, MD, FACC, Clinical Associate Professor, Division of Cardiology, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School; Medical Director, Cardiovascular, Novartis Pharmaceuticals Corporation
Coauthor(s): Hojun Yoo, MD, Chief Fellow, Department of Cardiology, Robert Wood Johnson University Hospital, University of Medicine and Dentistry of New Jersey
Contributor Information and Disclosures

Updated: Jun 26, 2007

Follow-up

Further Inpatient Care

Admit patient for testing and surgical intervention.

Further Outpatient Care

  • Close monitoring for symptom development is warranted.
  • Serial echocardiograms should be performed to evaluate LV function, LV dimensions (end-systolic and end-diastolic), and the severity of AR.
  • In patients in whom an adequate echocardiogram cannot be obtained, serial multigated radionuclide angiogram scans should be performed to monitor the LVEF and the volume of the left ventricle. Alternatively, serial cardiac MRIs can be obtained in centers experienced with this procedure.   
  • Serial multigated angiogram scans should be performed to monitor the LVEF and the volume of the left ventricle.
  • Exercise stress testing should be performed to determine functional capacity and symptomatic response in patients with a history of equivocal symptoms.
  • Carefully monitor medication doses and adverse effects.

Inpatient & Outpatient Medications

  • Medications include calcium channel blockers and ACE inhibitors.
  • Avoid calcium channel blockers in patients with CHF.
  • Use digoxin and diuretics for patients with CHF.

Transfer

Transfer may be required for further diagnostic evaluation and surgical intervention.

Deterrence/Prevention

  • Endocarditis prophylaxis is discussed as follows:
    • AR leads to damaged endothelial lining of the valve and predisposes the valve to platelet and fibrin deposition.
    • In the presence of bacteremia, colonization of platelets and/or fibrin deposition can lead to bacterial endocarditis; thus, antibiotic prophylaxis is important for preventing this serious complication.
  • Patients with LV dysfunction or CHF symptoms should not engage in vigorous sports or heavy exertion.

Complications

  • Congestive heart failure (See also, Medscape's Heart Failure Resource Center.)
  • Infective endocarditis
  • Arrhythmia
  • Sudden death

Prognosis

  • Asymptomatic patients with normal LV function have a mortality rate of less than 0.2% per year. The rate of progression to symptoms and/or LV dysfunction is less than 5% per year.
  • Patients with angina have a mortality rate of higher than 10% per year.
  • Patients with CHF have a mortality rate of higher than 20% per year.

Patient Education

Educate patients about symptoms associated with severe AR.

Miscellaneous

Medicolegal Pitfalls

  • Antibiotic prophylaxis for prevention of aortic valve endocarditis is an important part of continuing medical care of patients with significant AR.
  • Intra-aortic balloon pump use for hemodynamic support is contraindicated in patients with hemodynamically significant (ie, moderate or severe) AR.
  • Symptomatic patients (NYHA class III, IV) with severe AR should undergo valve replacement, regardless of LV systolic function.
 


More on Aortic Regurgitation

Overview: Aortic Regurgitation
Differential Diagnoses & Workup: Aortic Regurgitation
Treatment & Medication: Aortic Regurgitation
Follow-up: Aortic Regurgitation
Multimedia: Aortic Regurgitation
References
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References

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Further Reading

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Keywords

aortic regurgitation, AR, aortic insufficiency, aortic disease, syphilitic aortitis, rheumatic valvulitis, aortic root disorders, Marfan disease, Marfan syndrome, degeneration of bicuspid aortic valves, bicuspid aortic valve degeneration, regurgitant aortic flow

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Contributor Information and Disclosures

Author

Robert J Hilkert, MD, FACC, Clinical Associate Professor, Division of Cardiology, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School; Medical Director, Cardiovascular, Novartis Pharmaceuticals Corporation
Robert J Hilkert, MD, FACC is a member of the following medical societies: Alpha Omega Alpha, American College of Cardiology, American Heart Association, and American Society of Echocardiography
Disclosure: Novartis  Salary Employment; Novartis Stock ownership Employment

Coauthor(s)

Hojun Yoo, MD, Chief Fellow, Department of Cardiology, Robert Wood Johnson University Hospital, University of Medicine and Dentistry of New Jersey
Hojun Yoo, MD is a member of the following medical societies: American College of Cardiology, American College of Chest Physicians, and American College of Physicians
Disclosure: Nothing to disclose.

Medical Editor

Martin Keane, MD, FACC, FAHA, Associate Professor, Cardiovascular Medicine Division, Department of Medicine, University of Pennsylvania School of Medicine
Martin Keane, MD, FACC, FAHA is a member of the following medical societies: Alpha Omega Alpha, American College of Cardiology, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Heart Association, American Society of Echocardiography, Pennsylvania Medical Society, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Steven J Compton, MD, FACC, FACP, Director of Cardiac Electrophysiology, Alaska Heart Institute, Providence and Alaska Regional Hospitals
Steven J Compton, MD, FACC, FACP is a member of the following medical societies: Alaska State Medical Association, American College of Cardiology, American College of Physicians, and Heart Rhythm Society
Disclosure: Nothing to disclose.

CME Editor

Amer Suleman, MD, Consultant in Electrophysiology and Cardiovascular Medicine, Department of Internal Medicine, Division of Cardiology, Medical City Dallas Hospital
Amer Suleman, MD is a member of the following medical societies: American College of Physicians, American Heart Association, American Institute of Stress, American Society of Hypertension, Federation of American Societies for Experimental Biology, Royal Society of Medicine, and Society of Cardiac Angiography and Interventions
Disclosure: Nothing to disclose.

Chief Editor

Richard A Lange, MD, Professor and Executive Vice Chairman of Medicine
Richard A Lange, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Cardiology, American Heart Association, and Association of Subspecialty Professors
Disclosure: Nothing to disclose.

 
 
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