Circulation, Vol 58, 825-836, Copyright © 1978 by American Heart Association
WH Gaasch, CW Andrias and HJ Levine
Serial echocardiographic left ventricular (LV) studies were performed in 19
patients before (preop) and after (postop) aortic valve replacement (AVR)
for chronic aortic regurgitation (AR); the effect of AVR on LV volume, mass
and function was determined from the echocardiographic data. In the 12
patients who were considered to have successful surgical results, the
average LV end-diastolic dimension fell from a preop value of 6.9 +/- 0.2
cm to 5.5 +/- 0.2 cm (P less than 0.01) at the time of the early postop
study (seven to 10 days). Muscle cross-sectional area (CSA) derived from
dimension and wall thickness data was used as an index of LV muscle mass
(preop CSA = 26 +/- 1.3 cm2); CSA was unchanged at the early postop study,
but subsequently fell to near normal within six months after AVR (20 +/- 1
cm2, P less than 0.01). There was a trend toward improvement in systolic
performance by the late postop studies (12+ months). In two out of three
patients with postop paravalvular AR, LV dimension increased after an
initial fall. Four patients without paravalvular AR failed to show a
significant reduction in LV dimension in the postop studies. In this group
the preop studies showed a tendency toward a large end-diastolic dimension
and decreased fractional shortening, but the single preop parameter which
differentiated these four from the successfully treated group was an
end-diastolic radius-to-wall thickness (R/Th) ratio greater than or equal
to 4. Thus, successful AVR for chronic AR results in the normalization of
LV volume and a decrease in LV muscle mass to near normal. The R/Th ratio
has important prognostic value which appears to be independent of
fractional shortening in some patients with chronic AR.
ARTICLES
Chronic aortic regurgitation: the effect of aortic valve replacement on left ventricular volume, mass and function
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