Effects of successful, uncomplicated valve replacement on ventricular hypertrophy, volume, and performance in aortic stenosis and in aortic incompetence

Abstract

Preoperative and postoperative cardiac catheterization data were analyzed from 10 patients with aortic stenosis and eight with aortic incompetence with normal prosthetic function. In aortic stenosis, left ventricular mass decreased from 229 ± 39 to 123 ± 10 Gm. per square meter (p < 0.05); mean velocity of circumferential fiber shortening (mean Vcf) increased from 1.11 ± 0.13 to 1.57 ± 0.09 circ. per second (p < 0.025); ejection fraction increased from 0.65 ± 0.05 to 0.76 ± 0.03 (p < 0.025); left ventricular end-diastolic pressure (LVEDP), peak equatorial wall stress, left ventricular end-diastolic volume index (LVEDVI), and cardiac index showed no significant change. In aortic incompetence, the left ventricular mass decreased from 222 ± 18 to 128 ± 17 Gm. per square meter (p < 0.025), LVEDVI from 205 ± 22 to 140 ± 24 ml. per square meter (p < 0.01), and LVEDP from 22 ± 2 to 10 ± 2 mm. Hg (p < 0.005). Mean Vcf was depressed both preoperatively (0.64 ± 0.12) and postoperatively (0.80 ± 0.14 circ. per second). Peak equatorial wall stress, ejection fraction, and cardiac index showed no significant change. We conclude that myocardial hypertrophy with or without increased ventricular volume maintained adequate left ventricular pump function preoperatively in aortic stenosis and in aortic incompetence. Preoperatively, ventricular performance (mean Vcf) was more depressed in aortic incompetence than in aortic stenosis. Following successful, uncomplicated valve replacement, ventricular volume and/or mass decreased substantially, but not to normal levels. Adequate left ventricular pump function was maintained both in aortic stenosis and in aortic incompetence. Ventricular performance (mean Vcf) improved to normal in aortic stenosis but remained depressed in aortic incompetence.