title: Timing of operation for aortic regurgitation: relation to postoperative contractile state.
abstract: With angiography and pressure measurement, we determined left ventricular volume, wall stress, and systolic performance in 30 patients with aortic regurgitation before and after successful aortic valve replacement. End-systolic wall stress was greatly elevated preoperatively and decreased to normal postoperatively. Systolic pump performance assessed as ejection phase indexes was severely depressed preoperatively and improved to normal or near-normal postoperatively in most patients. The ratio of end-systolic wall stress to end-systolic volume index (ESS/ESVI), an index of myocardial contractility, was greatly decreased before operation. Postoperatively, the ratio increased in all patients, becoming normal in 12 of the 13 patients who had a preoperative ESS/ESVI of 2.9 or greater. However, 15 of 17 patients in whom the ESS/ESVI ratio was less than 2.9 still had subnormal ratios, which indicates the presence of irreversible contractile dysfunction. Stepwise multivariate analysis showed that preoperative ESS/ESVI was the only independent discriminator of postoperative normalization of the contractile function as assessed by ESS/ESVI. After aortic valve replacement, myocardial contractile state does not return to normal in a considerable number of patients. It is important to offer aortic valve replacement for aortic regurgitation before the chance for a good functional result is lost. The ESS/ESVI ratio may be a useful index in determining the timing of operation in patients with aortic regurgitation.
authors.affiliation: First Department of Surgery, Osaka University Medical School, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Taniguchi
authors.forename: S
authors.initials: S
authors.lastname: Nakano
authors.forename: H
authors.initials: H
authors.lastname: Matsuda
authors.forename: Y
authors.initials: Y
authors.lastname: Shimazaki
authors.forename: K
authors.initials: K
authors.lastname: Sakai
authors.forename: T
authors.initials: T
authors.lastname: Kawamoto
authors.forename: S
authors.initials: S
authors.lastname: Sakaki
authors.forename: J
authors.initials: J
authors.lastname: Kobayashi
authors.forename: H
authors.initials: H
authors.lastname: Shintani
authors.forename: M
authors.initials: M
authors.lastname: Mitsuno
mesh_terms: D000328:Adult; D001022:Aortic Valve Insufficiency / Q000503:physiopathology / Q000601:surgery*; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000502:physiology*; D011184:Postoperative Period; D013599:Systole / Q000502:physiology; D013997:Time Factors; D016277:Ventricular Function, Left / Q000502:physiology*