Q. Investigation of aortic regurgitation by Serial Testing?

Serial testing is indicated in asymptomatic patients with severe AR and preserved LV function since LV dysfunction may precede the onset of symptoms. The rationale is to identify those who develop symptoms, LV systolic dysfunction and rapid and progressive increase in LV size, when AVR becomes indicated. Patients with mild AR and normal LV size and systolic function need annual follow up or whenever signs and symptoms of worsening occur. Patients with severe AR and LV dilatation (LVEDD > 60 mm) require follow up once in 6 - 12 months while those with LVEDD > 70 mm or LVESD > 50 mm need more frequent follow up. Also patients with aortic root dilatation need more frequent follow up. Patients with change in effort intolerance should have prompt evaluation. When the symptoms change in equivocal or uncertain, exercise testing may be done. Otherwise it is not indicated. Radio nuclide or MRI may be done when the echo window is sub-optimal and there is discrepancy between clinical and echocardiographic findings. Chest X-ray and ECG may have additional value to echo in some patients.