Circulation, Vol 58, 255-264, Copyright © 1978 by American Heart Association
N Smith, JH McAnulty and SH Rahimtoola
Nineteen patients, aged 58-80 years, with severe isolated aortic valve
stenosis, severely reduced ejection fraction and clinical heart failure
underwent aortic valve replacement between January 1970 and April 1977. Ten
had concomitant coronary artery disease (all underwent additional coronary
bypass surgery), 17 had angina pectoris and four had syncope. Aortic valve
area index was 0.32 +/- 0.03 cm2/m2 (mean +/- SEM); left ventricular (LV)
end-diastolic volume index was 117 +/- 9 ml/m2 and LV ejection fraction was
0.37 +/- 0.02. There were four operative deaths and one late death. The
follow-up time ranged from six to 74 months (38 +/- 6 months). Actuarially
determined three-year survival is 74 +/- 10%; the expected five-year
survival is the same. One patient had a serious cerebrovascular accident.
Of the remaining survivors, seven were initially Functional Class IV and
six Class III; currently, six are Class I and seven Class II (New York
Heart Association classifications). The cardiothoracic ratio has decreased
from 0.54 +/- 0.03 to 0.49 +/- 0.03. Repeat hemodynamic evaluation has been
performed in 10 patients, 22 +/- 6 months after surgery. In these 10
patients, the aortic valve gradient decreased from 55 +/- 7 11 +/- 1.3 mm
Hg; LV end-diastolic pressure from 22 +/- 2.4 to 9 +/- 1.9 mm Hg; LV end-
diastolic volume index from 119 +/- 16 ml/m2 to 107 +/- 11 ml/m2. LV
ejection fraction has increased dramatically from 0.34 +/- 0.03 to 0.63 +/-
0.05 and mean velocity of circumferential fiber shortening from 0.57 +/-
0.08 to 1.3 +/- 0.18 circ/sec. The encouraging long-term survival, improved
functional class and the marked improvement in left ventricular function
that occurred in our patients indicate that all patients with severe aortic
stenosis in clinical heart failure should be offered aortic valve
replacement.
ARTICLES
Severe aortic stenosis with impaired left ventricular function and clinical heart failure: results of valve replacement
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|
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|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
S. H. RAHIMTOOLA The Need for Cardiac Catheterization and Angiography in Valvular Heart Disease is NotDisproven Ann Intern Med, September 1, 1982; 97(3): 433 - 439. [Abstract] [PDF]
|
|
|
|
 |
|
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|
|
|
|
|
|
J. ROSS Jr. Left Ventricular Function and the Timing of Surgical Treatment in Valvular Heart Disease Ann Intern Med, April 1, 1981; 94(4_Part_1): 498 - 504. [Abstract] [PDF]
|
|