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HCC Surveillance Post-SVR — RACP Adult Medicine MCQ

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HardGastroenterology & HepatologyHCC Surveillance Post-SVRRACP Adult Medicine

An asymptomatic 54-year-old has unequivocally severe chronic aortic regurgitation, LVEF 44% and LV end-systolic diameter 54 mm on reproducible imaging. There is no prohibitive comorbidity. What is the next management step?

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Correct answer: B — Refer for surgical aortic-valve intervention before further LV deterioration

Explanation lettering: E = shown as A · A = shown as E

B is correct. Severe AR with LV systolic dysfunction and marked end-systolic dilatation has crossed the intervention threshold despite absent symptoms; surgical valve assessment is indicated before irreversible remodelling. A waits too long. C routine TAVI evidence is for aortic stenosis, not standard operable AR. D does not correct volume overload. E medical afterload reduction cannot replace indicated surgery.

Reference: CSANZ, Structural and valvular heart disease echocardiography position statement 2024: https://www.csanz.edu.au/Common/Uploaded%20files/Smart%20Suite/Smart%20Library/4da25b2b-e4c7-41a9-ac2f-ec941ad5a681/2024%20CSANZ%20Position%20Statement%20on%20Indications%2C%20Assessment%20and%20Monitoring%20of%20Structural%20and%20Valvular%20Heart%20Disease%20With%20Transthoracic%20Echocardiography%20in%20Adults%282024%29.pdf; National Heart Foundation and CSANZ, Heart failure guideline: https://www.heartfoundation.org.au/getmedia/6ac5da9b-39e2-4771-8fe9-0f5da0a3e9df/heart-failure-guidelines.pdf