REGRESSION OF LEFT-VENTRICULAR DILATATION AND HYPERTROPHY AFTER AORTIC-VALVE REPLACEMENT

The aim of the study was to assess the influence of aortic valve repla cement on left ventricular size and muscle hypertrophy according to th e type of preexisting valve disease (aortic stenosis, insufficiency or combined disease). The study group consisted of 143 consecutive patie nts (pts) after aortic valve replacement (109 men, 34 women, mean age 48.1+/-10.9 years). Reason for the operation was aortic stenosis in 35 pts, aortic insufficiency in 64 pts and combined disease in 44 pts. E chocardiography was performed before surgery, 1 month and 1 year after operation, and yearly during 5-year follow-up. Transvalvular aortic p ressure gradients decreased significantly after valve replacement in a ll subsets without further changes during follow-up (P-max (mmHg): fro m 54.2+/-20.7 to 17.9+/-9.6 in combined disease pts, from 72.3+/-19.9 to 21.6+/-14.6 in aortic stenosis and from 34.5+/-24.2 to 15.6+/-11.3 in aortic insufficiency pts, respectively, P <0.0005). One year after surgery the diastolic dimension of the left ventricle decreased signif icantly in all subjects, whereas the systolic dimension only in aortic insufficiency and combined disease pts (from 44+/-11.8 to 31.6+/-5.4 mm, P <0.001 and from 41.9+/-11.5 to 33+/-6.7 mm, P <0.05, respectivel y). Further decrease of both diastolic and systolic dimensions was obs erved only in the aortic insufficiency group. Ejection fraction of lef t ventricle increased only in combined disease pts (from 51.6+/-10% to 56.8+/-8.2%, P <0.05). Wall thickness of the left ventricle decreased 1 year after valve replacement only in the aortic stenosis group and in further follow-up in the aortic stenosis and combined disease group . Normalization of left ventricular size is observed in more than 90% of patients during 5-year follow-up as opposed to left ventricular mus cle hypertrophy, regressed only in less than a half of the study popul ation. In patients with aortic valve disease the greatest hemodynamic improvement is observed 1 year after valve replacement. This is expres sed by marked reduction of the left ventricular dimensions and wall th ickness, without significant improvement of the ejection fraction. Fur ther regression of left ventricle dimensions occurs in patients operat ed on due to predominant valve insufficiency, whereas regression of le ft ventricular hypertrophy is observed in patients with preexisting va lvular stenosis.