The dynamics of aortic valvular disease

Abstract

1. 1. The circulatory dynamics in forty patients with aortic valvular disease was studied by catheterization of the right side of the heart and peripheral arterial pressure curves. Twenty-six patients had predominant aortic stenosis; fourteen, predominant aortic regurgitation. 2. 2. Measurements were made at rest and during exercise. The response to the Valsalva maneuver was determined. 3. 3. Although basically obstruction and regurgitation at the aortic orifice differ, the circulatory patterns were in many respects similar. 4. 4. The resting cardiac output is generally within normal limits. Although a rise in the cardiac output is the rule during exercise, it is frequently less than would be expected. The limited cardiac output either at rest or during activity may be due to: (a) the presence of coexisting mitral disease; (b) left ventricular failure; and (c) the lesion (stenosis or regurgitation) per se. 5. 5. The pulmonary circulation is usually normal. Pulmonary hypertension, when present, may be due to several factors: (a) left ventricular failure; (b) coexisting mitral stenosis; or (c) pulmonary vascular changes. Pulmonary vascular changes may be important contributing factors in the production of right ventricular failure in some cases. 6. 6. The peripheral arterial pressure curves are characteristic in aortic stenosis and aortic regurgitation. 7. 7. Marked changes are noted in the brachial arterial pressure tracings during and immediately following the Valsalva maneuver. It is suggested that this maneuver may be helpful in bringing out the anacrotic phenomenon and elucidating certain findings in the resting peripheral pressure curve.