HEMODYNAMICS AFTER AORTIC-VALVE REPLACEMENT WITH ST-JUDE-MEDICAL-VALVE FOR PATIENTS WITH SMALL AORTIC ANNULUS AND SEVERE LEFT-VENTRICULAR HYPERTROPHY

Background and aims of the study: Cardiac function alter aortic valve replacement (AVR) For patients with small aortic annulus and increased left ventricular (EV) wall thickness has not been clearly defined. Th e study aim was to examine a potential relationship between postoperat ive catheterization data (or radionuclide LV cardiac function) and til e size of the aortic valve ring of a small St. Jude Medical prosthesis , Methods: Sixty-one patients with small prosthesis (less than or equa l to 23 mm) were allocated to three groups based an the diameter of th e native aortic annulus or aortic valve ring of the prosthesis (group I, 19 mm; group II, 21 mm; group XII, 23 mm), Pre- and postoperative c ardiac function was evaluated from catheterization data and radioisoto pe (RD ventriculography. Results: There were no significant inter-grou p differences in preoperative pulmonary artery pressures (PAPs), total pulmonary resistance. (TPR), LV ejection fraction, peak ejection rate (PER) and peak filling rate (PFR). The mean postoperative Airs and TP R si group I were significantly elevated in ICU compared with those of groups II or III (PAP: group I, 20 +/- 5; group II, 17 +/- 4; group I II, 14 +/- 4 mmHg; p <0.01. TPR: group I, 505 +/- 268; group II, 316 /- 134; group III, 276 +/- 125 dynes.s.cm-5; p <0.05). Postoperative P APs and TPR of group I at one month after surgery were decreased, and no significant difference was found between the three groups. Cardiac function by RH study sheaved that postoperative PER and PFR improved i n all three groups compared with the preoperative values. Conclusions: Postoperative reversibility of PAPs and improvement of PER and PFR in patients with a prosthesis of 19 mm or 21 mm showed that a small-size d aortic SJM valve had hemodynamic advantages. However, careful postop erative management in the ICU must be applied to patients with a small aortic annulus of 19 mm and severe concentric hypertrophy.