Figure 50-22 Hemodynamics of aortic regurgitation. A, Normal conditions. B, The hemodynamic changes that occur in severe acute aortic regurgitation. Although total stroke volume is increased, forward stroke volume is reduced. Left ventricular end-diastolic pressure rises dramatically. C, Hemodynamic changes occurring in chronic compensated aortic regurgitation are shown. Eccentric hypertrophy produces increased end-diastolic volume, which permits an increase in total as well as forward stroke volume. The volume overload is accommodated, and left ventricular filling pressure is normalized. Ventricular emptying and end-systolic volume remain normal. D, In chronic decompensated aortic regurgitation, impaired left ventricular emptying produces an increase in end-systolic volume and a fall in ejection fraction, total stroke volume, and forward stroke volume. Further cardiac dilatation occurs along with re-elevation of left ventricular filling pressure. E, Immediately after valve replacement, preload estimated by end-diastolic volume decreases, as does filling pressure. End-systolic volume is also decreased, but to a lesser extent. The result is an initial fall in ejection fraction. Despite these changes, elimination of regurgitation leads to an increase in forward stroke volume. AoP, aortic pressure; EDV, end-diastolic volume; EF, ejection fraction; ESV, end-systolic volume; LVEDP, left ventricular end-diastolic pressure; RF, regurgitant fraction. (From Carabello BA: Aortic regurgitation: Hemodynamic determinants of prognosis. In Cohn LH, DiSesa VJ [eds]: Aortic Regurgitation: Medical and Surgical Management. New York, Marcel Dekker, 1986.)