Deep T wave inversions after value replacement for chronic aortic regurgitation: possible conversion from a diastolic to systolic overload pattern

This report describes deep, non-infarctional T wave inversions occurring after aortic valve replacement for severe, chronic aortic regurgitation. These new T wave inversions may reflect the effect of abruptly converting a severe preoperative diastolic overload state to a post-operative systolic overload state caused by mild or moderate prosthetic valve stenosis. Other factors such as non-infarctional intra-operative ischemia or mechanical injury may also play a role in the pathogenesis of these repolarization abnormalities. The T wave changes were most marked in the immediate post-operative period and tended to regress in the weeks and months following value replacement. The differential diagnosis of these ST-T changes is discussed.