Cardiology>>>>>Valvular heart disease and Endocarditis
Question 1#

You review a 59-year-old man with long-standing hypertension in clinic. He has no other comorbidities. He complains of some breathlessness, but this does not limit his physical activity. A transthoracic echocardiogram demonstrates aortic root dilatation and severe aortic regurgitation.

Which one of the following is not an indication for surgery?

A. NYHA class II breathlessness
B. Aortic root disease with maximal diameter 49 mm
C. Patients undergoing CABG, valve surgery, or surgery of the ascending aorta
D. Asymptomatic with resting LVEF ≤50%
E. Asymptomatic with end-diastolic dimension > 70 mm

Correct Answer is B


This man’s echocardiogram shows a dilated aortic root. In this case the likely cause is his long-standing hypertension. In aortic root disease indication for surgery is based on the maximal aortic diameter, regardless of the severity of aortic regurgitation. Patients with Marfan’s syndrome should be offered surgery when their aortic root diameter is ≥45 mm; the figure is ≥50 mm for patients with a bicuspid aortic valve and ≥55 mm for any other patient (including those with aortic root dilatation secondary to hypertension, as in this case). Other indications for surgery in severe aortic regurgitation are: