Myocardial structure in volume-overloaded hearts before and after valve replacement.
The purpose of this study was to evaluate the histological characteristics of left ventricular muscle in volume-overloaded hearts. A preoperative biopsy was obtained in 31 patients: 14 with mitral regurgitation, 14 with aortic regurgitation and 3 with mitral regurgitation and aortic regurgitation. Postoperative tissue samples were available in 15 patients. Histological findings were correlated with echocardiographic and angiographic data before (preop) and one year after (postop) operation. Myocardial cell diameter was correlated with both the end-diastolic (r = 0.77, p less than 0.01) and end-systolic (r = 0.78, p less than 0.01) dimensions of the left ventricle, but was inversely correlated with the end-diastolic wall thickness-to-radius (h/R) ratio (r = -0.71, p less than 0.01). Percent fibrosis increased proportionally to the diameter (r = 0.42, p less than 0.05). For one year after operation, echocardiographic left ventricular dimensions and angiographic left ventricular volumes were significantly reduced (p less than 0.05), but in some patients postoperative values remained greater than normal. With regard to left ventricular morphology, myocardial cell diameter and interstitial fibrosis decreased significantly after valve replacement (p less than 0.05). However, the myocardial fiber remained hypertrophied and interstitial fibrosis remained above normal after surgery. Thus, postoperative ventricular dilatation was dependent upon the degree of myocardial fiber hypertrophy and interstitial fibrosis.
D006332:Cardiomegaly / Q000473:pathology* / Q000503:physiopathology; D005355:Fibrosis; D006801:Humans; D009206:Myocardium / Q000473:pathology; D013318:Stroke Volume