Early postoperative changes in left ventricular chamber size, architecture, and function in aortic stenosis and aortic regurgitation and their relation to intraoperative changes in afterload: a prospective two-dimensional echocardiographic study.
- 1 July 1987
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Cell Metabolism
- Vol. 76 (1), 77-89
- https://doi.org/10.1161/01.cir.76.1.77
Abstract
We prospectively studied 16 patients with isolated aortic stenosis and eight with isolated aortic regurgitation undergoing aortic valve replacement, using two-dimensional echocardiography preoperatively, intraoperatively, and 41 +/- 7 days postoperatively to calculate the intraoperative change in afterload, quantify the postoperative changes in left ventricular chamber size, architecture, load and function, determine whether the postoperative left ventricular remodeling correlated with the intraoperative change in afterload in aortic stenosis and aortic regurgitation, and assess whether preoperative afterload excess precluded postoperative improvement in left ventricular function. Preoperative left ventricular mass, end-systolic meridional and circumferential wall stresses, ejection fraction, and stress-shortening relations in patients with aortic stenosis and aortic regurgitation were similar. However, our patients with aortic regurgitation had severe systolic dysfunction, with ejection fraction less than 55% in all but one patient, compared with only 10 of 16 patients with aortic stenosis. Left ventricular end-diastolic volume, mass/volume ratio, and chamber shape were significantly different in patients with aortic stenosis and aortic regurgitation (174 +/- 64 vs 294 +/- 140 ml, p less than .01; 1.81 +/- 0.63 vs 1.14 +/- 0.18, p less than .01; and 0.59 +/- 0.09 vs 0.69 +/- 0.09, p less than .05, respectively). Intraoperative end-systolic meridional and circumferential stresses fell significantly in patients with aortic stenosis but remained unchanged in those with aortic regurgitation. The changes in left ventricular volume and ejection fraction during early postoperative remodeling (6 weeks) correlated with the intraoperative change in afterload in patients with aortic stenosis. In contrast, there was no intraoperative change in afterload in patients with aortic regurgitation and no significant changes in left ventricular volume, architecture, or function at 6 weeks or at 6 months. The differences in left ventricular remodeling and changes in function between patients with aortic stenosis and aortic regurgitation in the early postoperative period most probably relates to the major difference in intraoperative reduction in afterload, although a contributory role may have been played by the preoperative left ventricular dysfunction in those with aortic regurgitation that was underestimated by measurement of ejection fraction.This publication has 34 references indexed in Scilit:
- Left ventricular stress-dimension-shortening relations before and after correction of chronic aortic and mitral regurgitationThe American Journal of Cardiology, 1985
- Estimation of left ventricular myocardial function by the ejection fraction in isolated, chronic, pure aortic regurgitationThe American Journal of Cardiology, 1984
- Chronic aortic regurgitation: Prognostic value of left ventricular end-systolic dimension and end-diastolic radius/thickness ratioJournal of the American College of Cardiology, 1983
- Serial changes in left ventricular function after correction of chronic aortic regurgitationThe American Journal of Cardiology, 1983
- Preoperative criteria predictive of late survival following valve replacement for severe aortic regurgitationAmerican Heart Journal, 1981
- Five to Eight-Year Follow-up of Patients Undergoing Porcine Heart-Valve ReplacementNew England Journal of Medicine, 1981
- End-systolic volume as a predictor of postoperative left ventricular performance in volume overload from valvular regurgitationAmerican Journal Of Medicine, 1980
- Pre- and postoperative left ventricular contractile function in patients with aortic valve disease.Heart, 1979
- Effects of successful, uncomplicated valve replacement on ventricular hypertrophy, volume, and performance in aortic stenosis and in aortic incompetenceThe Journal of Thoracic and Cardiovascular Surgery, 1978
- Myocardial mechanics in aortic and mitral valvular regurgitation: the concept of instantaneous impedance as a determinant of the performance of the intact heartJCI Insight, 1968