Diastolic function in aortic valve disease: techniques of evaluation and pre-/postoperative changes.
Passive diastolic properties of the left ventricle are determined by several factors intrinsic or extrinsic to the ventricle. In patients with myocardial hypertrophy due to longstanding pressure or volume overload increased muscle mass and structural alterations of the myocardium are responsible for changes in passive elastic properties. Evaluation of diastolic function includes determination of ventricular (= chamber) and myocardial (= muscle) stiffness from simultaneous pressure-volume and stress-strain relations during passive diastolic filling. The slope of the pressure-volume relationship is equal to the constant of chamber stiffness and the slope of the stress-strain relationship equal to the constant of myocardial stiffness. Passive diastolic properties were determined in ten control patients and 21 patients with aortic valve disease before and 17.5 months after successful valve replacement. Ten patients presented with severe aortic stenosis, five patients with combined valve lesions and six patients with severe aortic insufficiency. Simultaneous high-fidelity pressure measurements and M-mode echocardiography were carried out in all patients. Myocardial stiffness was calculated from a viscoelastic stress-strain relationship using a nonlinear curve-fit program. Standard hemodynamic measurements showed a significant decrease in pressure and volume overload after successful valve replacement. Left ventricular muscle mass index decreased in all three groups significantly after surgery, whereas systolic ejection fraction remained unchanged pre-/postoperatively.(ABSTRACT TRUNCATED AT 250 WORDS)
D001020:Aortic Stenosis, Subvalvular / Q000503:physiopathology; D001021:Aortic Valve / Q000503:physiopathology; D001022:Aortic Valve Insufficiency / Q000503:physiopathology* / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000503:physiopathology* / Q000601:surgery; D003971:Diastole; D006350:Heart Valve Prosthesis; D006352:Heart Ventricles / Q000503:physiopathology; D006439:Hemodynamics; D006801:Humans; D009200:Myocardial Contraction; D011183:Postoperative Complications / Q000503:physiopathology