Different functional recovery of the left ventricle after valve replacement for aortic regurgitation: correlation between grade of ventricular arrhythmia and long-term mortality.
Although aortic valve replacement for aortic regurgitation relieves left ventricular volume overload, ventricular size often remains abnormal after operation, particularly in the setting of marked or prolonged preoperative left ventricular dysfunction. The aim of this study is to assess the relationship between the grade of ventricular arrhythmias before operation and the recovery of left ventricular function after aortic valve replacement. Between January 1980 and August 1993, 229 patients with pure aortic regurgitation underwent aortic valve replacement at our institution. In this group, 50 patients (21.8%) who showed left ventricular end-systolic volume index (LVESVI) of 150 ml/m2 or greater received 24-hour ambulatory electrocardiographic recordings before and after operation. According to the preoperative grade of ventricular arrhythmias, the patients were divided into three groups. Group A included 20 patients with severe and frequent ventricular premature beats (VPBs). Group B included nine patients with severe and non-frequent ventricular premature beats (VPBs). Group C included 21 patients with non-severe and non-frequent VPBs. Left ventricular end-systolic dimension (LVDs), end-diastolic dimension (LVDd) and fractional shortening (LVFS) were measured in each echocardiogram before, and one year and five years after operation. LVDd significantly decreased at one year after operation in all three groups. At one year after operation, LVDs significantly decreased in group B (42.0 +/- 7.6 mm) and group C (42.6 +/- 8.6 mm), while LVDs showed no significant change in Group A (55.4 +/- 11.1 mm). After five postoperative years, further significant decrease of LVDs was found in group C (32.4 +/- 7.1 mm).(ABSTRACT TRUNCATED AT 250 WORDS)
Noji
S
S
Department of Cardiovascular Surgery, Heart Institute of Japan, Tokyo Women's Medical College.
Kitamura
M
M
Hachida
M
M
Endo
M
M
Hashimoto
A
A
Koyanagi
H
H
D000328:Adult; D000368:Aged; D001021:Aortic Valve; D001022:Aortic Valve Insufficiency / Q000150:complications / Q000401:mortality / Q000503:physiopathology* / Q000601:surgery*; D001145:Arrhythmias, Cardiac / Q000209:etiology / Q000503:physiopathology*; D005260:Female; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D015996:Survival Rate; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left