LONG-TERM CHANGES IN LEFT-VENTRICULAR MASS, CHAMBER SIZE AND FUNCTIONAFTER VALVE-REPLACEMENT IN PATIENTS WITH SEVERE AORTIC-STENOSIS AND DEPRESSED EJECTION FRACTION

We studied 21 patients undergoing valve replacement for severe aortic stenosis and marked left ventricular dysfunction (mean ejection fracti on 27 +/- 7.9%) without significant coronary disease or other valve di seases. At 5-60 months (average 26 +/- 18) after surgery, the patients underwent a clinical history, physical examination and a complete M-m ode, two-dimensional and Doppler transthoracic echocardiographic study . Thirteen patients were examined with cardiopulmonary exercise testin g. Two patients with a low preoperative transvalvular pressure gradien t (<50 mm Hg) died postoperatively. Nineteen patients were tested at f ollow-up. All patients showed an improvement in functional class, an i ncrease in ejection fraction (EF), a normalization in left ventricular diameters, volumes and stress indices and a reduction in left ventric ular mass which correlated with EF increase. Cardiopulmonary exercise testing showed a good exercise capacity. In conclusion, in patients af fected by severe aortic stenosis and marked preoperative left ventricu lar dysfunction valve replacement induces a favorable remodeling of th e left ventricle, as shown by a late postoperative examination. The re gression of hypertrophy is a positive event which correlates with the improvement in EF.