Evaluation of Left Ventricular Functions after Aortic Valve Replacement in a Specific Young Male Patient Population with Pure Aortic Insufficiency or Aortic Stenosis: 5-Years Follow-up

Authors

  • Cengiz Bolcal
  • Suat Doganci
  • Oben Baysan
  • Vedat Yildirim
  • Murat Sargin
  • Ufuk Demirkilic
  • Harun Tatar

DOI:

https://doi.org/10.1532/HSF98.20061142

Abstract

Background. The aim of this study was to evaluate the left ventricular functions and the regression of left ventricular hypertrophy after aortic valve replacement (AVR) in young male patients with pure aortic stenosis or aortic insufficiency with no additional disease.

Methods. Young male patients who underwent AVR because of pure aortic stenosis (AS = 68) and insufficiency (AI = 70) were enrolled in the study. The mean age was 23.2 ± 1.3 and 22.6 ± 1.6 years, respectively. The follow-up time was 5 years. The parameters checked by transthoracic echocardiography were interventricular septum diastolic thickness, left ventricular posterior wall diastolic thickness, left ventricular end-diastolic diameter, left ventricle mass, left ventricle mass index, ejection fraction, and peak aortic gradient. Relative ventricle wall thickness was also calculated. Both groups values from the preoperative, postoperative sixth month, second year, and fifth year time intervals were compared.

Results. In the AS group, the preoperative left ventricular ejection fraction (%) value of 53.68 ± 5.04 increased to 63.24 ± 4.11 at the end of the fifth year. In the AI group, the preoperative left ventricular ejection fraction (%) value of 48.40 ± 3.56 increased to 59.77 ± 2.75 at the end of the fifth year. The other left ventricular geometric parameters were also compared within each group. At the end of the fifth year, there were significant and positive changes in each group.

Conclusion. The regression of the left ventricular parameters is a process that occurs over many years following the correction of the primary hemodynamic abnormality. Although the results were similar in the AI and AS group, in the AS group the remodeling process had earlier results than in the AI group.

References

Aurigemma GP, Silver KH, McLaughlin M, et al. 1994. Impact of chamber geometry and gender on left ventricular systolic function in patients >60 years of age with aortic stenosis. Am J Cardiol 74:794-8.nBech-Hanssen O, Wallentin I, Houltz E, et al. 1999. Gender differences in patients with severe aortic stenosis: impact on preoperative left ventricular geometry and function, as well as early postoperative morbidity and mortality. Eur J Cardiothorac Surg 15:24-30.nBenjamin EJ, Levy D. 1999. Why is left ventricular hypertrophy so predictive of morbidity and mortality? Am J Med Sci 317:168-75.nBonow RO, Dodd JT, Maron BJ, et al. 1988. Long-term serial changes in left ventricular function and reversal of ventricular dilatation after valve replacement for aortic regurgitation. Circulation 78:1108-20.nDevereux RB, de Simone G, Ganau A, et al. 1994. Left ventricular hypertrophy and geometric remodeling in hypertension: stimuli, functional consequences and prognostic implications. J Hypertens Suppl 12:S117-27. Review.nFlachskampf FA, Daniel WG. 2004. Aortic valve stenosis. Internist 45:1281-90.nGaasch WH, Carroll JD, Levine HJ, et al. 1983. Chronic aortic regurgitation: prognostic value of left ventricular end-systolic dimension and end-diastolic radius/thickness ratio. J Am Coll Cardiol 1:775-82.nGaudino M, Alessandrini F, Glieca F, et al. 2005. Survival after aortic valve replacement for aortic stenosis: does left ventricular mass regression have a clinical correlate. Eur Heart J 26:51-7.nHwang MH, Hammermeister KE, Oprian C, et al. 1989. Preoperative identification of patients likely to have left ventricular dysfunction after aortic valve replacement. Circulation 80:165-176.nJin XY, Gibson DG, Pepper JR. 1995. Early changes in regional and global left ventricular function after aortic valve replacement: comparison of crystalloid, cold blood, and warm blood cardioplegias. Circulation 92(9 suppl):II155-62.nJin XY, Zhang ZM, Gibson DG, Yacoub MH, Pepper JR. 1996. Effects of valve substitute on changes in left ventricular function and hypertrophy after aortic valve replacement. Ann Thorac Surg 62:683-90.nKrayenbuehl HP, Hess OM, Monrad ES, et al. 1989. Left ventricular myocardial structure in aortic valve disease before, intermediate, and late after aortic valve replacement. Circulation 79:744-55.nLamb HJ, Beyerbacht HP, de Roos A, et al. 2002. Left ventricular remodeling early after aortic valve replacement: differential effects on diastolic function in aortic valve stenosis and aortic regurgitation. J Am Coll Cardiol 40:2182-8.nLevy D, Garrison RJ, Savage DD, et al. 1990. Prognostic implications of echocardiographically determined left ventricular mass in the Framingham Heart Study. N Engl J Med 322:1561-6.nLund O. 1990. Preoperative risk evaluation and stratification of long-term survival after valve replacement for aortic stenosis. Reasons for earlier operative intervention. Circulation 82:124-39.nLund O, Emmertsen K, Dorup I, et al. 2003. Regression of left ventricular hypertrophy during 10 years after valve replacement for aortic stenosis is related to the preoperative risk profile. Eur Heart J 24:1437-46.nLund O, Kristensen LH, Baandrup U, et al. 1998. Myocardial structure as a determinant of pre and postoperative ventricular function and long-term prognosis after valve replacement for aortic stenosis. Eur Heart J 19:1099-108.nLund O, Magnussen K, Knudsen M, et al. 1996. The potential for normal long-term survival and morbidity rates after valve replacement for aortic stenosis. J Heart Valve Dis 5:258-67.nLund O, Vaeth M. 1987. Prediction of late results following valve replacement in aortic stenosis. Seventeen years of follow-up examined with the Cox regression analysis. Thorac Cardiovasc Surg 35:295-303.nMonrad ES, Hess OM, Murakami T, et al. 1988. Time course of regression of left ventricular hypertrophy after aortic valve replacement. Circulation 77:1345-55.nOrsinelli DA, Aurigemma GP, Battista S, et al. 1993. Left ventricular hypertrophy and mortality after aortic valve replacement for aortic stenosis. J Am Coll Cardiol 22:1679-83.nRoman MJ, Klein L, Devereux RB, et al. 1989. Reversal of left ventricular dilatation, hypertrophy, and dysfunction by valve replacement in aortic regurgitation. Am Heart J 118:553-63.n

Published

2006-12-05

How to Cite

Bolcal, C., Doganci, S., Baysan, O., Yildirim, V., Sargin, M., Demirkilic, U., & Tatar, H. (2006). Evaluation of Left Ventricular Functions after Aortic Valve Replacement in a Specific Young Male Patient Population with Pure Aortic Insufficiency or Aortic Stenosis: 5-Years Follow-up. The Heart Surgery Forum, 10(1), E57-E63. https://doi.org/10.1532/HSF98.20061142

Issue

Section

Article