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Severe AR with LV Dilatation — RACP Adult Medicine MCQ

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ModerateCardiologySevere AR with LV DilatationRACP Adult Medicine

A 45-year-old man with a bicuspid aortic valve presents with severe aortic regurgitation. He has a widened pulse pressure (BP 160/40), bounding pulses (Corrigan pulse), and a decrescendo early diastolic murmur. LVEDD is 70 mm (dilated) and LVEF has declined from 60% to 48% over 12 months. He has mild dyspnoea. What is the most appropriate management?

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Correct answer: D — Surgical aortic valve replacement (SAVR)

Severe AR with LV dilatation (LVEDD >70 mm or LVESD >50 mm) and declining LVEF (<55% or dropping) with symptoms warrants surgical AVR. TAVI is not currently established for pure aortic regurgitation (designed for calcified stenotic valves). In a young patient with bicuspid valve, aortic root assessment is important (ascending aorta aneurysm risk). If aortic root >45 mm with bicuspid valve, concomitant aortic root replacement is needed.

Reference: CSANZ – 2024 – VHD; ESC 2021 VHD