Related Experiment Videos
[Regression of myocardial hypertrophy in aortic valve disease following aortic valve replacement]
H P Krayenbühl1, O M Hess, J Schneider
1Medizinische Poliklinik, Universitätsspital, Zürich.
Insights
Successful aortic valve replacement significantly reduces left ventricular mass and fibrosis in patients with aortic valve disease. Early and sustained cardiac remodeling occurs, challenging previous beliefs about irreversible interstitial fibrosis.
Area of Science:
- Cardiology
- Cardiac Surgery
- Pathology
Context:
- Aortic valve disease significantly impacts left ventricular structure and function.
- Valve replacement is a common intervention for severe aortic valve disease.
- Understanding post-operative cardiac remodeling is crucial for patient outcomes.
Purpose:
- To investigate the long-term effects of aortic valve replacement on left ventricular mass, hypertrophy, and fibrosis.
- To determine factors influencing the normalization of left ventricular mass post-surgery.
- To re-evaluate the concept of irreversible interstitial fibrosis in hypertrophied ventricles.
Summary:
- Successful aortic valve replacement leads to a significant decrease in left ventricular angiographic mass (31-37% of preoperative values) 14-15 months post-surgery.
- Normalization of left ventricular mass occurs in 2/3 of aortic stenosis patients and 1/3 of aortic insufficiency patients, dependent on preoperative hypertrophy.
- Muscle fiber diameter decreases, and interstitial fibrosis shows early increases but ultimately decreases significantly by five years, indicating reversibility.
Impact:
- Findings challenge the long-held belief that established interstitial fibrosis is irreversible after hemodynamic burden removal.
- Demonstrates significant and sustained cardiac remodeling following aortic valve replacement.
- Provides valuable insights for managing patients with aortic valve disease and predicting long-term cardiac health.
Abstract:
In patients with aortic valve disease successful valve replacement leads to a significant decrease in left ventricular angiographic mass, which 14-15 months postoperatively ranges between 31 and 37% of the preoperative value. Postoperative normalization of angiographic mass occurs in 2/3 of the patients with aortic stenosis and in 1/3 of the patients with aortic insufficiency. The degree of preoperative hypertrophy determines whether angiographic mass does or does not normalize after valve replacement. In patients with aortic stenosis and combined lesions, left ventricular end-diastolic wall thickness decreases postoperatively and remains unchanged in the patients with aortic insufficiency. Muscle fiber diameter decreases significantly in the first two years after valve replacement and thereafter remains unchanged. The upper limit of normal (20 mu) is not reached. Relative interstitial fibrosis increases early after surgery whereas left ventricular fibrous content remains unchanged during the first two years after valve replacement. Five years postoperatively there was a significant decrease in left ventricular fibrous content both in patients with aortic stenosis and with aortic insufficiency. Hence there appears to be no longer any validity in the earlier concept that a once established interstitial fibrosis in patients with concentric and eccentric hypertrophy is irreversible after removal of the abnormal hemodynamic burden.