How should I manage a patient with asymptomatic aortic regurgitation and normal left ventricular function?

For a patient with asymptomatic aortic regurgitation and normal left ventricular function, the management approach is primarily conservative with regular monitoring. Referral to a specialist is recommended if the aortic regurgitation is moderate or severe, even if asymptomatic, to ensure appropriate specialist assessment and follow-up. Intervention is generally not indicated unless there is evidence of left ventricular dysfunction (LVEF less than 55%) or significant left ventricular dilation (end systolic diameter more than 50 mm or indexed end systolic diameter more than 24 mm/m²). In the absence of these findings, ongoing surveillance with echocardiography to monitor left ventricular size and function is advised.

Patients should be educated about symptoms that might indicate progression, such as breathlessness or fatigue, and advised to seek prompt review if these develop. Pharmacological treatment is not routinely indicated unless there are other cardiovascular indications. Specialist referral is also advised for patients with bicuspid aortic valve disease regardless of severity.