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[Regression of heart hypertrophy in patients with operated aortic valve diseases]
Insights
Valve replacement surgery significantly reduced left ventricular muscle mass in patients with aortic stenosis and combined aortic valve lesions. While ejection fraction improved across groups, normalization of muscle mass was less frequent in patients with chronic aortic insufficiency.
Area of Science:
- Cardiovascular Surgery
- Cardiac Physiology
- Valvular Heart Disease
Context:
- Aortic stenosis (AS) and aortic insufficiency (AI) are significant valvular heart conditions.
- Left ventricular remodeling is a key pathophysiological feature of these diseases.
- Surgical valve replacement is the primary treatment modality.
Purpose:
- To evaluate the impact of valve replacement on left ventricular angiographic muscle mass (LMMI) and ejection fraction (EF) in patients with AS, combined AS + AI, and AI.
- To assess the rate of LMMI normalization post-surgery.
- To identify factors influencing LMMI normalization.
Summary:
- Successful valve replacement led to a significant decrease in LMMI across all patient groups (AS, AS + AI, AI).
- Left ventricular end-diastolic wall thickness decreased in AS and AS + AI groups but not in the AI group.
- Ejection fraction improved post-surgery in all groups, though it remained lower in the AI group compared to others and controls.
Impact:
- Postoperative LMMI normalization occurred in 67% of AS, 52% of AS + AI, and 35% of AI patients.
- Age and time to recatheterization did not influence LMMI normalization.
- These findings highlight the differential impact of valve replacement on left ventricular remodeling based on the specific valvular lesion.
Abstract:
In 33 patients with aortic stenosis (AS), 27 with combined aortic valve lesion (AS + AI) and 23 with chronic aortic insufficiency (AI) left ventricular angiographic muscle mass (LMMI) was determined before and after successful valve replacement. Preoperative age in the three groups was 51, 47 and 42 years (P less than 0.05 vs. AS) respectively; recatheterization was carried out 17, 20 and 21 months postoperatively (not significant). In all three groups angiographic mass decreased (P less than 0.001) following surgery: In AS from 167 to 117, in AS + AI from 200 to 127 and in AI from 192 to 142 g/m2. Left ventricular end-diastolic wall thickness decreased from 1.22 to 1.02 (P less than 0.001) in AS and from 1.19 to 1.03 cm (P less than 0.001) in AS + AI. No change of wall thickness occurred in the patients with AI. Left ventricular ejection fraction (EF) increased from 61 to 68% (P less than 0.01) in AS, from 58 to 68% (P less than 0.005) in AS + AI and from 52 to 59% (P less than 0.02) in AI. The postoperative EF in the patients with AI was smaller (P less than 0.05) than in AS, AS + AI and in controls (EF = 68%, n = 18). Postoperative normalization of LMMI (less than or equal to 120 g/M2) occurred in 22/33 (67%) patients with AS, in 14/27 (52%) with AS + AI and in 8/23 (35%) with AI. The age of the patients and the time interval between surgery and recatheterization had no influence on postoperative normalization or non-normalization of LMMI.(ABSTRACT TRUNCATED AT 250 WORDS)