Circulation, Vol 61, 471-483, Copyright © 1980 by American Heart Association
WL Henry, RO Bonow, JS Borer, JH Ware, KM Kent, DR Redwood, CL McIntosh, AG Morrow and SE Epstein
Fifty consecutive patients undergoing aortic valve replacement for isolated
aortic regurgitation were studied prospectively by echocardiography,
electrocardiography and cardiac catheterization. Good quality
echocardiograms were obtained in 49 of the 50 patients. Left ventricular
(LV) dilatation was present in all 49 patients. LV systolic function, as
assessed by echocardiographic percent fractional shortening, was normal in
many patients but was moderately to severely reduced (less than 25%) in 14
patients (29%). Echocardiographic studies 6 months postoperatively revealed
significant reductions in LV end- diastolic dimension (73.8 mm vs 58.7 mm;
p less than 0.01), and serial echocardiographic studies early and late
after operation revealed that the decrease in LV size had occurred by the
time of the early study (8- 22 days postoperatively), with little
additional change thereafter. Operative deaths occurred in three of the 49
patients (6%). Eight of the 49 patients (16%) died of congestive heart
failure (CHF) after hospital discharge at times ranging from 5-43 months
after operation. Preoperative echocardiographic measurements of the LV
end-systolic dimension and percent fractional shortening were strongly
associated (p less than 0.01) with these late CHF deaths. Preoperative LV
end- systolic dimension greater than 55 mm and fractional shortening less
than 25% identified the high-risk group: nine of 13 patients (69%) in this
group died either at operation or subsequently from CHF. In contrast, of 32
patients with LV end-systolic dimension less than 55 mm, only one died at
operation and one died late from CHF. Thus, the population at high risk of
late death from CHF was identified before operation by echocardiography.
ARTICLES
Observations on the optimum time for operative intervention for aortic regurgitation. I. Evaluation of the results of aortic valve replacement in symptomatic patients
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