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Q. Can I stop follow-up for aortic regurgitation if there are no symptoms?

Answered by
Dr. Muhammad Zohaib Siddiq
and medically reviewed by Dr. Preetha J
This is a premium question & answer published on Nov 14, 2021

Hi doctor,

I have a query for a cardiologist. It is about trace aortic regurgitation. I was found to have this 14 years back. I followed up 11 years back, 8 years back, and 5 years back, but no changes were noted. I was advised for further follow-up. Is it fine?

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#

Hi,

Welcome to icliniq.com.

Thanks for the query madam.

Trace AR (aortic regurgitation) is of no significance. No need to repeat Echocardiography in less than 5 years. Only control your blood pressure. The rest of the aortic valve structure is normal, so future progression is very less likely.

Hi doctor,

Thank you for your reply.

I made a mistake in my original question. What I meant to write was: "I was advised like no need for further follow-up." In other words, no need to repeat ultrasounds every five years because the regurgitation is so trivial, and there was no progression over the nine years I was checked. So do I want to check, or is it okay not to have further scans in the future?

Thank you.

#

Hi,

Welcome back to icliniq.com.

Yes, no need to repeat. If you have symptoms of palpitations, shortness of breath, or excessive tiredness upon ordinary activities or slight exertion, then have a visit to a cardiologist. He will examine your pulse, blood pressure and auscultate your heart for murmurs. If found, then Echocardiography should be repeated, otherwise no need. No need for routine five-yearly repeat Echocardiography.

Hi doctor,

Thank you for your reply.

I occasionally have extra-systoles, but I have had these 19 years of back during the normal echos. Is it ok not to recheck? Is that vena contracta of 2-3 mm not worrying? I read that 6 mm with the aortic valve counts as severe? I know regurgitation in the other valves is insignificant but is that true for the aortic valve too?

Thank you.

#

Hi,

Welcome back to icliniq.com.

There are two conditions in which AR can occur:

1. Either the aortic valve itself is abnormal due to congenital abnormalities or old age-related degeneration and excessive calcium deposition or infection of valve called infective endocarditis.

2. Normal valve but dilated aortic root also occur due to congenital issues or non-cardiac causes that affect the aortic root, most common of which are connective tissue diseases or ankylosing spondylitis (do not worry about medical terminology).

You do not have any of these, so progression to mild or moderate AR is extremely unlikely.

Prevention:

Try to control blood pressure and cholesterol levels. Some extrasystoles are a normal occurrence in healthy people. Yes, this is insignificant even for the aortic valve.

Hi doctor,

Thank you for your reassurance.

Finally, can I check? Did you see my report? It says that the cause of my AR is a slightly asymmetrical valve with a hardening of the margins. Is it still okay? Some centers say that I should follow up every five years but really no need in my case. And does this also mean no need for antibiotic prophylaxis with dental extractions or major surgery?

Thank you.

#

Hi,

Welcome back to icliniq.com.

Thanks for the follow-up.

Guidelines say that follow-up for five-yearly in case of mild AR. But your's is less than that. If symptoms develop at any time, then you have to have follow-up Echocardiography. There is no need for antibiotic prophylaxis in case of dental manipulation or surgery. Antibiotic prophylaxis is needed in some specific cardiac lesions and no need in AR as per American and European guidelines.

Hardening of margins is of no significance. Control your blood pressure, cholesterol, and thyroid function (in case you have thyroid issues).

Hi doctor,

Can you kindly confirm that you saw my attached report with the measurements and ultrasound images? And are you still happy with my reports? Those reports taken 8 years back were unchanged from the other reports taken 14 years back and 11 years back. I do not have the report taken 5 years back, as that was in the UK, and the doctor just said it was trivial and no need to worry.

#

Hi,

Welcome back to icliniq.com.

Yes, I have seen your report (attachment removed to protect patient identity), madam. The Echocardiography report is fine. There is also an ECG which is normal too. If the last Echocardiography was done 5 years back and it had trivial AR, with no symptoms right now, no need to repeat, madam.


Investigations to be done:

No need.


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