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Published on: May 21, 2017
Regression of coronary artery dimensions after successful aortic valve replacement
1Department of Internal Medicine, University Hospital, Zurich, Switzerland.
Insights
Regression of myocardial hypertrophy after aortic valve replacement reduces coronary artery size in patients with aortic valve disease. Although coronary artery dimensions decrease, they remain adequate for the reduced left ventricular mass.
Area of Science:
- Cardiology
- Cardiac Surgery
- Vascular Biology
Background:
- Patients with aortic valve disease often develop myocardial hypertrophy.
- The impact of reducing this hypertrophy on coronary artery dimensions is not fully understood.
Purpose of the Study:
- To evaluate the effect of regression of myocardial hypertrophy on coronary artery dimensions after aortic valve replacement.
- To assess if coronary artery size remains appropriate relative to left ventricular mass post-surgery.
Main Methods:
- Quantitative coronary arteriography was used to measure the cross-sectional area (CSA) of major coronary arteries (left anterior descending [LAD], left circumflex [LCx], and right coronary artery) in 15 patients before and after aortic valve replacement.
- Left ventricular (LV) mass was calculated, and coronary artery size was normalized per 100g of LV mass.
- Twelve healthy subjects served as controls.
Main Results:
- Preoperatively, CSA of the LAD and LCx were significantly larger in patients with aortic valve disease compared to controls.
- Following valve replacement, the CSA of the LAD and LCx decreased significantly but remained larger than in controls.
- The CSA of the right coronary artery did not differ between patients and controls, either before or after surgery.
- LV muscle mass significantly decreased after valve replacement but remained elevated compared to controls.
- The index of CSA per 100g of LV mass was initially abnormal in patients but normalized postoperatively.
Conclusions:
- Aortic valve replacement leads to a regression of myocardial hypertrophy and a decrease in the size of the left main coronary arteries (LAD and LCx).
- Despite the reduction, the size of the LAD and LCx remains adequate for the normalized left ventricular mass after surgery.
- The right coronary artery size is unaffected by aortic valve replacement and regression of hypertrophy.
Background:
The effect of regression of myocardial hypertrophy on coronary artery dimensions was evaluated in patients with aortic valve disease who underwent valve replacement.
Methods And Results:
Cross-sectional area (CSA) of the three major coronary arteries (left anterior descending [LAD], left circumflex [LCx], and right coronary artery) was determined by quantitative coronary arteriography in 15 patients with aortic valve disease before and 38 months (range, 14-113 months) after successful aortic valve replacement. Twelve normal subjects served as controls. Left ventricular (LV) angiographic mass was calculated according to the method of Rackley. CSA of the left coronary artery was larger in aortic valve disease than in controls (LAD, 15 versus 8 mm2, p less than 0.001; LCx, 14 versus 6 mm2, p less than 0.001). After valve replacement, CSA of the left coronary artery decreased (LAD, 12 mm2, p less than 0.05 versus before surgery; LCx, 11 mm2, p less than 0.05 versus before surgery) but remained significantly larger than in controls. CSA of the right coronary artery in patients with aortic valve disease was not different from controls. LV muscle mass was significantly increased in aortic valve disease patients before (364 g) and after (250 g) valve replacement compared with controls (135 g). The appropriateness of coronary artery size with respect to muscle mass was evaluated by normalizing CSA of the left coronary artery (LAD + LCx) per 100 g of LV muscle mass (mm2/100 g). This index amounted to 11 mm2/100 g in controls, to 8 mm2/100 g in preoperative patients (p less than 0.05 versus controls), and to 10 mm2/100 g in postoperative patients with aortic valve disease (p = NS versus controls).
Conclusions:
In patients with aortic valve disease, CSA of the proximal LAD and LCx is increased, but this increase is not sufficient to keep CSA per 100 g of LV mass within normal limits. The postoperative decrease in muscle mass is associated with a decrease in the size of LAD and LCx, whereas the size of the right coronary artery remains unchanged. In contrast to the preoperative state, the residually hypertrophied LV myocardium after aortic valve replacement is supplied by an enlarged but adequately sized LAD and LCx.
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