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Myocardial function and structure in aortic valve disease before and after surgery

Krayenbuehl, H. P. ; Schneider, J. ; Turina, M. ; Senning, Å.

In: European Heart Journal, 1982, vol. 3, p. 149-153

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    Title
    • Myocardial function and structure in aortic valve disease before and after surgery
    Author
    • Krayenbuehl, H. P.. Medical Policlinic, Cardiology, Institute of Pathology and Surgical Clinic A, University Hospital, Zurich, Switzerland
    • Schneider, J.. Medical Policlinic, Cardiology, Institute of Pathology and Surgical Clinic A, University Hospital, Zurich, Switzerland
    • Turina, M.. Medical Policlinic, Cardiology, Institute of Pathology and Surgical Clinic A, University Hospital, Zurich, Switzerland
    • Senning, Å.. Medical Policlinic, Cardiology, Institute of Pathology and Surgical Clinic A, University Hospital, Zurich, Switzerland
    Document Type
    • Postprint
    OAI-PMH Identifier
    • oai:doc.rero.ch:296325
    Summary
    Left ventricular (LV) micromanometry, cine-angiography and endomyocardial biopsies were performed in 13 patients with aortic valve disease {AVD) before and 12 to 28 months after successful valve replacement. (AVR). Patients with coronary artery disease were excluded. In nine patients (Group I: five AS, four AI) postoperative LV ejection fraction (EF) and total pressure Vmax were normal(EF ≥ 0.61; Vmax ≥ 1.50 ML/s). In four patients (Group II: three AS, one AT) postoperative EF (0.41) and Vmax (1.21 ML/s) were depressed. Pre-operative muscle fiber diameter (MFD; normal < 20 n) was 31 μ in Group I and 38 μ in Group II (P < 0.01). After AVR MFD decreased to 27 μ in Group I (P < 0.005) and to 28 μ in Group II (P < 0.02). Prior to surgery EF and Vmax showed no significant correlation with the LV fibrous content (FC in g/m2; FC = interstitial fibrosis in percent × LV angiographic muscle mass/100) in the 13 patients with AVD. After AVR, however, FC was related inversely to EF (P < 0.01, r = −0.69) and to Vmax (P < 0.025, r = −0.63). It is concluded that: (1) in AVD massive pre-operative fiber hypertrophy heralds impaired postoperative LV function; (2) fiber hypertrophy regresses following AVR regardless of the-LV functional state, and (3) the content of fibrous tissue appears to be a determinant of postoperative LV function