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AR Multiple Surgical Criteria — EECC MCQ

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ModerateValvular Heart DiseaseAR Multiple Surgical CriteriaEECC

A 75-year-old man with severe symptomatic AR presents for assessment. His echocardiogram shows LVEF 50%, LVESD 55 mm, LVESDi 28 mm/m², and LVEDV 280 mL. What is the surgical indication?

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Correct answer: D — Surgery is indicated — he meets multiple criteria: symptomatic severe AR (Class I), LVESDi >22 mm/m² (2025 threshold), and LVEF at the lower limit (surgery indicated at LVEF ≤55%)

This patient meets multiple 2025 ESC VHD Guidelines criteria for surgical intervention in severe AR: (1) Symptomatic severe AR = Class I for surgery regardless of LV parameters; (2) LVEF ≤55% = Class I (his LVEF of 50% meets this); (3) LVESDi >22 mm/m² = Class IIa in asymptomatic patients with preserved LVEF (his 28 mm/m² far exceeds this). The updated 2025 guidelines lowered the LVESDi threshold from >25 to >22 mm/m², reflecting data showing that earlier intervention produces better post-operative outcomes. This patient's severely dilated LV (LVEDV 280 mL, LVESDi 28 mm/m²) with borderline-reduced LVEF (50%) represents relatively late presentation — the ideal is to intervene before LVEF drops below 55%.

Reference: ESC/EACTS (2025): VHD Guidelines