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. 2001 Sep;86(3):309–316. doi: 10.1136/heart.86.3.309

Four year follow up of aortic valve replacement for isolated aortic stenosis: a link between reduction in pressure overload, regression of left ventricular hypertrophy, and diastolic function

I Ikonomidis 1, A Tsoukas 1, F Parthenakis 1, A Gournizakis 1, A Kassimatis 1, L Rallidis 1, P Nihoyannopoulos 1
PMCID: PMC1729883  PMID: 11514485

Abstract

OBJECTIVE—To evaluate changes in left ventricular function and the impact of ventricular hypertrophy and pressure gradient early and late after aortic valve replacement in patients with isolated aortic stenosis.
DESIGN—41 patients with isolated aortic stenosis and normal systolic function underwent cross sectional and Doppler echocardiography two months before and two weeks and four years after aortic valve replacement.
RESULTS—Early after the operation, left ventricular mass index (mean (SD)) decreased from 187 (44) g/m2 to 179 (46) g/m2, because of a reduction in end diastolic diameter (p < 0.05). Aortic pressure gradients were reduced, as expected. Isovolumic relaxation time was reduced from 93 (20) ms to 78 (12) ms, and deceleration time from 241 (102) ms to 205 (77) ms (p < 0.05). At four years, left ventricular mass index was further reduced to 135 (30) g/m2 (p < 0.01) as a result of wall thickness reduction in the interventricular septum (from 14 (1.6) mm to 12 (1.4) mm, p < 0.01) and the posterior wall (from 14 (1.6) mm to 12 (1.3) mm, p < 0.01). Diastolic function, expressed by a reduction in isovolumic relaxation time from 93 (20) ms to 81 (15) ms (p < 0.01) and deceleration time from 241 (102) ms to 226 (96) ms (p < 0.05), remained improved. Prolonged isovolumic relaxation time was associated with significant septal and posterior wall hypertrophy (wall thickness > 13 mm) (p < 0.05), whereas prolonged deceleration time was related to high residual gradient (peak gradient > 30 mm Hg ) (p < 0.01).
CONCLUSIONS—Left ventricular diastolic function improves early after surgery for aortic stenosis in parallel with the reduction in the aortic gradient. However, prolongation of Doppler indices of myocardial relaxation and ventricular filling is observed in patients with significant left ventricular hypertrophy and a residual pressure gradient early after surgery. At four years postoperatively, diastolic function remains improved.


Keywords: diastolic function; hypertrophy regression; aortic valve replacement; aortic stenosis

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Figure 1  .

Figure 1  

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Changes of diastolic Doppler indices in a 68 year old patient with a bileaflet aortic prosthesis and significant residual aortic gradient (peak gradient, 38 mm Hg). Note the prolonged deceleration time after surgery which is maintained four years later despite the regression of hypertrophy.

Figure 2  .

Figure 2  

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(A) Isovolumic relaxation time in patients in whom both ventricular septal and posterior wall thickness values were > 13 mm (n = 26) compared with those with wall thickness values < 13 mm (n = 15) two weeks after aortic valve replacement. IVRT-post, isovolumic relaxation time (ms). (B) Deceleration time in patients with a peak pressure gradient of > 30 mm Hg (n = 22) compared with those with a peak pressure gradient < 30 mm Hg (n = 19) two weeks after aortic valve replacement. DT-post, deceleration time (ms) two weeks postoperatively. Values are represented as box plots. The middle line represents the median of the values, the upper and lower lines represent the 25th and 75th centiles, respectively, and the T lines represent the minimum and maximum values.

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