Left ventricular mass index reduction early after an isolated aortic valve replacement with St. Jude Medical 19A-HP.
OBJECTIVE
It has been reported that the left ventricular mass index (LVMI) for the hypertrophic myocardium is reduced at an early stage following surgery. In this study, those factors affecting the changes in early postoperative LVMI were investigated in cases in which a St. Jude Medical 19A-HP (19HP) mechanical heart valve was used.


METHODS
We studied 16 consecutive patients with pure aortic stenosis undergoing isolated aortic valve replacement using a 19HP between January 1994 and July 2001. The patients were all female, aged 64 +/- 6 years, with a body surface area of 1.44 +/- 0.10 m2 and preoperative New York Heart Association (NYHA) classification of 2.2 +/- 0.5. All patients underwent transthoracic echocardiography at 4.2 +/- 3.3 days before and 16.3 +/- 10.2 days after operation, and cardiac catheterization within a mean period of one month before operation. The correlations between the decrease of LVMI at 16.3 +/- 10.2 days after operation and perioperative parameters were determined.


RESULTS
There was significant LVMI regression postoperatively (15 +/- 12%, p = 0.01), and only a significant negative correlation between the decrease of LVMI and preoperative left ventricular pressure (LVp) [r = -0.74, p < 0.01]. There was no effective LVMI reduction in the high preoperative LVp group (> or = 210 mmHg).


CONCLUSIONS
It is expected that in the high LVp group, huge wall stress was being applied to the left ventricular muscle immediately before surgery and in the early period after surgery. Preoperative LVp is an important index for determining the surgical timing and safe perioperative management. We recommend early surgical treatment before LVp becomes more than 210 mmHg.
Uchikawa
Shin
S
Department of Cardiovascular Surgery, The Heart Institute of Japan, Tokyo Women's Medical University, Tokyo, Japan.
Aomi
Shigeyuki
S
Kawai
Akihiko
A
Yamazaki
Kenji
K
Tomizawa
Yasuko
Y
Nishida
Hiroshi
H
Endo
Masahiro
M
Koyanagi
Hitoshi
H
D000368:Aged; D001021:Aortic Valve / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005947:Glucose / Q000627:therapeutic use; D006349:Heart Valve Diseases / Q000503:physiopathology / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000295:instrumentation*; D006352:Heart Ventricles / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D007328:Insulin / Q000627:therapeutic use; D007564:Japan; D008353:Mannitol / Q000627:therapeutic use; D008875:Middle Aged; D011188:Potassium / Q000627:therapeutic use; D011189:Potassium Chloride / Q000627:therapeutic use; D011343:Procaine / Q000627:therapeutic use; D011474:Prosthesis Design; D012189:Retrospective Studies; D013223:Statistics as Topic; D013318:Stroke Volume / Q000502:physiology; D013997:Time Factors; D016896:Treatment Outcome; D017725:Ventricular Pressure / Q000502:physiology
C039984:Bretschneider cardioplegic solution; D007328:Insulin; C030396:glucose-insulin-potassium cardioplegic solution; D008353:Mannitol; D011343:Procaine; D011189:Potassium Chloride; D005947:Glucose; D011188:Potassium