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2025 AR Surgery Thresholds — EECC MCQ

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HardValvular Heart Disease2025 AR Surgery ThresholdsEECC

A patient with chronic severe aortic regurgitation is asymptomatic. LVEF has fallen from 61% to 56% and LV end-systolic diameter indexed to body surface area is 21 mm/m². What is the best next step?

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Correct answer: C — Refer for intervention assessment using serial LV measures

Chronic severe AR can cause irreversible myocardial damage before overt symptoms. Borderline decline in LVEF and indexed LV end-systolic enlargement require expert review, confirmation of measurements and consideration of intervention using contemporary thresholds and the trajectory over time. A single unindexed dimension or a rigid symptom-only strategy is inadequate, particularly in a smaller patient. Anticoagulation does not prevent volume-overload remodelling, and long surveillance intervals are unsafe when ventricular parameters are changing.

Reference: 2025 ESC/EACTS Guidelines for valvular heart disease. https://www.escardio.org/guidelines/clinical-practice-guidelines/all-esc-practice-guidelines/valvular-heart-disease/