Skip to main content
NCBI home page
British Heart Journal logoLink to British Heart Journal
. 1982 Dec;48(6):589–597. doi: 10.1136/hrt.48.6.589

Irreversible morphological changes contributing to depressed cardiac function after surgery for chronic aortic regurgitation.

R M Donaldson, R Florio, A F Rickards, J G Bennett, M Yacoub, D N Ross, E Olsen
PMCID: PMC482754  PMID: 6216905

Abstract

The timing of surgery in chronic aortic regurgitation remains a difficult problem. To identify variables predictive of postoperative haemodynamic improvement, changes in left ventricular mass, volume, morphology, and histochemistry were analysed in 67 patients undergoing surgery for chronic aortic regurgitation. Patients were divided into two groups: those in whom the left ventricular echo diameters returned to normal after operation (51 patients, group A), and those with postoperative dilatation (16 patients, group B). A preoperative biopsy was obtained in all patients; postoperative tissue samples were available in 13 patients (five from group A, eight from group B). Data were correlated with the postoperative clinical, haemodynamic state over a follow-up period of three years. Regression of hypertrophy was usually incomplete. Echocardiographic and angiographic data could not define the type and degree of dysfunction which was irreversible. Massive fibre hypertrophy (mean 34.1 micrometers), moderately or severely increased interstitial fibrous tissue, reduced levels of the myofibrillar and mitochondrial enzymes adenosine triphosphates and succinate dehydrogenase in pre- and post-operative tissue samples correlated with persistent dilation, cardiac failure, and early death (group B). Irreversible morphological and functional changes contributed to a depressed cardiac function after operation. Preoperative ventricular biopsies are thus of prognostic importance in volume overload.

Full text

PDF
589

Images in this article

591Image
on p.591
591Image
on p.591
593Image
on p.593
594Image
on p.594

Selected References

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

  1. Baandrup U., Florio R. A., Olsen E. G. Do endomyocardial biopsies represent the morphology of the rest of the myocardium? A quantitative light microscopic study of single v. multiple biopsies with the King's bioptome. Eur Heart J. 1982 Apr;3(2):171–178. doi: 10.1093/oxfordjournals.eurheartj.a061281. [DOI] [PubMed] [Google Scholar]
  2. Berson G., Swynghedauw B. Cardiac myofibrillar ATPase and electrophoretic pattern in experimental heart failure produced by a two-step mechanical overloading in the rat. Cardiovasc Res. 1973 Jul;7(4):464–469. doi: 10.1093/cvr/7.4.464. [DOI] [PubMed] [Google Scholar]
  3. Boucher C. A., Bingham J. B., Osbakken M. D., Okada R. D., Strauss H. W., Block P. C., Levine F. H., Phillips H. R., Pohost G. M. Early changes in left ventricular size and function after correction of left ventricular volume overload. Am J Cardiol. 1981 May;47(5):991–1004. doi: 10.1016/0002-9149(81)90204-6. [DOI] [PubMed] [Google Scholar]
  4. Brooksby I. A., Jenkins B. S., Coltart D. J., Webb-Peploe M. M., Davies M. J. Left-ventricular endomyocardial biopsy. Lancet. 1974 Nov 23;2(7891):1222–1225. doi: 10.1016/s0140-6736(74)90744-2. [DOI] [PubMed] [Google Scholar]
  5. Canković-Darracott S., Braimbridge M. V., Williams B. T., Bitensky L., Chayen J. Myocardial preservation during aortic valve surgery. Assessment of five techniques by cellular chemical and biophysical methods. J Thorac Cardiovasc Surg. 1977 May;73(5):699–706. [PubMed] [Google Scholar]
  6. Clark D. G., McAnulty J. H., Rahimtoola S. H. Valve replacement in aortic insufficiency with left ventricular dysfunction. Circulation. 1980 Feb;61(2):411–421. doi: 10.1161/01.cir.61.2.411. [DOI] [PubMed] [Google Scholar]
  7. Gaasch W. H., Andrias C. W., Levine H. J. Chronic aortic regurgitation: the effect of aortic valve replacement on left ventricular volume, mass and function. Circulation. 1978 Nov;58(5):825–836. doi: 10.1161/01.cir.58.5.825. [DOI] [PubMed] [Google Scholar]
  8. Henry W. L., Bonow R. O., Borer J. S., Ware J. H., Kent K. M., Redwood D. R., McIntosh C. L., Morrow A. G., Epstein S. E. Observations on the optimum time for operative intervention for aortic regurgitation. I. Evaluation of the results of aortic valve replacement in symptomatic patients. Circulation. 1980 Mar;61(3):471–483. doi: 10.1161/01.cir.61.3.471. [DOI] [PubMed] [Google Scholar]
  9. Henry W. L., Bonow R. O., Rosing D. R., Epstein S. E. Observations on the optimum time for operative intervention for aortic regurgitation. II. Serial echocardiographic evaluation of asymptomatic patients. Circulation. 1980 Mar;61(3):484–492. doi: 10.1161/01.cir.61.3.484. [DOI] [PubMed] [Google Scholar]
  10. Mercadier J. J., Lompré A. M., Wisnewsky C., Samuel J. L., Bercovici J., Swynghedauw B., Schwartz K. Myosin isoenzyme changes in several models of rat cardiac hypertrophy. Circ Res. 1981 Aug;49(2):525–532. doi: 10.1161/01.res.49.2.525. [DOI] [PubMed] [Google Scholar]
  11. Oldershaw P. J., Brooksby I. A., Davies M. J., Coltart D. J., Jenkins B. S., Webb-Peploe M. M. Correlations of fibrosis in endomyocardial biopsies from patients with aortic valve disease. Br Heart J. 1980 Dec;44(6):609–611. doi: 10.1136/hrt.44.6.609. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Pantely G., Morton M., Rahimtoola S. H. Effects of successful, uncomplicated valve replacement on ventricular hypertrophy, volume, and performance in aortic stenosis and in aortic incompetence. J Thorac Cardiovasc Surg. 1978 Mar;75(3):383–391. [PubMed] [Google Scholar]
  13. Peters T. J., Wells G., Oakley C. M., Brooksby I. A., Jenkins B. S., Webb-Peploe M. M., Coltart D. J. Enzymic analysis of endomyocardial biopsy specimens from patients with cardiomyopathies. Br Heart J. 1977 Dec;39(12):1333–1339. doi: 10.1136/hrt.39.12.1333. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Rahimtoola S. H. Early valve replacement for preservation of ventricular function? Am J Cardiol. 1977 Sep;40(3):472–475. doi: 10.1016/0002-9149(77)90175-8. [DOI] [PubMed] [Google Scholar]
  15. Rickards A., Seabra-Gomes R., Thurston P. The assessment of regional abnormalities of the left ventricle by angiography. Eur J Cardiol. 1977 Mar;5(2):167–182. [PubMed] [Google Scholar]
  16. Schuler G., Peterson K. L., Johnson A. D., Francis G., Ashburn W., Dennish G., Daily P. O., Ross J., Jr Serial noninvasive assessment of left ventricular hypertrophy and function after surgical correction of aortic regurgitation. Am J Cardiol. 1979 Oct;44(4):585–594. doi: 10.1016/0002-9149(79)90273-x. [DOI] [PubMed] [Google Scholar]
  17. Selzer A. Cardiac valve replacement: an unanswered question. Am J Cardiol. 1976 Feb;37(2):322–324. doi: 10.1016/0002-9149(76)90330-1. [DOI] [PubMed] [Google Scholar]

Articles from British Heart Journal are provided here courtesy of BMJ Publishing Group

RESOURCES