Aortic Regurgitation

Aortic regurgitation is usually a chronic condition characterized by a prolonged asymptomatic phase and gradual left ventricular (LV) dilatation. Other conditions such as infective endocarditis and aortic dissection can result in acute severe aortic regurgitation. The recommendations are for chronic aortic regurgitation.

Recommendation parameters for aortic regurgitation include the severity of the diagnosis, LV size, and the presence of signs or symptoms.

Mild or moderate aortic regurgitation occurs in the presence of normal LV systolic function and little or no LV enlargement.

Severe aortic regurgitation occurs with a normal LV systolic function but significant LV dilatation.

Waiting period

No recommended time frame

You should not certify the driver until etiology is confirmed and treatment has been shown to be adequate/effective, safe, and stable.

Decision

Maximum certification period — 1 year

Recommend to certify if:

The driver has:

• Mild aortic regurgitation that is asymptomatic.
• Moderate aortic regurgitation with normal LV function, no or mild LV enlargement, and the driver is asymptomatic.

Recommend not to certify if:

The driver has:

• Symptoms.
• Moderate aortic regurgitation with abnormal LV function or more than mild LV enlargement.

Monitoring/Testing

Echocardiography repeated every 2 to 3 years when certified with mild or moderate aortic regurgitation.

Follow-up

The driver should have an annual medical examination.

Aortic Regurgitation Recommendation Table (PDF)

Waiting period

Minimum — 3 months if post-aortic valve repair

NOTE: If more than one waiting period applies (because of multiple cardiac conditions or other comorbid diseases), examine the driver for certification after the completion of the longest waiting period.

Decision

Maximum certification period — 6 months if not surgically repaired

Maximum certification period — 1 year if post-aortic valve repair

NOTE: The certification interval should not exceed the interval required for adequate monitoring.

Recommend to certify if:

The driver has:

• No symptoms.
• Normal LV function.
• LV dilatation:
  • LV end-diastolic dimension (LVEDD) less than or equal to 60 mm.
  • LV end-systolic dimension (LVESD) less than or equal to 50 mm.

The driver who has had surgical repair for severe aortic regurgitation and meets guidelines for post-aortic valve repair may be recertified for 1 year.

Recommend not to certify if:

The driver:

• Is symptomatic.
• Is unable to achieve workload greater than 6 METS on Bruce protocol.
• Has reduced left ventricular ejection fraction less than 50%.
• Has LV dilatation:
  • LVEDD greater than 70 mm.
  • LVESD greater than 55 mm.

Monitoring/Testing

Echocardiography repeated every:

• 6 to 12 months if LVEDD less than 60mm or LVESD less than 50 mm.
• 4 to 6 months if LVEDD equal to 60mm or LVESD equal to 50 mm.

NOTE: The certification interval for severe aortic regurgitation that has not been surgically repaired should not exceed 6 months even if the monitoring interval is greater than 6 months.

Follow-up

The driver with severe aortic regurgitation should have a semi-annual medical examination. If surgically repaired, the driver may have an annual medical examination.

Aortic Regurgitation Recommendation Table (PDF)