Review Note

2021 Clinical Applications

51. A 64 year old man presents with breathlessness and was found to have severe aortic regurgitation. Which of the following is the strongest indication for aortic valve replacement?

a.                   Left ventricular end diastolic diameter <65mm

b.                   Left ventricular ejection fraction <50%

c.                    Holodiastolic aortic flow reversal

d.                   Fluttering of the mitral valve leaflets

a.                   Left ventricular end diastolic diameter <65mm: diameter of LV at the end of diastole. Enlarged can indicate a dilated CM but < 65mm is normal-ish. It’s LVESD < 50

b.                   Left ventricular ejection fraction <50%: This threshold is considered an important sign of impaired ventricular function due to chronic volume overload caused by the regurgitant flow.