Background: Aortic regurgitation (AR) represents pressure and volume overload resulting in left ventricular (LV) dysfunction. Poor LV functionwas shown to be reversible after aortic valve replacement (AVR) which is the only effective treatment. The surgical risk increases in the presence of LV dysfunction. The aim of this study was to determine effect of AVR on LV functions in severe AR. Methods: Sixty patients were included with severe chronic AR with NYHA classes III and IV, diagnosed clinically and by imaging studies as transthoracic echocardiography (TTE) and cardiac catheterization. Patients were followed up postoperatively at regular intervals by TTE examination. Results: TTE values at discharge and 6 months after AVR were compared with preoperative findings. We found no significant statistical difference between LV functions pre-operatively and at discharge. However, there was statistical improvement in these functions at 6 months post-operatively compared to their values at discharge. ECHO findings of NYHA class III and IV at 6 months post-operatively showed evidence of improvement in LV functions of class III patients while those in class IV didn't show change or even some deterioration in the ECHO findings. Conclusions: LV functions showed mild or no improvement in early follow-up while after 6 months it showed that patients in NYHA class III got benefits more than those in class IV. © 2018 Publishing services by Elsevier B.V. on behalf of The Egyptian Society of Cardiothoracic Surgery. This is an open access article under the CC BY-NC-ND license