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[Left intraventricular dynamic gradients in the follow-up of aortic valve replacement: an echo-Doppler study]
M Laurent1, C Varin, V Pasquali
1Service de cardiologie B, Hôtel-Dieu, Rennes.
Insights
Dynamic intraventricular pressure gradients are common after aortic stenosis surgery. Doppler echocardiography helps identify these gradients, guiding treatment to avoid aggravating medications.
Area of Science:
- Cardiology
- Echocardiography
- Hemodynamics
Background:
- Intraventricular pressure gradients in aortic stenosis patients pose a high risk for postoperative complications.
- Severe aortic stenosis is defined as a valve area less than 0.75 cm2.
Purpose of the Study:
- To investigate the prevalence and characteristics of intraventricular flow dynamics after aortic stenosis valve replacement using Doppler echocardiography.
- To identify factors associated with these gradients and their clinical implications.
Main Methods:
- Doppler echocardiographic study of left ventricular flow in 51 patients post-aortic valve replacement.
- Measurement of intraventricular systolic velocities, pressure gradients, and left ventricular dimensions.
- Assessment of factors influencing gradients, including ventricular size and wall thickness.
Main Results:
- Significant intraventricular systolic velocities (>2.5 m/s) were observed in 8 patients at baseline and 7 after amyl nitrite inhalation.
- Highest velocities were localized at the mitral papillary muscle level, associated with reduced ventricular cavity size.
- High gradients correlated with smaller ventricular dimensions, thicker walls, and smaller preoperative aortic valve area.
Conclusions:
- Dynamic intraventricular gradients are prevalent after surgical aortic stenosis correction.
- Doppler echocardiography is valuable for detecting these gradients and informing treatment decisions.
- Avoidance of certain drugs like inotropic agents, vasodilators, and diuretics is recommended to prevent exacerbation of hemodynamic abnormalities.
Abstract:
The possibility of an intraventricular pressure gradient in patients with aortic stenosis is well known: this entity is associated with a high risk of postoperative complications. The authors carried out a Doppler echocardiographic study of flow in the left ventricle in 51 patients who had recently undergone valve replacement for severe aortic stenosis (valve area < 0.75 cm2). Before surgery, only one patient had significant acceleration of intraventricular systolic flow attaining 3.8 m/s (maximum pressure gradient of 60 mmHg). After surgery, maximum intraventricular systolic velocities of over 2.5 m/s with a typical end systolic peak were observed in 8 patients under basal conditions (gradients of 30 to 115 mmHg), and in 7 others after inhalation of amyl nitrite. Pulsed spectral and color Doppler flow mapping showed that the highest velocities were located at the mitral papillary muscle level. In addition, these patients had significant reduction in cavity size. Only one patient had systolic anterior motion of the anterior mitral leaflet with septal contact. Left ventricular dimensions were measured by TM echocardiography. High intraventricular velocities seemed to be significantly related to the smallest ventricular dimensions, the thickest ventricular walls and the smallest preoperative aortic valve surface area. The highest intraventricular pressure gradients-disappeared with betablocker therapy (4 cases), after correction of hypovolemia (1 case), after drainage of large pericardial effusions (2 cases) or spontaneously (1 case). This study confirms the relatively high prevalence of dynamic intraventricular gradients after surgical cure of aortic stenosis and the value of Doppler echocardiography for the avoidance of certain drugs (inotropic agents, vasodilators, diuretics), which could aggravate the hemodynamic abnormality.(ABSTRACT TRUNCATED AT 250 WORDS)