P1: SBT
0521779407-04 CUNY1086/Karliner 0 521 77940 7 June 13, 2007 7:8
Aortic Insufficiency (AI) 145■Coronary angiography (required prior to aortic valve replacement in
older patients)
differential diagnosis
■Mitral stenosis (Austin-Flint murmur may be mistaken for mitral
stenosis)
management
n/a
specific therapy
Medical
■Antibiotic prophylaxis in all patients
■Mild symptoms and preserved LV function and dimensions on echo
➣Vasodilator therapy (may delay need for aortic valve replacement)
➣Diuretics
Surgical(usually aortic valve replacement (AVR)
■Moderate to severe symptoms
■Mild symptoms or asymptomatic with deterioration of LV function:
LVEF < 55% or LV end-systolic dimension > 50 mm
➣Extremely important – asymptomatic patients or patients with
mild AI must have serial echo/Doppler studies to assess LV func-
tion and size:
End-systolic dimension < 40 mm – echo/Doppler every 2 years
End-systolic dimension 40–50 mm–echo/Doppler every
6 months
follow-up
n/a
complications and prognosis
Complications
■Medical
➣See complications under vasodilator therapy (section on Heart
Failure)
➣LV function deteriorates when AVR delayed
■Surgery (AVR)
➣Acute
Complications associated with cardiopulmonary bypass and
major surgery
➣Long-term
Thromboembolism
Valve failure
Bleeding from anticoagulation therapy
Endocarditis