Complications
The most common complication of severe AR. Mild to moderate AR may remain asymptomatic throughout the patient's life or may progress to severe AR and then heart failure.
Chronic severe AR patients should be referred for aortic valve replacement/repair (AVR) as soon as they develop any symptoms, impaired exercise tolerance, or decreased ejection fraction.[32][33]
Patients with severe left ventricular dysfunction and symptoms of heart failure should be started on medical therapy (inotropes and vasodilators) and referred for AVR.
Stretching and dilation of the left atrium results in atrial fibrillation, which leads to weakness, dyspnea, palpitations, and occasionally syncope.
The atrioventricular node, due to its proximity to the aortic valve, may be damaged secondary to stretching and scarring, which sometimes results in bradyarrhythmias and different degrees of block that are treated with medications and/or a pacemaker.
Bacteremia with organisms likely to cause endocarditis results in this complication in patients with underlying structural valvular defects.
Patients with AR are considered to be at low risk of developing endocarditis, and prophylactic antibiotics are not required before bacteremia-causing procedures.[34]
Sudden death is rare in patients with severe AR and normal ventricular function. Annual mortality is 0.4%.
One paper reported unexpected sudden deaths in patients with maintained systolic function but severe ventricular dilation.[35]
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