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Immediate effect of aortic valve replacement for aortic stenosis on left ventricular diastolic chamber stiffness
P A McKenney1, C S Apstein, L A Mendes
1Department of Medicine, Boston Medical Center and Boston University School of Medicine, Massachusetts 02118, USA.
Insights
Aortic valve replacement for aortic stenosis increases left ventricular (LV) diastolic chamber stiffness. This finding suggests potential worsening diastolic function post-surgery, impacting cardiac performance.
Area of Science:
- Cardiology
- Cardiac Surgery
- Echocardiography
Background:
- Diastolic dysfunction is a known complication following coronary artery bypass surgery.
- Left ventricular (LV) hypertrophy in patients with aortic stenosis may exacerbate diastolic dysfunction after aortic valve replacement (AVR).
Purpose of the Study:
- To investigate the impact of AVR on LV diastolic function in patients with aortic stenosis.
- To determine if pre-existing LV hypertrophy influences diastolic function changes post-AVR.
Main Methods:
- Utilized transesophageal echocardiography to obtain LV images.
- Measured simultaneous pulmonary arterial wedge pressures to assess LV diastolic function.
- Defined the LV diastolic pressure-cross-sectional area relationship before and immediately after AVR in 14 patients.
Main Results:
- LV diastolic chamber stiffness significantly increased in all patients post-AVR.
- A leftward shift in the LV diastolic pressure-cross-sectional area relation indicated increased stiffness.
- Mean LV end-diastolic cross-sectional area decreased by 32% (from 17.9 to 12.1 cm²) at comparable filling pressures.
Conclusions:
- Aortic valve replacement for aortic stenosis leads to increased LV diastolic chamber stiffness.
- These findings highlight a potential for impaired diastolic function after AVR, warranting further investigation.
Abstract:
Diastolic dysfunction is common after coronary artery bypass surgery, and we hypothesized that left ventricular (LV) hypertrophy associated with aortic stenosis may lead to worsening LV diastolic function after aortic valve replacement for aortic stenosis. Transesophageal echocardiographic LV images and simultaneous pulmonary arterial wedge pressures were used to define the LV diastolic pressure cross-sectional area relation before and immediately after aortic valve replacement for aortic stenosis in 14 patients. In all patients, LV diastolic chamber stiffness increased, as evidenced by a leftward shift in the LV diastolic pressure cross-sectional area relation. At comparable LV filling (pulmonary arterial wedge) pressures the mean LV end-diastolic cross-sectional area preoperatively was 17.9 +/- 1.7 cm2, but decreased by 32% after aortic valve replacement to 12.1 +/- 1.2 cm2 (p = 0.0001). In conclusion, after aortic valve replacement, diastolic chamber stiffness increased in all patients.