Monitoring
Patients who present to their physician with AR on initial evaluation need to be followed up closely due to the protracted course and potential complications of the disease. These patients need to be serially monitored based on the severity of AR, left ventricular ejection fraction (LVEF), and left ventricular (LV) diameters.
Serial echocardiograms are recommended every 3 to 5 years in asymptomatic patients with mild chronic AR, and every 1 to 2 years in asymptomatic people with moderate AR.[1] In patients with severe asymptomatic AR, echocardiogram is recommended every 6 to 12 months, with more frequent monitoring recommended with LV dilation.[1]
Patients with aortic root dilation and diameter >4 cm should undergo serial evaluations of aortic root and ascending aorta by echocardiography or magnetic resonance imaging yearly. For more than 0.3 mm increase in aortic diameter, confirmation with computed tomography angiogram is recommended.
Patients who undergo aortic valve replacement/repair need close follow-up during the early and late postoperative course and need to be serially monitored. Asymptomatic patients need to be followed up yearly for a complete history and physical exam. Any change in clinical status demands echocardiography.
Prosthetic valve patients are at high risk for thromboembolism and need antithrombotic therapy. The risk of bleeding must be weighed against the benefit of anticoagulation.
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