title: Midterm follow-up dynamic echocardiography evaluation after aortic valve repair for aortic valve insufficiency.
abstract: We prospectively evaluated 46 patients who underwent aortic valve repair (AVR) for AV regurgitation. Rest/stress echocardiography follow-up was performed. Follow-up duration was 30.7 months, age 56 ± 14 years, ejection fraction% 57.5 ± 10.5%. Preoperative bicuspid AV was present in 14 (30.4%), leaflets calcifications in 8 (17.4%), thickening in 17 (37.0%) and prolapse in 22 (47.8%). Surgical technique included commissuroplasty (22, 47.8%), leaflet remodelling (17, 37.0%), decalcification (7, 15.2%) and raphe removal (14, 30.4%). At follow-up, rest/stress echocardiography median AV regurgitation (rest 1.0 vs. stress 1.0) and mean indexed AV area (IAVA) (rest 2.6 ± 0.74 cm(2)/m(2) vs. stress 2.8 ± 0.4 cm(2)/m(2)) were unchanged (P = ns). Mean (rest 4.7 ± 3.9 mmHg vs. stress 9.7 ± 5.8 mmHg) and peak (rest 9.5 ± 7.2 mmHg vs. stress 19.0 ± 10.5 mmHg) transvalvular gradients were significantly increased (P < 0.0001). At linear regression, there was an independent inverse correlation between commissuroplasty and AV gradients during stress (B = -9.9, P = 0.01, confidence interval= -17.7 to -2.1). Although follow-up haemodynamics of repaired AVs are satisfactory, there was a fixed IAVA and significant increase in AV gradients. We were not able to identify any pre-existing anatomical condition independently related to this non-physiological behaviour under stress. Moreover, commissuroplasty seems to prevent abnormal increase of the AV gradients.
authors.affiliation: Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Palermo, Italy. gdancona@ismett.edu
authors.forename: Giuseppe
authors.initials: G
authors.lastname: D'Ancona
authors.forename: Andrea
authors.initials: A
authors.lastname: Amaducci
authors.forename: John
authors.initials: J
authors.lastname: Prodromo
authors.forename: Francesco
authors.initials: F
authors.lastname: Pirone
authors.forename: Marco
authors.initials: M
authors.lastname: Follis
authors.forename: Calogero
authors.initials: C
authors.lastname: Falletta
authors.forename: Michele
authors.initials: M
authors.lastname: Pilato
mesh_terms: D000328:Adult; D000368:Aged; D001021:Aortic Valve / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D018619:Echocardiography, Doppler, Pulsed; D025401:Echocardiography, Stress; D005080:Exercise Test; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007558:Italy; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left