Circulation, Vol 70, 570-579, Copyright © 1984 by American Heart Association
RO Bonow, DR Rosing, BJ Maron, CL McIntosh, M Jones, SL Bacharach, MV Green, RE Clark and SE Epstein
Preoperative left ventricular systolic function is an important predictor
of postoperative prognosis in patients with aortic regurgitation. Although
left ventricular dysfunction is reversible after aortic valve replacement
to a greater extent in patients with good preoperative exercise capacity
compared with patients with impaired exercise capacity, not all patients
with preserved exercise capacity demonstrate improved left ventricular
function after aortic valve replacement. To determine the influence of
duration of preoperative left ventricular dysfunction on postoperative
reversal of left ventricular dysfunction, we studied 37 patients with
aortic regurgitation who preoperatively had left ventricular dysfunction,
defined as subnormal echocardiographic fractional shortening (less than
29%), and good preoperative exercise capacity, defined as completion of
stage I of the NIH treadmill protocol without limiting symptoms. Eight
patients were asymptomatic. In 11 patients left ventricular dysfunction was
documented 18 to 57 months preoperatively (prolonged); in 10 patients left
ventricular dysfunction developed in an interval of 14 months or less
preoperatively (brief); in 16 patients duration of left ventricular
dysfunction was unknown. Patients with brief vs those with prolonged left
ventricular dysfunction did not differ with respect to severity of
preoperative symptoms or exercise tolerance, echocardiographically
determined left ventricular dimensions or fractional shortening (25 +/- 3%
[SD] vs 25 +/- 3%), or radionuclide angiographic ejection fraction (42 +/-
5% vs 42 +/- 5%).(ABSTRACT TRUNCATED AT 250 WORDS)
ARTICLES
Reversal of left ventricular dysfunction after aortic valve replacement for chronic aortic regurgitation: influence of duration of preoperative left ventricular dysfunction
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