Circulation, Vol 86, 926-936, Copyright © 1992 by American Heart Association
G Aurigemma, S Battista, D Orsinelli, A Sweeney, L Pape and H Cuenoud
BACKGROUND. We examined the clinical and echocardiographic characteristics
of patients undergoing aortic valve replacement for aortic stenosis whose
continuous wave Doppler studies showed abnormal intracavitary flow
acceleration. METHODS AND RESULTS. The clinical and Doppler
echocardiographic records of 53 consecutive patients undergoing aortic
valve replacement for aortic stenosis were reviewed. Doppler
echocardiography was performed at a mean of 6.6 days (range, 0-22 days)
after surgery. Thirteen patients (group 1) had a dagger-shaped high-
velocity systolic flow signal indicative of abnormal intracavitary flow
acceleration on their postoperative Doppler study; group 2 comprised 40
aortic stenosis patients who underwent aortic valve replacement but had no
postoperative evidence of abnormal intracavitary flow acceleration. Group 1
postoperative abnormal intracavitary flow velocities ranged from 1.8 to 6.8
m/sec (mean, 4.9 +/- 0.9 m/sec): Resulting dynamic gradients ranged from 10
to 184 mm Hg (mean, 104.6 +/- 32 mm Hg). Compared with group 2, group 1
patients had a distinctive ventricular geometry with more-pronounced
hypertrophy, smaller cavities, and higher ejection fraction. Systolic
anterior motion of the mitral valve did not accompany abnormal
intracavitary flow acceleration in any patient. Six of 13 group 1 patients
suffered postoperative hemodynamic compromise characterized by severe
hypotension despite adequate pulmonary capillary wedge pressures; group 1
postoperative mortality was significantly greater than that seen in group 2
patients (38% versus 12%, p less than 0.05). CONCLUSIONS. Abnormal
intracavitary flow acceleration after aortic valve replacement for severe
aortic stenosis is associated with a distinctive ventricular geometry and
supernormal systolic function but not systolic anterior motion of the
mitral valve. Such flow acceleration appears to be a marker for increased
postoperative morbidity and mortality. Preoperative and postoperative
Doppler echocardiography may be useful in risk stratification and guiding
therapy.
ARTICLES
Abnormal left ventricular intracavitary flow acceleration in patients undergoing aortic valve replacement for aortic stenosis. A marker for high postoperative morbidity and mortality
Noninvasive Laboratory, University of Massachusetts Medical Center, Worcester 01655.
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