Circulation, Vol 78, 1108-1120, Copyright © 1988 by American Heart Association
RO Bonow, JT Dodd, BJ Maron, PT O'Gara, GG White, CL McIntosh, RE Clark and SE Epstein
In most patients with aortic regurgitation, valve replacement results in
reduction in left ventricular dilatation and an increase in ejection
fraction. To determine the relation between serial changes in ventricular
dilatation and changes in ejection fraction, we studied 61 patients with
chronic severe aortic regurgitation by echocardiography and radionuclide
angiography before, 6-8 months after, and 3-7 years after aortic valve
replacement. Between preoperative and early postoperative studies, left
ventricular end-diastolic dimension decreased (from 75 +/- 6 to 56 +/- 9
mm, p less than 0.001), peak systolic wall stress decreased (from 247 +/-
50 to 163 +/- 42 dynes x 10(3)/cm2), and ejection fraction increased (from
43 +/- 9% to 51 +/- 16%, p less than 0.001). Between early and late
postoperative studies, diastolic dimension and peak systolic wall stress
did not change, but ejection fraction increased further (to 56 +/- 19%, p
less than 0.001). The increase in ejection fraction correlated with
magnitude of reduction in diastolic dimension between preoperative and
early postoperative studies (r = 0.63), between early and late
postoperative studies (r = 0.54), and between preoperative and late
postoperative studies (r = 0.69). Late increases in ejection fraction
usually represented the continuation of an initial increase occurring early
after operation. Thus, short-term and long-term improvement in left
ventricular systolic function after operation is related significantly to
the early reduction in left ventricular dilatation arising from correction
of left ventricular volume overload. Moreover, late improvement in ejection
fraction occurs commonly in patients with an early increase in ejection
fraction after valve replacement but is unlikely to occur in patients with
no change in ejection fraction during the first 6 months after operation.
ARTICLES
Long-term serial changes in left ventricular function and reversal of ventricular dilatation after valve replacement for chronic aortic regurgitation
Cardiology Branch, National Heart, Lung, and Blood Institute, Bethesda, Maryland 20892.
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