Treatment of Rheumatic Heart Disease with Aortic Regurgitation

Rheumatic heart disease can result in structural valve damage that progresses to significant aortic regurgitation (AR). This scenario requires careful clinical assessment to determine the appropriate intervention and timing.

Clinical scenario

This protocol addresses rheumatic heart disease presenting with aortic regurgitation — a valve lesion in which the aortic valve fails to close properly, placing a chronic volume burden on the left ventricle. Management decisions depend on the severity of the regurgitation and the patient's clinical status.

Treatment approach

When severe valvular dysfunction is present, a surgical approach to the aortic valve is the central intervention — the form of surgery and choice of technique depend on valve anatomy and other patient factors. The full treatment algorithm, including selection criteria, procedural details, and follow-up strategy, is available in the complete protocol.

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References

DOI: 10.1161/CIR.0000000000000921

Treatment with angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, and β-blockers has been shown to be beneficial in large population cohort studies in patients with AR, particularly those with left ventricular dysfunction.
When there is severe valvular dysfunction, especially if the patient is symptomatic, surgery is indicated.
When aortic valve repair is not possible, there remains the question of the choice of valve substitute, essentially between mechanical prostheses and bioprostheses.
The lower incidence of these complications with aortic prostheses and the greater difficulty with aortic valve repair makes aortic valve replacement more acceptable.

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