Aortic regurgitation

Aortic regurgitation

Anesthetic relevance
Anesthetic management	{{{anesthetic_management}}}
Specialty
Signs and symptoms
Diagnosis
Treatment
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Provide a brief summary of this comorbidity here.

Anesthetic implications

Preoperative optimization

• Increased risk of perioperative cardiovascular decompensation

Intraoperative management

• Hemodynamic goals are to maintain forward flow and decrease regurgitant volume
  • Preload: normal-high to augment CO
  • Afterload: low-normal to promote forward flow
  • Rate: high-normal
  • Rhythm: sinus (rate more important)
  • Contractility: high-normal

Pathophysiology

• Hemodynamic sequelae of AI:
  • LA distension > Volume overload > Subendothelial ischemia
  • CHF > pulmonary edema
  • RV failure > pulmonary HTN
• In acute AI, sudden increase in LV volume can induce cardiogenic shock and pulmonary edema
  • Sudden AI that does not allow time for compensatory LV dilation can result in acute pulmonary congestion

Treatment

Medication

• Diuretics, anticoagulants
• Immediate management of acute AI involves afterload reduction (nitroprusside) & augmentation of contractility & rate (dobutamine)

Surgery

• Severe acute AI may require emergency AV repair/replacement
• Note that intra-aortic balloon pump is contraindicated