Aortic insufficiency medical management

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Medical therapy of chronic aortic insufficiency involves the use of vasodilators. Small trials have demonstrated a benefit from the administration of ACE inhibitors, nifedipine, sodium nitroprusside and hydralazine in improving left ventricular wall stress, ejection fraction, and left ventricular mass . The use of these vasodilators is indicated only in those individuals who suffer from hypertension in addition to aortic insufficiency. The goal in using these pharmacologic agents is to decrease the afterload so that the left ventricle is unloaded. This results in reduction in left ventricular end diastolic pressure thereby preserving the left ventricular systolic function and also benefits the patients in left ventricular failure secondary to aortic insufficiency.

Long term therapy with nifedipine and hydralazine have shown to increase left ventricular ejection fraction, reduce left ventricular end diastolic volume and reduction in left ventricular mass thereby delaying the need for valve surgery . While ACE inhibitors such as enalapril and quinapril have shown to decrease left ventricular mass and end diastolic volume but with no influence on ejection fraction

AHA guidelines for use of Vasodilator therapy in Chronic Aortic Insufficiency

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Class I Vasodilator therapy is indicated for chronic therapy in patients with severe AR who have symptoms or LV dysfunction when surgery is not recommended because of additional cardiac or noncardiac factors. Class IIa Vasodilator therapy is reasonable for short-term therapy to improve the hemodynamic profile of patients with severe heart failure symptoms and severe LV dysfunction before proceeding with AVR. Class IIb Vasodilator therapy may be considered for long-term therapy in asymptomatic patients with severe AR who have LV dilatation but normal systolic function. Class III Vasodilator therapy is not indicated for long-term therapy in asymptomatic patients with mild to moderate AR and normal LV systolic function. Vasodilator therapy is not indicated for long-term therapy in asymptomatic patients with LV systolic dysfunction who are otherwise candidates for AVR. Vasodilator therapy is not indicated for long-term therapy in symptomatic patients with either normal LV function or mild to moderate LV systolic dysfunction who are otherwise candidates for AVR.

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