[Relation between surgical outcome and preoperative end-systolic volume of the left ventricle in patients with regurgitant valvular heart disease].
The relation between the end-systolic volume index of the left ventricle (ESVI (ml/m2)) and the early and late results after valve replacement were reviewed in 249 patients with pure aortic regurgitation (AR) and 189 patients with pure mitral regurgitation (MR). The patients with AR were classified into 4 groups (A1-A4) and those with MR were classified into 3 groups (M1-M3) according to the ESVI. The ESVI, the number of patients (No of P), early mortality rate (EM) and the actuarial survival rate at 12 years after valve replacement (AS at 12 yr) in each group are shown in the following Table. [table: see text] The actuarial survival rate at 12 years after operation in A1 and A2 were significantly lower than that in A3 and A4. In 57% of the late deaths in A1 and A2 patients, the cause of the death was thought to be rhythm disturbance. In contrast, there were no differences in late survival among the three groups with MR (M1, M2 and M3). The minor axis of the left ventricle at end-diastole and at end-systole (Dd and Ds) and shortening fraction of the left minor axis (FS), evaluated by echocardiography, were normalized early after the operation in A1 patients only. The Dd, Ds and FS in A2 and A3 returned to normal late after the operation. However, in A4, these parameters still remained abnormal. Thus, patients with a deteriorated left ventricle can survive the operation. However, the long-term results in patients with AR with ESVI more than 150 ml/m2 were unsatisfactory.(ABSTRACT TRUNCATED AT 250 WORDS)
Nakano
K
K
Department of Cardiovascular Surgery, Heart Institute of Japan, Tokyo Women's Medical College.
Nakatani
H
H
Hagino
I
I
Uchida
S
S
Ishitoya
H
H
Kitamura
M
M
Endo
M
M
Hashimoto
A
A
Koyanagi
H
H
D001022:Aortic Valve Insufficiency / Q000503:physiopathology / Q000601:surgery*; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D006801:Humans; D008944:Mitral Valve Insufficiency / Q000503:physiopathology / Q000601:surgery*; D011379:Prognosis; D013318:Stroke Volume; D016896:Treatment Outcome; D016277:Ventricular Function, Left