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Chronic Severe Aortic Regurgitation — EECC MCQ

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HardValvular Heart DiseaseChronic Severe Aortic RegurgitationEECC

A 50-year-old woman with chronic severe aortic regurgitation (AR) is asymptomatic. Echocardiography shows LVEF 52%, LV end-diastolic diameter 72 mm, and LV end-systolic diameter index (LVESDi) 24 mm/m². What is the recommended management according to the 2025 ESC/EACTS VHD Guidelines?

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Correct answer: E — Aortic valve surgery should be considered given the LVESDi exceeds the intervention threshold

The 2025 ESC/EACTS VHD Guidelines provide refined thresholds for intervention in asymptomatic chronic severe AR. Surgical intervention should be considered (Class IIa) in asymptomatic patients when LVESDi >22 mm/m² or LVESVi >45 mL/m² or LVEF ≤55%, provided operative risk is low. This patient's LVESDi of 24 mm/m² exceeds the 22 mm/m² threshold, indicating adverse LV remodelling that warrants surgery to prevent irreversible myocardial damage. The LVEF of 52% also approaches the intervention threshold. Aortic valve repair should be considered at expert centres when durable results are expected.

Reference: ESC/EACTS (2025): Guidelines for the Management of Valvular Heart Disease