[Is the alternating pulse a prognostically unfavorable sign for the postoperative course in patients with severe...

Pulsus alternans has been observed in patients with severe aortic valve disease and hypertensive or coronary artery disease, and has been considered a sign of severe ventricular dysfunction. Between 1974 and 1982 we observed 12 patients with severe aortic valve disease (10 aortic stenosis, 1 aortic insufficiency and 1 with a combination of both valve lesions) and pulsus alternans (group 1). Twelve patients (9 aortic stenosis, 1 aortic insufficiency and 2 with a combination of both valve lesions), but without pulsus alternans, served as controls (group 2). All 24 patients underwent surgery and were followed up for 36 months (group 1) and 50 months (group 2) respectively. One patient from group 2 died after surgery from cerebral hemorrhage. Mean age was similar in both groups (56 vs. 55 years). Preoperatively, the patients in group 1 were in a higher NYHA class (2.7 vs. 2.3; p less than 0.05) and had a higher heart rate (90 vs. 71 beats/min; p less than 0.005) than patients in group 2. M-mode echocardiography showed reduced left ventricular systolic shortening (23% vs. 35%; p less than 0.001) and increased left atrial diameter (4.6 cm vs. 3.8 cm; p less than 0.05) in group 1 compared with group 2. Systolic pressure gradient, aortic regurgitation, left ventricular end-diastolic and peak systolic pressure were, however, similar in both groups. Left ventricular angiographic ejection fraction was significantly reduced in group 1 (48% vs. 60%; p less than 0.01) compared with group 2. Postoperative follow-up was similar in both groups.(ABSTRACT TRUNCATED AT 250 WORDS)