Long-term serial changes in left ventricular fuction and reversal of ventricular dilatation after valve replacement for chronic aortic regurgitation

R. O. Bonow, J. T. Dodd, B. J. Maron, P. T. O'Gara, G. G. White, C. L. McIntosh, R. E. Clark, S. E. Epstein

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155 Scopus citations

Abstract

In most patient with aortic regurgitation, valve replacement result in reduction in left ventricular dilatation and an increase in ejection fraction. To determine the relation between serial changes in ventricular dilatation and changes in ejection fraction, we studied 61 patients with chronic severe aortic regurgitation by echocardiography and radionuclide angiography before, 6-8 months after, and 3-7 years after aortic valve replacment. Between preoperative and early postoperative studies, left ventricular end-diastolic dimension decreased (from 75 ± 6 to 56 ± 9 mm, p < 0.001), peak systolic wall stress decreased (from 247 ± 50 to 163 ± 42 dynes x 103/cm2), and ejection fraction increased (from 43 ±9% to 51 ± 16%, p < 0.001). Between early and late postoperative studies, diastolic dimension and peak systolic wall stress did not change, but ejection fraction increased further (to 56 ± 19%, p < 0.001). The increase in ejection fraction correlated with magnitude of reduction in diastolic dimension between preoperative and early postoperative studies (r = 0.63), beteen early and late postoperative studies (r = 0.54), and between preoperative and late postoperative studies (r = 0.69). Late increases in ejection fraction usually represented the continuation of an initial increase occurring early after operation. Thus, short-term and long-term improvement in left ventricular systolic fuction after operation is related significantly to the early reduction in left ventricular dilatation arising from correction of left ventricular volume overload. Moreover, late improvement in ejection fraction occurs commonly in patients with an early increase in ejection fraction after valve replacement but is unlikely to occur in patients with no change in ejection fraction during the first 6 months after operation.

Original languageEnglish (US)
Pages (from-to)1108-1120
Number of pages13
JournalCirculation
Volume78
Issue number5 I
DOIs
StatePublished - 1988

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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