Effect of depressed left ventricular function on hemodynamics of normal St. Jude medical prosthesis in the aortic valve position

Abstract

To evaluate the effect of left ventricular (LV) dysfunction on Doppler-derived transprosthetic hemodynamic indexes in patients with normally functioning St. Jude aortic valve prostheses, 74 consecutive patients were studied. LV ejection fraction was assessed by using Simpson's biplane rule. The 34 patients with normal ejection fraction (≥0.51) (group A) generally had the highest values of peak (31 ± 13 mm Hg) and mean (16 ± 6 mm Hg) gradients, whereas 19 patients with moderate to severe reduction of ejection fraction (≤0.31) (group C) had the lowest values (17 ± 6 and 9 ± 3 mm Hg, respectively) (p < 0.05). Significant decreases (p < 0.05) for acceleration and corrected (for heart rate) velocity time integral in group C were noted compared to group A, and group B (21 patients with mild to moderately reduced ejection fraction [0.50 to 0.32]). A significant inverse correlation for Doppler-derived peak and mean gradients and corrected velocity time integral was demonstrated with increasing aortic valve prosthetic sizes from 19 to 29 mm in group A patients (r = −0.41 to −0.71) but less so in group B or C. Thus, in addition to valve size, LV function should be considered an important factor in detecting prosthetic valvular flow characteristics and dysfunction. A normal derived velocity and gradient in patients with moderately to severely depressed LV function may not rule out significant valvular stenosis.