From the Guidelines
Chronic aortic regurgitation leads to paradoxical septal motion due to volume overload of the left ventricle, which causes left ventricular dilation and remodeling, shifting the interventricular septum toward the right ventricle during diastole and resulting in abnormal septal motion during systole. In this condition, blood flows backward from the aorta into the left ventricle during diastole, causing left ventricular dilation and remodeling over time, as noted in a systematic review of clinical practice guidelines and recommendations for aortic regurgitation management 1. This enlargement shifts the interventricular septum toward the right ventricle during diastole. Then, during early systole, the septum moves paradoxically toward the right ventricle instead of its normal leftward movement. This abnormal motion occurs because the volume-overloaded left ventricle contracts against the regurgitant load, creating altered pressure dynamics between the ventricles. Some key points to consider in the management of chronic aortic regurgitation include:
- The El Khoury functional classification can be helpful to appraise the mechanism of AR, guide valve repair technique, and predict recurrence of AR 1.
- Volume overload imposed by significant AR leads to increased total stroke volume, resulting in systolic hypertension and afterload mismatch, which can eventually lead to left ventricular decompensation 1.
- Severe AR is associated with significant cardiovascular morbidity and mortality, with a mortality rate of up to 19% within 6.6 years of diagnosis, even in asymptomatic patients 1. The paradoxical septal motion can be observed on echocardiography and represents an adaptation to chronic volume overload rather than a primary septal abnormality. This finding helps differentiate chronic aortic regurgitation from other cardiac conditions and indicates significant hemodynamic compromise. Key considerations in the management of chronic aortic regurgitation include prompt diagnosis, close monitoring, and timely intervention to prevent left ventricular decompensation and reduce morbidity and mortality.