SUMMARY We retrospectively studied 252 operated and 47 unoperated patients with isolated aortic valve disease. Aortic valve replacement (AVR) was recommended to all patients based on clinical and hemodynamic data. Preoperative hemodynamic and angiographic data were similar in operated and unoperated cohorts. Seventy-one percent of patients received a Bjork-Shiley prosthesis. Operative mortality was 7% for the entire surgical series. For patients with predominant aortic stenosis (AS), survival at 3 years was 87% in operated and 21% in unoperated patients (p < 0.001). For patients with predominant aortic insufficiency (Al), the 5-year survival rate was 86% in operated and 87% in unoperated patients (NS). AVR improved long-term survival in patients with AS who had normal or impaired left ventricular (LV) function. In patients with Al and normal LV function, survival was not improved after AVR, but those with LV dysfunction who were operated on tended to survive longer (NS). Long-term survival of unoperated patients with AI was better than that in unoperated patients with AS.We conclude that AVR improves long-term survival in patients with AS who have normal or abnormal LV function, and that AVR does not change long-term survival in patients with Al, although those with LV dysfunction tended to survive longer. valve, symptoms (angina pectoris, syncope, congestive heart failure), the presence or progression of cardiac enlargement on serial chest radiographs, and abnormally low ejection fraction (EF) (54% or less as defined previously2). Categorizing patients according to predominant lesion showed that 144 patients had predominant AS (peak-to-peak transvalvular pressure gradient of 45-150 mm Hg with or without associated aortic regurgitation) and 155 patients had predominant Al (massive regurgitation documented by aortic root angiography,3 with or without peak-to-peak transvalvular pressure gradient of less than 30 mm Hg). Cardiac CatheterizationAll patients underwent right-and left-heart catheterization within 6 months before operation. A #8.5F Brockenbrough catheter was positioned by transseptal puncture into the left ventricle and a pigtail catheter (#7F) was advanced retrogradely into the aortic root. Pressures were recorded on an Oscillomink directwriting system with Statham transducers before injection of contrast material. LV end-diastolic pressure was measured after the "a" wave. The cardiac index was determined by the Fick method. Valve areas were not calculated, because cases with associated angiographically visible mild-to-moderate aortic regurgitation were placed in this AS group. Single-plane 35-mm cineangiograms of the left ventricle were filmed (50 ml Urografin 76) at 50 frames/sec, in the 300 right anterior oblique projection with a Phillips image-intensifier system. Aortic root angiography was performed to estimate the degree of aortic regurgitation.

The pathogenesis of angina pectoris in patients with left ventricular hypertrophy secondary to arterial hypertension and with normal coronary arteries remains uncertain. We measured coronary blood flow (argon method) in 12 control subjects and in 16 patients with arterial hypertension at rest and after intravenous administration of dipyridamole (0.5 mg/kg). In the patients with arterial hypertension, coronary blood flow response to dipyridamole was markedly reduced ( the extravascular component of coronary resistance.5-13 To further evaluate hypertensive patients with angina but with normal coronary arteriograms, the following studies were performed in addition to left ventricular and coronary angiography: (1) coronary blood flow (CBF) was measured at rest and during dipyridamoleinduced coronary vasodilation and (2) biopsy specimens were taken from left ventricular myocardium for microscopic evaluation of intramyocardial vessels and of the myocardial cells. Materials and methodsGroup A (control subjects) consisted of 12 patients (seven men, five women; mean age 44.8 years) without detectable heart disease. These patients suffered from recurrent atypical chest pain and they were referred for coronary arteriography to exclude an organic cause of the symptoms. All patients in this group had normal electrocardiograms (ECGs) at rest and during exercise and normal coronary and left ventricular angiograms.Group B comprised 16 patients (11 men, five women; mean age 51.4 years) with arterial hypertension class 1 or 11.14 The history of hypertension varied from 4 to more than 20 years (average 9.5 + 6.2 years). Patients were treated in addition to thiazide-type diuretics with /-adrenergic blocking agents (n = 12) and/or hydralazine (n = 3) or prazosin (n = 3). All patients had typical stress-induced angina pectoris that could be promptly relieved by nitroglycerin. The ECG showed evidence of left

No abstract

No abstract