Management of Mild to Moderate Central Aortic Regurgitation

Definition and Diagnosis

The American College of Cardiology defines mild aortic regurgitation (AR) as having a jet width <25% of left ventricular outflow tract (LVOT), vena contracta <0.3 cm, regurgitant volume <30 mL/beat, regurgitant fraction <30%, effective regurgitant orifice (ERO) <0.10 cm², and angiography grade 1 1
The American College of Cardiology defines moderate AR as having a jet width 25%-64% of LVOT, vena contracta 0.3-0.6 cm, regurgitant volume 30-59 mL/beat, regurgitant fraction 30% to 49%, ERO 0.10-0.29 cm², and angiography grade 2 1

The European Heart Journal recommends regular monitoring for patients with mild to moderate AR, with clinical evaluation and echocardiography every 3-5 years for mild AR and every 1-2 years for moderate AR 2, 3
More frequent monitoring (every 3-6 months) is recommended if there is evidence of increasing left ventricular (LV) size or decreasing LV function 2

The European Heart Journal states that no specific medical therapy is required for asymptomatic patients with mild to moderate AR and normal LV function 3, 4
The American College of Cardiology recommends treating hypertension in patients with AR, preferably with vasodilators 1
ACE inhibitors or dihydropyridine calcium channel blockers may be beneficial in managing hypertension in patients with AR 2

The American College of Cardiology and European Heart Journal recommend surgical intervention for mild to moderate AR if the patient develops symptoms attributable to AR 1, 2
Surgical intervention is also recommended if there is evidence of LV dysfunction (LVEF ≤55%) 1, 6
The European Heart Journal suggests considering concomitant aortic valve surgery for patients with moderate AR undergoing cardiac surgery for another indication 2, 3

The European Heart Journal recommends considering concomitant aortic valve surgery for patients with moderate AR undergoing cardiac surgery for another indication, based on individual factors including age, etiology of AR, and possibility of valve repair 5, 4
Patients with moderate AR and normal LV function can generally undergo non-cardiac surgery without additional risk, but medical optimization should be performed before elective non-cardiac surgery if LV dysfunction is present (LVEF <30%) or pulmonary artery systolic pressure is elevated (≥50-60 mmHg) 3
The American College of Cardiology notes that factors associated with more rapid progression of AR include bicuspid aortic valve, rheumatic valve disease, and aortic root dilation 1

The American College of Cardiology and European Heart Journal recommend using an integrative approach to determine AR severity, rather than relying on a single echocardiographic parameter 1, 2
Associated aortic root or ascending aorta dilation should not be missed, as it may require more frequent monitoring 1, 2