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Reduction of left ventricular hypertrophy with St. Jude Medical 19 mm valve prosthesis
1Department of Surgery, Kobe University School of Medicine, Japan.
Insights
The St. Jude Medical 19 mm valve effectively reduces left ventricular hypertrophy in aortic stenosis or regurgitation patients with a body surface area under 1.6 m2. However, caution is advised due to potential pressure gradient increases during exercise.
Area of Science:
- Cardiovascular Surgery
- Biomedical Engineering
- Clinical Cardiology
Background:
- The St. Jude Medical 19 mm valve (SJM19) is used as an aortic prosthesis.
- Assessing the functional range of prosthetic valves is crucial for patient outcomes.
- Left ventricular (LV) hypertrophy is a significant consequence of aortic valve disease.
Purpose of the Study:
- To evaluate the permissible range of the St. Jude Medical 19 mm valve (SJM19) in aortic prosthesis implantation.
- To assess transvalvular maximal pressure gradient (maxPG) and postoperative reduction of LV hypertrophy following SJM19 implantation.
Main Methods:
- Doppler echocardiography was used to measure maxPG at rest and during dobutamine administration in 21 patients.
- LV mass and cross-sectional area were measured to quantify hypertrophy reduction.
- Patients with aortic regurgitation (AR) and aortic stenosis (AS) were included, with body surface area (BSA) ranging from 1.28-1.56 m2.
Main Results:
- Resting maxPG was 31 +/- 16 mmHg and increased to 32.1 +/- 15 mmHg during dobutamine administration, with no significant differences based on disease type or BSA.
- Postoperative reduction in LV mass was 26 +/- 19% and LV cross-sectional area was 21 +/- 15% at a mean of ten months.
- No significant differences in hypertrophy reduction rates were observed between AR and AS patients or based on BSA.
Conclusions:
- The SJM19 valve facilitates reduction of LV hypertrophy in patients with AR or AS and BSA < 1.6 m2.
- The valve demonstrates acceptable pressure gradients at rest and during stress.
- Limited use is recommended due to the potential for increased pressure gradients during exercise, necessitating careful patient selection.
Abstract:
To determine the permissible range of the St. Jude Medical 19 mm valve (SJM19) as an aortic prosthesis, transvalvular maximal pressure gradient (maxPG) and postoperative reduction of left ventricular (LV) hypertrophy were examined in 21 patients (body surface area [BSA] 1.28-1.56 m2, mean 1.42 m2). Doppler echocardiographically measured maxPG at rest was 31 +/- 16 mmHg, which showed no significant difference from the differences in patients' diseases (aortic regurgitation = AR or stenosis = AS), or BSA. The maxPG, also measured during dobutamine administration when they were less than 40 mmHg at rest, increased significantly from 21 +/- 11 mmHg to 32.1 +/- 15 mmHg, having no differences from the differences in diseases or BSA. Reduction of LV hypertrophy was achieved postoperatively (mean postoperative period of ten months), with the reduction rates of 26 +/- 19% in LV mass and 21 +/- 15% in LV cross-sectional area. No significant differences were found between the reduction rates and the differences in the patients' diseases or BSA. These results indicate that, following the implantation of SJM19, LV hypertrophy was reduced in patients with AR as well as with AS, when their BSA values were less than 1.6 m2. However, limited use is recommended because the increase in pressure gradient during exercise cannot be ignored.