The Failure of Hemodynamic Improvement After Valve Replacement Surgery

Abstract

Of 280 consecutive patients who had single or multiple valve replacement with Starr-Edwards prostheses, the clinical, hemodyanmic and anatomical information on 17 whose symptoms either became worse or failed to improve was reviewed. Electrocardiographic findings, the radiographic heart size, and the hemodynamie measurements on 14 of these patients were compared with 28 patients in whom there was symptomatic improvement. Twelve patients had valvular abnormalities, either of a prosthesis or of other valves than those replaced initially, and 9 patients had evidence of primary myocardial disease. There was a significantly greater decrease in radiographic heart size in the good group than in the poor group and significant differences were also found in hemodynamie measurements. It is concluded that there is a strong correlation between the postoperative changes and symptoms, radiographic heart size, and hemodynamie measurements following valve replacement surgery. The causes of poor surgical results include both abnormalities of valvular and myocardial function. Complete diagnostic studies, including both postoperative hemodynamie measurements and angiocardiograms, are essential for correct diagnosis of the cause of a poor surgical result. When the cause of a poor surgical result is primarily an abnormality of valvular function, reoperation can result in symptomatic and hemodynamic improvement.