Early improvement of left ventricular function after implantation of a transcutaneous aortic valve: A tissue Doppler ultrasound study

Abstract

The long-term effects of surgical treatment for aortic narrowing in left ventricular (LV) remodelling have been well described. The immediate benefit after release of obstruction is unknown. Nineteen patients with significant and symptomatic aortic stenosis underwent transcutaneous implantation of an aortic valve. A conventional and tissue Doppler echocardiography was performed 48 hours before and 24 hours after the procedure. Apart from the dimensions, LV function and aortic haemodynamics, we measured systolic and diastolic myocardial velocities and systolic strain. The procedure resulted in a decrease to the mean transaortic gradient (from 43+/-13 to 10+/- 3 mmHg, p=0.001), an increase of the aortic surface area (from 0.6+/-0.1 to 1.7+/-0.1cm(2), p=0.001) and a reduction in the systolic LV volume (62+/-27 to 48+/-22, p=0.04). We observed an improvement in the systolic radial and longitudinal strain of the posterior wall (p<0.05), septal wall (p<0.05) and lateral wall (p<0.05). Improvement in systolic velocities on these walls and the inferior wall (p<0.01) was also recorded. The regional diastolic velocity was significantly better on the posterior (p<0.05) and septal (p<0.05) walls. The immediate drop in the transaortic gradient resulted in an improvement in myocardial velocities and strain, a sign of improvement in the regional systolic and diastolic regional function.