Left ventricular hypertrophy in aortic valve disease. Regression of ventricular mass and volume following surgery for chronic volume overload.

Abstract

The compensatory ventricular hypertrophy of volume overload decreased after surgery in 49 (73%) out of 67 patients with severe chronic aortic regurgitation. Most of the ECG and echocardiographic changes occurred within one year of surgery. Regression of ventricular hypertrophy, although significant, was usually incomplete. End-diastolic diameter was normal after valve replacement in 51 patients; 16 had persistent postoperative dilatation. Echocardiographic parameters could not define the type and degree of ventricular hypertrophy and dilatation which was irreversible. Ventricular biopsies were obtained before and one year after surgery in 12 patients; five of the patients had normal end-diastolic dimensions postoperatively and seven had persistent postoperative dilitation. Increased fibrous tissue and loss of myofibrillar components from hypertrophied myocardial cells correlated with persistent dilatation and hypertrophy. Progressive ventricular conduction abnormalities and an abnormal postoperative haemodynamic response to exercise was documented in patients with persistent ventricular dilatation.