Predominant Aortic Regurgitation Research Articles

Prevalence and significance of reversible radionuclide ischemic perfusion defects in symptomatic aortic valve disease patients with or without concomitant coronary disease

To determine the prevalence and significance of exercise-induced localized perfusion defects in symptomatic patients with aortic valve disease, thallium-201 rest and exercise studies were performed in a consecutive series of 29 such patients prior to left heart catheterization with coronary arteriography. Eight patients had repeat studies after aortic valve replacement. Twelve of 17 patients with predominant aortic regurgitation (AR) had distinct LV apical defects during exercise despite normal coronary arteries, while 10 of 12 patients with aortic valve disease and associated coronary artery disease (CAD) had localized perfusion defects in LV areas other than the apex. In patients with AR, reversible apical perfusion defects can occur without CAD; these apical detects are probably a reflection of severe LV volume overload in AR. LV perfusion defects in areas other than the apex are specific for CAD in aortic valve disease, and concomitant CAD may not provoke regional LV perfusion deficits in aortic stenosis patients with severe LV hypertrophy.

Cardiac hemodynamics immediately following aortic valve surgery

Comments and summary There have been a few reports concerning hemodynamic studies following cardiac surgery. 6, 7, 8 The present study describes a method of obtaining serial hemodynamic profiles on postoperative cardiac patients and presents data from a group of patients with isolated acquired aortic valve disease. Perhaps the most striking finding in this study is that the average patient following Starr-Edwards valve replacement for acquired aortic valvular disease demonstrated essentially normal hemodynamics, despite the fact that all of the patients had been limited by their heart disease preoperatively. Even patients with decreased cardiac indices preoperatively, unless they also had marked left ventricular failure, promptly returned to normal in the postoperative period. Patients with preoperative evidence of marked left ventricular failure, however, and also patients who immediately postoperatively evidenced reduced cardiac indices did not do so well. Many of them evidenced continued low cardiac indices, low systemic blood pressures, and left ventricular failure; all three of the hospital deaths were in this group. There was very little difference following Starr-Edwards valve replacement in patients with predominant aortic stenosis and those with predominant aortic regurgitation. The postoperative hemodynamic data also indicated that coronary perfusion was superior to myocardial hypothermia in its protective effects on the heart and the consequent myocardial performance in the early postoperative period. From the data presented here, there did not seem to be any significant difference between left coronary perfusion and bilateral coronary perfusion.

Prognostic significance of anterolateral peri-infarction block in surgery for aortic regurgitation ∗

Eighty-four patients underwent open heart surgery with ball-valve (Starr-Edwards or Magovern) replacement for pure or predominant aortic regurgitation. Of the 58 having normal axis deviation, 40 survived; all 5 having left axis deviation alone survived; of the 20 having marked left axis deviation plus anterolateral peri-infarction block, 1 survived; neither of the two having marked right axis deviation survived. No difference between patients with normal axis or left axis deviation with or without peri-infarction block was found by gross pathologic or histologic study, review of physiologic data, review of degree of coronary atherosclerosis, degree of left ventricular fibrosis, or other parameters of investigation. Five patients with aortic regurgitation had abnormal glucose tolerance tests; 3 of these had left axis deviation. It is suggested that anterolateral peri-infarction block accompanying aortic regurgitation indicates an abnormality of the myocardium which may be expressed as failure to defibrillate, poor myocardial contraction and increased irritability. Because of the absence of infarction or histologic evidence of specific abnormality, the term, anterolateral myopathic block might be more appropriate than anterolateral peri-infarction block in the individual with aortic regurgitation. The presence of this electrocardiographic abnormality in a patient with aortic regurgitation indicates an increased risk of cardiopulmonary bypass and aortic valve replacement.

The dynamics of aortic valvular disease

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.