Aortic Valve Replacement in Aortic Stenosis and Regression of Left Ventricular Hypertrophy

  • H. Drost
Chapter
Part of the Developments in Cardiovascular Medicine book series (DICM, volume 33)

Summary

Twenty-three patients with isolated valvular aortic stenosis who underwent aortic valve replacement between January 1976 and January 1982 were studied before and after operation. Cardiothoracic ratio on chest X-ray, LVH criteria on the ECG, and echocardiographic measures were used to assess regression of left ventricular hypertrophy.

The disease was symptomatic in 18 patients, angina occurred in 10, syncopes in 9 and congrestive heart failure in 10. Preoperative catheterization in 21 patients revealed peak systolic pressure differences across the valve from 40 to 130 mm Hg (mean value 90 mm Eg), and left ventricular end-diastolic pressure values from 6 to 32 mm Hg (mean value 17 mm Hg). There were no perioperative deaths, but three patients (13%) died of subsequent complications: one during reoperation for valve leakage and two from infectious endocarditis. Functional class (according to NYHA) of the remaining 20 patients improved from 2.30 ± 0.24 before to 1.35 ± 0.13 after operation. Left ventricular ejection time corrected for heart rate decreased from 115.6 ± 1.2% of normal preoperatively to 97.0 ± 1.2% after operation, indicating that pressure load on the ventricle was effectively reduced. CT ratio before and after operation did not differ significantly.

Electrocardiographic criteria of LVH could be assessed in 15 patients; LBBB or AV block prevented electrocardiographic assessment in most of the others. R and S wave voltages showed regression over a six-month period after operation. ST- and T-wave abnormalities were found in nine patients preoperatively and disappeared in six. Five patients had no abnormalities before and after operation and the remaining six were on chronic treatment with digitalis.

M-mode echocardiography was possible in 13 patients. Preoperatively LV wall thickening without LV dilation was common. Decrease of LV wall thickness, but not a complete normalization, occurred within 5.0 ± 0.6 months after operation (p < 0.02). Repeat measurements of LV wall thickness in eight patients 24.6 ± 1.7 months after operation showed no further change.

Data suggest that successful replacement of a stenotic aortic valve leads to reversal of left ventricular hypertrophy. Reduction of LV wall thickness is completed within six months of operation.

Keywords

Left Ventricular Hypertrophy Aortic Stenosis Aortic Valve Replacement Prosthetic Valve Endocarditis Ventricular Outflow Tract Obstruction 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
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Copyright information

© Martinus Nijhoff Publishers 1983

Authors and Affiliations

  • H. Drost
    • 1
  1. 1.Department of CardiologyLeiden University HospitalLeidenThe Netherlands

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