Therapy of AR
Acute AR:
Vasodilation with sodium nitroprusside is used as a bridge to emergency surgery. Aortic balloon counterpulsation is absolutely contraindicated. Beta blockers prolong diastole and may worsen AR.
Chronic AR:
Medical therapy is aimed at reducing systolic hypertension, and thereby wall stress, and improving LV function.
Two randomized studies have shown improvement of LV function with hydralazine and nifedipine, respectively. Theoretically, vasodilation with ACE/ARB should also be beneficial. Significant reduction of the regurgitant volume cannot be achieved with medical
therapy because the regurgitant orifice area is fixed and the diastolic blood pressure already low. Thus, vasodilator therapy is recommended either in inoperable patients or as a bridge to surgery or in asymptomatic patients who have LV dilation but normal LVEF.
Surgery for AVR is indicated in patients with severe AR and symptoms or signs of reduced LV function.