Skip to main content
NCBI home page
The Texas Heart Institute Journal logoLink to The Texas Heart Institute Journal
. 1992;19(2):97–106.

Left Ventricular Dynamics after Aortic Valve Replacement

A Long-term, Combined Radionuclide Angiographic and Ultrasonographic Study

Claudio S Masotti 1,2,3, Paola Bonfranceschi 1,2,3, Guido Rusticali 1,2,3, Franco Rusticali 1,2,3, Angelo Pierangeli 1,2,3
PMCID: PMC326262  PMID: 15227421

Abstract

Between January 1985 and July 1990, we studied 71 patients at our institution who underwent aortic valve replacement for either aortic valve regurgitation (40 patients) or stenosis (31 patients). The following prostheses were implanted: 25 St. Jude Medical valves (bileaflet), 16 Björk-Shiley (monoleaflet, tilting disc, 60° convexo-concave), 16 Medtronic-Hall (monoleaflet, tilting disc), and 14 Starr-Edwards (caged ball). The patients were evaluated pre-and postoperatively by means of gated blood-pool scintigraphy and Doppler echocardiography. Postoperatively, each patient was studied at 6 months, 1 year, and then annually. The evaluations focused upon 1) scintigraphically assessed left ventricular performance indicators (end-diastolic and end-systolic volume, as well as resting and exercise ejection fraction) and 2) Doppler-derived hemodynamic indexes (peak and mean transvalvular pressure gradient, effective orifice area, regurgitant flow, and systolic wall stress).

Early after aortic valve replacement, 55 (77.5%) of the patients had substantial symptomatic relief, with normal hemodynamic values both at rest and during exercise (New York Heart Association functional class I or II); another 6 patients (8.5%) maintained their preoperative status in those classes. Within a year after surgery, a majority of patients showed a significant reduction in left ventricular dimensions. The patients with preoperative aortic valve stenosis had a significantly reduced end-diastolic and end-systolic volume (p<0.05), a moderately reduced left ventricular mass index (p<0.01), and a significantly increased exercise ejection fraction (p<0.05); moreover, in all 31 of these cases, systolic wall stress returned to normal or lower-than-control values (p<0.005). The patients with preoperative aortic valve regurgitation had a significant reduction in end-diastolic and end-systolic volume (p<0.005), diastolic wall stress (p<0.005), and a significant increase in exercise ejection fraction (p<0.01); however, their left ventricular mass index was not significantly reduced.

Optimal long-term survival was afforded by the St. Jude valve in the small size (21 mm) and the Starr-Edwards valve in the large size (27 mm).

This study represents the first reported use of a serial, combined radionuclide and echocardiographic procedure for the follow-up of patients undergoing aortic valve replacement. During the 5½-year follow-up period, this combined technique proved highly accurate for collecting follow-up data, often complementing or correcting simple ultrasound results. This diagnostic approach enabled us to 1) obtain information comparable to or better than that provided by cardiac catheterization, 2) identify complications early, 3) differentiate between valvular and ventricular failure, and 4) suggest the valve of choice (not always that with the best hemodynamic performance) in patients with different cardiac variables. Further research is needed to confirm this study, the results of which could change many medical and surgical strategies for clinical management of the diseased aortic valve. (Texas Heart Institute Journal 1992; 19:97-106)

Keywords: Aortic valve insufficiency

Keywords: aortic valve stenosis

Keywords: echocardiography, Doppler

Keywords: heart valve diseases

Keywords: heart valve prosthesis

Keywords: hemodynamics

Keywords: radionuclide angiography

Keywords: ventricular function, left

Full text

PDF
97

Images in this article

101Image
on p.101
102Image
on p.102
102Image
on p.102
102Image
on p.102

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Antunes M. J. Isolated replacement of a prosthesis or a bioprosthesis in the aortic valve position. Am J Cardiol. 1987 Feb 1;59(4):350–352. doi: 10.1016/0002-9149(87)90812-5. [DOI] [PubMed] [Google Scholar]
  2. Baumgartner H., Khan S., DeRobertis M., Czer L., Maurer G. Discrepancies between Doppler and catheter gradients in aortic prosthetic valves in vitro. A manifestation of localized gradients and pressure recovery. Circulation. 1990 Oct;82(4):1467–1475. doi: 10.1161/01.cir.82.4.1467. [DOI] [PubMed] [Google Scholar]
  3. Bonow R. O., Picone A. L., McIntosh C. L., Jones M., Rosing D. R., Maron B. J., Lakatos E., Clark R. E., Epstein S. E. Survival and functional results after valve replacement for aortic regurgitation from 1976 to 1983: impact of preoperative left ventricular function. Circulation. 1985 Dec;72(6):1244–1256. doi: 10.1161/01.cir.72.6.1244. [DOI] [PubMed] [Google Scholar]
  4. Callahan R. J., Froelich J. W., McKusick K. A., Leppo J., Strauss H. W. A modified method for the in vivo labeling of red blood cells with Tc-99m: concise communication. J Nucl Med. 1982 Apr;23(4):315–318. [PubMed] [Google Scholar]
  5. Carabello B. A., Usher B. W., Hendrix G. H., Assey M. E., Crawford F. A., Leman R. B. Predictors of outcome for aortic valve replacement in patients with aortic regurgitation and left ventricular dysfunction: a change in the measuring stick. J Am Coll Cardiol. 1987 Nov;10(5):991–997. doi: 10.1016/s0735-1097(87)80335-2. [DOI] [PubMed] [Google Scholar]
  6. Chafizadeh E. R., Zoghbi W. A. Doppler echocardiographic assessment of the St. Jude Medical prosthetic valve in the aortic position using the continuity equation. Circulation. 1991 Jan;83(1):213–223. doi: 10.1161/01.cir.83.1.213. [DOI] [PubMed] [Google Scholar]
  7. Clements I. P., Zinsmeister A. R., Gibbons R. J., Brown M. L., Chesebro J. H. Exercise radionuclide ventriculography in evaluation of coronary artery disease. Am Heart J. 1986 Sep;112(3):582–588. doi: 10.1016/0002-8703(86)90524-7. [DOI] [PubMed] [Google Scholar]
  8. Daniel W. G., Hood W. P., Jr, Siart A., Hausmann D., Nellessen U., Oelert H., Lichtlen P. R. Chronic aortic regurgitation: reassessment of the prognostic value of preoperative left ventricular end-systolic dimension and fractional shortening. Circulation. 1985 Apr;71(4):669–680. doi: 10.1161/01.cir.71.4.669. [DOI] [PubMed] [Google Scholar]
  9. Devereux R. B., Casale P. N., Kligfield P., Eisenberg R. R., Miller D., Campo E., Alonso D. R. Performance of primary and derived M-mode echocardiographic measurements for detection of left ventricular hypertrophy in necropsied subjects and in patients with systemic hypertension, mitral regurgitation and dilated cardiomyopathy. Am J Cardiol. 1986 Jun 1;57(15):1388–1393. doi: 10.1016/0002-9149(86)90224-9. [DOI] [PubMed] [Google Scholar]
  10. Fioretti P., Roelandt J., Sclavo M., Domenicucci S., Haalebos M., Bos E., Hugenholtz P. G. Postoperative regression of left ventricular dimensions in aortic insufficiency: a long-term echocardiographic study. J Am Coll Cardiol. 1985 Apr;5(4):856–861. doi: 10.1016/s0735-1097(85)80423-x. [DOI] [PubMed] [Google Scholar]
  11. Gibbons R. J., Fyke F. E., 3rd, Clements I. P., Lapeyre A. C., 3rd, Zinsmeister A. R., Brown M. L. Noninvasive identification of severe coronary artery disease using exercise radionuclide angiography. J Am Coll Cardiol. 1988 Jan;11(1):28–34. doi: 10.1016/0735-1097(88)90162-3. [DOI] [PubMed] [Google Scholar]
  12. Hiratzka L. F., Kouchoukos N. T., Grunkemeier G. L., Miller D. C., Scully H. E., Wechsler A. S. Outlet strut fracture of the Björk-Shiley 60 degrees Convexo-Concave valve: current information and recommendations for patient care. J Am Coll Cardiol. 1988 May;11(5):1130–1137. doi: 10.1016/s0735-1097(98)90075-4. [DOI] [PubMed] [Google Scholar]
  13. Miller T. D., Taliercio C. P., Zinsmeister A. R., Gibbons R. J. Risk stratification of single or double vessel coronary artery disease and impaired left ventricular function using exercise radionuclide angiography. Am J Cardiol. 1990 Jun 1;65(20):1317–1321. doi: 10.1016/0002-9149(90)91320-6. [DOI] [PubMed] [Google Scholar]
  14. Mirsky I., Corin W. J., Murakami T., Grimm J., Hess O. M., Krayenbuehl H. P. Correction for preload in assessment of myocardial contractility in aortic and mitral valve disease. Application of the concept of systolic myocardial stiffness. Circulation. 1988 Jul;78(1):68–80. doi: 10.1161/01.cir.78.1.68. [DOI] [PubMed] [Google Scholar]
  15. Monrad E. S., Hess O. M., Murakami T., Nonogi H., Corin W. J., Krayenbuehl H. P. Abnormal exercise hemodynamics in patients with normal systolic function late after aortic valve replacement. Circulation. 1988 Mar;77(3):613–624. doi: 10.1161/01.cir.77.3.613. [DOI] [PubMed] [Google Scholar]
  16. Panidis I. P., Ross J., Mintz G. S. Normal and abnormal prosthetic valve function as assessed by Doppler echocardiography. J Am Coll Cardiol. 1986 Aug;8(2):317–326. doi: 10.1016/s0735-1097(86)80046-8. [DOI] [PubMed] [Google Scholar]
  17. Rashtian M. Y., Stevenson D. M., Allen D. T., Yoganathan A. P., Harrison E. C., Edmiston W. A., Faughan P., Rahimtoola S. H. Flow characteristics of four commonly used mechanical heart valves. Am J Cardiol. 1986 Oct 1;58(9):743–752. doi: 10.1016/0002-9149(86)90349-8. [DOI] [PubMed] [Google Scholar]
  18. Rothbart R. M., Castriz J. L., Harding L. V., Russo C. D., Teague S. M. Determination of aortic valve area by two-dimensional and Doppler echocardiography in patients with normal and stenotic bioprosthetic valves. J Am Coll Cardiol. 1990 Mar 15;15(4):817–824. doi: 10.1016/0735-1097(90)90280-3. [DOI] [PubMed] [Google Scholar]
  19. Schelbert H. R., Henning H., Ashburn W. L., Verba J. W., Karliner J. S., O'Rourke R. A. Serial measurements of left ventricular ejection fraction by radionuclide angiography early and late after myocardial infarction. Am J Cardiol. 1976 Oct;38(4):407–415. doi: 10.1016/0002-9149(76)90455-0. [DOI] [PubMed] [Google Scholar]
  20. Williams G. A., Labovitz A. J. Doppler hemodynamic evaluation of prosthetic (Starr-Edwards and Björk-Shiley) and bioprosthetic (Hancock and Carpentier-Edwards) cardiac valves. Am J Cardiol. 1985 Aug 1;56(4):325–332. doi: 10.1016/0002-9149(85)90858-6. [DOI] [PubMed] [Google Scholar]
  21. Wisenbaugh T., Elion J. L., Nissen S. E. Influence of aortic valve disease on systolic stiffness of the human left ventricular myocardium. Circulation. 1987 May;75(5):964–972. doi: 10.1161/01.cir.75.5.964. [DOI] [PubMed] [Google Scholar]

Articles from Texas Heart Institute Journal are provided here courtesy of Texas Heart Institute

RESOURCES