Postoperative regression of left ventricular dimensions in aortic insufficiency: A long-term echocardiographic study

Abstract

The ability of preoperative M-mode echocardiography to predict the clinical course and the decrease in left ventricular size was assessed in 42 patients after uncomplicated valve replacement for isolated aortic insufficiency. During follow-up study, one patient died of chronic heart failure. The New York Heart Association functional class of the 41 survivors improved from 2.4 to 1.2. All patients had a preoperative M-mode echocardiogram. Serial echocardiographic measurements, available in 33 patients, showed a sustained decrease in left ventricular end-diastolic dimension after the first postoperative year from 73 +/- 8 to 57 +/- 9 mm at 6 to 12 months and to 53 +/- 9 mm at 3 years postoperatively (p less than 0.01). Left ventricular cross-sectional area decreased from 31 +/- 8 to 26 +/- 7 cm2 and then to 23 +/- 5 cm2 at the latest follow-up study (p less than 0.01). At 3 years postoperatively, M-mode echocardiograms were available in 37 patients: 24 had a normal left ventricular dimension (group 1), while 13 still had an enlarged left ventricle (group 2). The clinical course in these two groups was similar. The best preoperative predictor of persistent left ventricular enlargement was the end-diastolic dimension (p less than 0.05), whereas fractional shortening and the end-diastolic radius/thickness ratio were not predictive.(ABSTRACT TRUNCATED AT 250 WORDS)

2008 Focused Update Incorporated Into the ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease

“…[235][236][237][238][239][240][241][242][243][244][245][246] With time, during which the ventricle develops progressive chamber enlargement and a more spherical geometry, depressed myocardial contractility predominates over excessive loading as the cause of progressive systolic dysfunction. This can progress to the extent that the full benefit of surgical correction of the regurgitant lesion, in terms of recovery of LV function and improved survival, can no longer be achieved.…”

Preoperative Indexed Left Ventricular Dimensions to Predict Early Recovery of Left Ventricular Function After Aortic Valve Replacement for Chronic Aortic Regurgitation

“…Previous studies demonstrated that persistent ventricular dilatation and dysfunction identifies patients at risk of death from congestive heart failure. 17, 19 Recently, operative mortality and overall survival was shown to decline after AVR in a high-risk group. Therefore, we prefer surgical correction over medically conservative care even in high-risk patients.…”

The role of angiography in the congruence of cardiovascular measurements between autopsy and postmortem imaging

“…In spite of the anatomical proximities and the pathological functioning [42][43][44][45][46][47][48][49][50][51] that urged our study to analyze the correlation between the right atrium and the tricuspid valve, the right ventricle and the pulmonary valve, the left atrium and the mitral valve, and the left ventricle and the aortic valve, our results did not display any correlation. This outcome could be explained by two hypotheses.…”