412 Severe aortic stenosis and functional mitral regurgitation. Incidence, associated factors and prognosis after aortic valve replacement

Abstract

Eur J Echocardiography Abstracts Supplement, December 2006 rolateral commissure (A2). Based on the interval when a dehiscence was uncovered after the surgery we divided the group into the early and late dehiscences with 3 months cut-off value. In our patients about the two third of dehiscences occurred early after the surgery. Conclusion: Three-dimensional echocardiography is feasible and valuable method in identification of mechanism of residual regurgitation following the mitral valve repair. However to completely describe the repaired valve both data from 2D scans and 3D reconstruction must be considered. The presence of systemic hypertension, a condition frequently associated with valvular aortic stenosis may influence the plasma BNP level after AVR. Aims: To evaluate plasma BNP level in patients with AVR for calcific aortic valve stenosis in elderly and to examine the correlation between BNP and left ventricular mass index, ejection fraction and geometry preoperatively and two month post AVR in patients with and without sistemic hypertension. Method and results: 68 patients over 60 years (17 F/51 M) were included. Plasma BNP, clinical assesment and echocardiographic measurements were performed two month after AVR. BNP was elevated post AVR (200.33±131.7 pg/ml) and hypertensive patients had higher values of BNP compared to normotensives (251.47±151.47 vs 109.44±25.26 pg/ml, p<0.001). Postoperative left ventricular mass (308±116 g) and left ventricular mass index (171±64 g/m2) correlated with BNP (r=0.63 and r=0.65) irrespective of the presence of systemic hypertension. Regarding left ventricular geometry, both preoperative and postoperative eccentric remodeling is characterised by the highest plasma BNP values (280±166 pg/ml and 377±111 pg/ml) independent of left ventricular ejection fraction. No correlation was found between BNP and pre/postoperative transprotetic gradiens or ejection fraction. Conclusion: BNP is increased in elderly patients post AVR for calcific aortic stenosis and hypertensive patients had elevated values compared to normotensives. Plasma BNP level is correlated with pre and postoperative left ventricular mass index and geometry. Associated systemic hypertension seems to contribute to a high BNP level in elderly post AVR for calcific aortic stenosis. Aditional reduction of blood pressure in these patients could favorably influence the regression of BNP but this hipothesis needs further approach.