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Normalization of diastolic dysfunction in aortic stenosis late after valve replacement
B Villari1, G Vassalli, E S Monrad
1Department of Internal Medicine, University Hospital, Zurich, Switzerland.
Circulation
|May 1, 1995
Summary
Left ventricular remodeling after aortic valve replacement (AVR) for aortic stenosis shows initial diastolic stiffness and reduced relaxation. Full normalization of diastolic function and interstitial fibrosis takes years post-AVR.
Area of Science:
- Cardiology
- Cardiac Surgery
- Cardiovascular Research
Background:
- Aortic stenosis (AS) causes significant left ventricular (LV) remodeling.
- Aortic valve replacement (AVR) aims to reverse these changes.
- Understanding the timeline of LV recovery post-AVR is crucial.
Purpose of the Study:
- To investigate the long-term structural and functional changes in the left ventricle after aortic valve replacement in patients with severe aortic stenosis.
- To assess the progression and regression of left ventricular remodeling, including diastolic function and interstitial fibrosis.
Main Methods:
- Prospective study of 12 patients with severe AS before and after AVR (early and late follow-up).
- Utilized left ventricular biplane angiograms, pressure measurements, and endomyocardial biopsies.
- Compared findings with 10 healthy controls.
Main Results:
- LV muscle mass remained elevated post-AVR, though decreased significantly. Ejection fraction slightly increased.
- LV relaxation improved, but diastolic stiffness initially increased then normalized late after AVR.
- Interstitial fibrosis and fibrous content decreased significantly late after AVR, indicating tissue regression.
Conclusions:
- Diastolic dysfunction in AS post-AVR improves over years, paralleled by interstitial fibrosis regression.
- Both muscular and non-muscular tissue regression contribute to late normalization of diastolic function.
- Complete reversal of diastolic dysfunction and remodeling is a lengthy process following AVR.