Pressure-volume loops in patients with aortic stenosis.
OBJECTIVE
Preoperative left ventricular (LV) function is the strongest predictor of outcome after valve replacement for aortic stenosis (AS). Although pressure-volume analysis with the conductance catheter technique can provide detailed information on LV systolic and diastolic function, this technique has not yet been used in AS patients. The present study examined the potential use of LV function measurements using pressure-volume analysis with a conductance catheter during surgery for AS.


METHODS
In six patients with severe symptomatic AS, a conductance catheter was placed under transesophageal echocardiographic guidance in the left ventricle via the right superior pulmonary vein.


RESULTS
The procedure was successful in all patients and lengthened the duration of surgery by <30 min, but with no increase in bypass or aortic cross-clamp times. Pressure-volume analysis showed that systolic function was normal in all patients (ejection fraction 42-59%, end-systolic elastance 1.6-4.5 mmHg/ml), while diastolic dysfunction was found in all patients (Tau 32-96 ms, LV end-diastolic pressure 7-42 mmHg, atrial kick 25-60%). After valve replacement, systolic function improved, but diastolic function did not.


CONCLUSIONS
The conductance catheter placed via the pulmonary vein can determine LV systolic and diastolic dysfunction in detail in an individual patient with AS before and after valve replacement. The technique may be used to extend diagnostic data from less-invasive modalities and to determine prognosis in the individual patient.
Dekker
André L A J
AL
Department of Cardiothoracic Surgery, Academic Hospital Maastricht, Maastricht, The Netherlands.
Barenbrug
Paul J C
PJ
van der Veen
Frederik H
FH
Roekaerts
Paul
P
Mochtar
Bas
B
Maessen
Jos G
JG
D000368:Aged; D001024:Aortic Valve Stenosis / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery*; D006328:Cardiac Catheterization / Q000379:methods; D017548:Echocardiography, Transesophageal; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012494:Sampling Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000502:physiology*; D017725:Ventricular Pressure / Q000502:physiology*