Changes in left ventricular systolic performance immediately after percutaneous aortic balloon valvuloplasty

David H. Harpole; Charles J. Davidson; Thomas N. Skelton; Katherine B. Kisslo; Robert H. Jones; Thomas M. Bashore

doi:10.1016/0002-9149(90)90976-8

Changes in left ventricular systolic performance immediately after percutaneous aortic balloon valvuloplasty

David H. Harpole, Charles J. Davidson, Thomas N. Skelton, Katherine B. Kisslo, Robert H. Jones, Thomas M. Bashore^*

^*Corresponding author for this work

Medicine, Cardiology Division

Research output: Contribution to journal › Article › peer-review

9 Scopus citations

Abstract

To evaluate the acute changes in left ventricular (LV) performance before and immediately after percutaneous aortic valvuloplasty, 25 patients underwent first-pass radionuclide angiocardiography for construction of pressure-volume loops. Simultaneously, high-fidelity micromanometric aortic and LV pressures were recorded. Echocardiographic wall thickness was used to define wall stress. After valvuloplasty, no acute changes were observed in the heart rate, aortic systolic pressure, cardiac output or degree of aortic insufficiency. Valvuloplasty decreased the peak aortic valve gradient from 73 to 40 mm Hg (p < 0.001) and the mean gradient from 61 to 30 mm Hg (p < 0.001); aortic valve area increased from 0.55 to 0.80 cm² (p < 0.001). Meridional end-systolic wall stress decreased from 83 to 55 × 10³ dynes/cm² (p < 0.01). LV ejection fraction increased from 0.41 to 0.48 (p < 0.01). LV end-diastolic volume decreased from 186 to 160 ml (p < 0.001), end-systolic volume decreased from 115 to 87 ml (p < 0.001) and end-diastolic pressure decreased from 22 to 17 mm Hg (p < 0.01). LV stroke work decreased from 16.0 to 14.0 × 10⁶ erg (p < 0.001). No change was observed in peak positive LV soldP dt or the end-systolic pressure-volume ratio. This study documents variable and complex changes in the measures of cardiac function after aortic valvuloplasty. A decrease in the amount of LV outflow obstruction with maintenance of the cardiac output at a decreased level of LV filling occurs.

Original language	English (US)
Pages (from-to)	1213-1218
Number of pages	6
Journal	The American journal of cardiology
Volume	65
Issue number	18
DOIs	https://doi.org/10.1016/0002-9149(90)90976-8
State	Published - May 15 1990

Funding

From the Departments of Medicine and Surgery, Duke University Medical Center, Durham, North Carolina. This study was supported in part by SCOR Grant HL 17670 from the National Heart, Lung, and Blood Institute, Bethesda, Maryland. Manuscript received July 21, 1989; revised manuscript received and accepted January 5, 1990. Address for reprints: Thomas M. Bashore, MD, Box 3012, Duke University Medical Center, Durham, North Carolina 27710.

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/0002-9149(90)90976-8

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title = "Changes in left ventricular systolic performance immediately after percutaneous aortic balloon valvuloplasty",

abstract = "To evaluate the acute changes in left ventricular (LV) performance before and immediately after percutaneous aortic valvuloplasty, 25 patients underwent first-pass radionuclide angiocardiography for construction of pressure-volume loops. Simultaneously, high-fidelity micromanometric aortic and LV pressures were recorded. Echocardiographic wall thickness was used to define wall stress. After valvuloplasty, no acute changes were observed in the heart rate, aortic systolic pressure, cardiac output or degree of aortic insufficiency. Valvuloplasty decreased the peak aortic valve gradient from 73 to 40 mm Hg (p < 0.001) and the mean gradient from 61 to 30 mm Hg (p < 0.001); aortic valve area increased from 0.55 to 0.80 cm2 (p < 0.001). Meridional end-systolic wall stress decreased from 83 to 55 × 103 dynes/cm2 (p < 0.01). LV ejection fraction increased from 0.41 to 0.48 (p < 0.01). LV end-diastolic volume decreased from 186 to 160 ml (p < 0.001), end-systolic volume decreased from 115 to 87 ml (p < 0.001) and end-diastolic pressure decreased from 22 to 17 mm Hg (p < 0.01). LV stroke work decreased from 16.0 to 14.0 × 106 erg (p < 0.001). No change was observed in peak positive LV soldP dt or the end-systolic pressure-volume ratio. This study documents variable and complex changes in the measures of cardiac function after aortic valvuloplasty. A decrease in the amount of LV outflow obstruction with maintenance of the cardiac output at a decreased level of LV filling occurs.",

author = "Harpole, {David H.} and Davidson, {Charles J.} and Skelton, {Thomas N.} and Kisslo, {Katherine B.} and Jones, {Robert H.} and Bashore, {Thomas M.}",

note = "Funding Information: From the Departments of Medicine and Surgery, Duke University Medical Center, Durham, North Carolina. This study was supported in part by SCOR Grant HL 17670 from the National Heart, Lung, and Blood Institute, Bethesda, Maryland. Manuscript received July 21, 1989; revised manuscript received and accepted January 5, 1990. Address for reprints: Thomas M. Bashore, MD, Box 3012, Duke University Medical Center, Durham, North Carolina 27710.",

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T1 - Changes in left ventricular systolic performance immediately after percutaneous aortic balloon valvuloplasty

AU - Harpole, David H.

AU - Davidson, Charles J.

AU - Skelton, Thomas N.

AU - Kisslo, Katherine B.

AU - Jones, Robert H.

AU - Bashore, Thomas M.

N1 - Funding Information: From the Departments of Medicine and Surgery, Duke University Medical Center, Durham, North Carolina. This study was supported in part by SCOR Grant HL 17670 from the National Heart, Lung, and Blood Institute, Bethesda, Maryland. Manuscript received July 21, 1989; revised manuscript received and accepted January 5, 1990. Address for reprints: Thomas M. Bashore, MD, Box 3012, Duke University Medical Center, Durham, North Carolina 27710.

PY - 1990/5/15

Y1 - 1990/5/15

N2 - To evaluate the acute changes in left ventricular (LV) performance before and immediately after percutaneous aortic valvuloplasty, 25 patients underwent first-pass radionuclide angiocardiography for construction of pressure-volume loops. Simultaneously, high-fidelity micromanometric aortic and LV pressures were recorded. Echocardiographic wall thickness was used to define wall stress. After valvuloplasty, no acute changes were observed in the heart rate, aortic systolic pressure, cardiac output or degree of aortic insufficiency. Valvuloplasty decreased the peak aortic valve gradient from 73 to 40 mm Hg (p < 0.001) and the mean gradient from 61 to 30 mm Hg (p < 0.001); aortic valve area increased from 0.55 to 0.80 cm2 (p < 0.001). Meridional end-systolic wall stress decreased from 83 to 55 × 103 dynes/cm2 (p < 0.01). LV ejection fraction increased from 0.41 to 0.48 (p < 0.01). LV end-diastolic volume decreased from 186 to 160 ml (p < 0.001), end-systolic volume decreased from 115 to 87 ml (p < 0.001) and end-diastolic pressure decreased from 22 to 17 mm Hg (p < 0.01). LV stroke work decreased from 16.0 to 14.0 × 106 erg (p < 0.001). No change was observed in peak positive LV soldP dt or the end-systolic pressure-volume ratio. This study documents variable and complex changes in the measures of cardiac function after aortic valvuloplasty. A decrease in the amount of LV outflow obstruction with maintenance of the cardiac output at a decreased level of LV filling occurs.

AB - To evaluate the acute changes in left ventricular (LV) performance before and immediately after percutaneous aortic valvuloplasty, 25 patients underwent first-pass radionuclide angiocardiography for construction of pressure-volume loops. Simultaneously, high-fidelity micromanometric aortic and LV pressures were recorded. Echocardiographic wall thickness was used to define wall stress. After valvuloplasty, no acute changes were observed in the heart rate, aortic systolic pressure, cardiac output or degree of aortic insufficiency. Valvuloplasty decreased the peak aortic valve gradient from 73 to 40 mm Hg (p < 0.001) and the mean gradient from 61 to 30 mm Hg (p < 0.001); aortic valve area increased from 0.55 to 0.80 cm2 (p < 0.001). Meridional end-systolic wall stress decreased from 83 to 55 × 103 dynes/cm2 (p < 0.01). LV ejection fraction increased from 0.41 to 0.48 (p < 0.01). LV end-diastolic volume decreased from 186 to 160 ml (p < 0.001), end-systolic volume decreased from 115 to 87 ml (p < 0.001) and end-diastolic pressure decreased from 22 to 17 mm Hg (p < 0.01). LV stroke work decreased from 16.0 to 14.0 × 106 erg (p < 0.001). No change was observed in peak positive LV soldP dt or the end-systolic pressure-volume ratio. This study documents variable and complex changes in the measures of cardiac function after aortic valvuloplasty. A decrease in the amount of LV outflow obstruction with maintenance of the cardiac output at a decreased level of LV filling occurs.

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Changes in left ventricular systolic performance immediately after percutaneous aortic balloon valvuloplasty

Abstract

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