title: Value of the regurgitant volume to end diastolic volume ratio to predict the regression of left ventricular dimensions after valve replacement in aortic insufficiency.
abstract: The aim of this study was to assess the value of regurgitant stroke volume (RSV) to end-diastolic volume (EDV) ratio to predict the regression of left ventricular (LV) dimensions after uncomplicated valve replacement in 34 patients with severe pure aortic insufficiency. The RSV/EDV ratio was measured by contrast ventriculography and thermodilution techniques. LV end-diastolic diameter (EDD) was measured pre- and postoperatively by M-mode echocardiography (at a median interval of 3.3 years after valve replacement). LV/EDD decreased from 74 +/- 8 mm to 54 +/- 11 mm (P less than 0.001). Eleven patients had a persistent postoperative LV enlargement (median EDD 65 mm, range 56-100 mm) while, in 23 patients, EDD became normal (median 49 mm, range 40-55 mm). During follow-up, one patient with LV enlargement died of congestive heart failure. Preoperative RSV/EDV ratio was significantly higher in patients with normal postoperative EDD as compared to those with persistent LV enlargement (0.32 +/- 0.06 vs. 0.24 +/- 0.07, P less than 0.005). The best cutoff point of RSV/EDV to predict the normalization of LV dimensions was 0.28. Postoperative EDD remained abnormal in eight out of 16 patients (50%) with RSV/EDV ratio less than 0.29, while it remained enlarged in only three out of 18 patients (17%) with a preoperative RV/EDV ratio greater than 0.28. The other usual preoperative catheterization and echocardiographic variables were equally or less predictive than RSV/EDV ratio. In conclusion, despite the limitations due to the use of different techniques, we confirmed that the RSV/EDV ratio is a potentially useful variable for the assessment of the proper timing of valve replacement in patients with severe isolated aortic insufficiency.
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001021:Aortic Valve / Q000601:surgery; D001022:Aortic Valve Insufficiency / Q000503:physiopathology / Q000601:surgery*; D006328:Cardiac Catheterization; D006332:Cardiomegaly / Q000503:physiopathology*; D004452:Echocardiography; D005260:Female; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000503:physiopathology*; D013318:Stroke Volume