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©2013 UpToDate ® Print Email ACC/AHA guideline summary: Indications for aortic valve repair or replacement (AVR) in adolescents or young adults with chronic aortic regurgitation (AR) Class I - There is evidence and/or generalagreement that aortic valve repair or replacement (AVR) is indicated inadolescents or young adults with chronic AR in the following settings •  Severe AR with symptoms of angina, syncope, or dyspnea on exertion •  Asymptomatic severe AR with a left ventricular ejection fraction (LVEF) less than 50 percent on serial studies separated by one to three months. •  Asymptomatic severe AR with progressive left ventricular enlargement to an end-diastolic dimension more than four standard deviations greater than normal. •  Coronary angiography before aortic valve surgery when a pulmonary autograft (Ross procedure) is considered when the origin of the coronary arteries was not identified by noninvasive testing. Class IIb - The weight of evidence oropinion is less well established for the usefulness of AVR inadolescents or young adults with chronic AR in the following settings •  Asymptomatic adolescents with severe AR who also have moderate aortic stenosis (peak left ventricle-to-peak aortic gradient greater than 40 mmHg at cardiac catheterization). •  Asymptomatic adolescents with severe AR who develop ST depression or T wave inversion over the left precordium. Data from Bonow RO, Carabello BA, Chatterjee K, et al. ACC/AHA 2006 guidelines for the management of patients with valvular heart disease. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing committee to revise the 1998 guidelines for the management of patients with valvular heart disease). J Am Coll Cardiol 2006; 48:e1.