Indications

1) Symptomatic patient with normal LV function (ejection fraction 2 0.5 at rest). If they are in class In or IV NYHA, surgery is recommended. In this group of patients, if they are in class I or 2 symptoms, the decision-milking is are difficult. Exercise testing may help in deciding about surgery.

2) Symptomatic patients with left ventricular dysfunction-the ventricular dysfunction can be graded as mi1d)to moderate (ejection fraction 0.25-0.49 and LV end systolic dimension 50 to $5 mms). If the ejection fraction is (less than 9.25) and end systolic dimension is more than 60mms, surgery should-not 'be delayed as results of medical management are worse.

3) Asympomatic patients-aortic valve replacement in asymptomatic with AR is a controversial topic. If the ejection fraction is I 0.5, generally surgery's recommended. At times an asymptomatic patient may, have -normal left ventricut rejection fraction but the ventricles may be severely dilated (end diastolic dimension > 75mms and end systolic dimension > 55mms). Such patients are in danger of sudden death and should be treated surgical File. or more for angina with or without coronary LV dysfunction at rest (ejection fraction 0.25 to 0.49) surgery of aorta or Other heart valves LV Function (EF 2 0.5) with stable LV size and systolic function On several studies and stable exercise tolerance (ejection fraction =- 0.5) but with severe LV dilatation

(end diastolic dimension > 75mm or end systolic

dimension > 55mms)