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Rest and exercise hemodynamics before and after valve replacement--a combined Doppler/catheter study
U Nellessen1, G Inselmann, J Ludwig
1Johanniter-Krankenhaus der Altmark, Stendal gGmbH, Medizinische Klinik II, Germany.
Clinical Cardiology
|February 19, 2000
Summary
Following valve replacement, some patients exhibit abnormal exercise hemodynamics, including exercise-induced pulmonary hypertension and abnormal left ventricular filling pressures. These issues may not be due to prosthesis obstruction and can be masked at rest.
Area of Science:
- Cardiovascular Surgery
- Cardiology
- Pulmonary Hypertension
Background:
- Hemodynamic improvement is typical after valve replacement surgery.
- Some patients display abnormal exercise hemodynamics despite a functioning prosthesis and normal ejection fraction.
Purpose of the Study:
- To evaluate rest and exercise hemodynamics in patients post-aortic or mitral valve replacement.
- To compare postoperative findings with preoperative data in patients without coronary artery disease or left ventricular failure.
Main Methods:
- Combined catheterization and Doppler study in 23 patients (12 aortic, 11 mitral).
- Measured cardiac output, pulmonary pressures, and pulmonary resistance via right heart catheterization.
- Assessed valve prosthesis gradient using Doppler echocardiography at rest and during exercise.
Main Results:
- Significant increase in cardiac output with exercise in both groups.
- Reduced pulmonary pressures and resistance postoperatively, but elevated significantly during exercise.
- Increased valve prosthesis gradients noted, but no correlation with pulmonary pressures.
Conclusions:
- Exercise-induced pulmonary hypertension and abnormal left ventricular filling pressures are frequent post-valve replacement.
- These abnormalities are likely unrelated to prosthesis obstruction and may present atypically at rest.