title: Impact of aortic prosthesis-patient mismatch on left ventricular mass regression.
abstract: BACKGROUND
  Prostheses used for aortic valve replacement may be small in relation to body size, causing prosthesis-patient mismatch and delaying left ventricular mass regression. This study examined the effect of prosthesis-patient mismatch on regression of left ventricular mass after aortic valve replacement.
  
  
  METHODS
  We prospectively studied 96 patients undergoing aortic valve replacement between 2007 and 2012. Mean and peak gradients and indexed effective orifice area were measured by transthoracic echocardiography at 3 and 6 months postoperatively. Patient-prosthesis mismatch was defined as indexed effective orifice area ≤0.85 cm(2)·m(-2).
  
  
  RESULTS
  Moderate prosthesis-patient mismatch was present in 25% of patients. There were no significant differences in demographic and operative data between patients with and without prosthesis-patient mismatch. Left ventricular dimensions, posterior wall thickness, transvalvular gradients, and left ventricular mass decreased significantly after aortic valve replacement in both groups. The interventricular septal diameter and left ventricular mass index regression, and left ventricular ejection fraction were better in patients without prosthesis-patient mismatch. There was a significant positive correlation between the postoperative indexed effective orifice area of each valve prosthesis and the rate of left ventricular mass regression.
  
  
  CONCLUSIONS
  Prosthesis-patient mismatch leads to higher transprosthetic gradients and impaired left ventricular mass regression. A small-sized valve prosthesis does not necessarily result in prosthesis-patient mismatch, and may be perfectly adequate in patient with small body size.
authors.affiliation: Prince Salman Heart Center, King Fahd Medical City, Riyadh, Saudi Arabia Cardiothoracic Surgery Department, Banha University, Egypt dmohamedabdelwahab@gmail.com.
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: Alassal
authors.affiliation: Cardiothoracic Surgery Department, Tanta University, Egypt.
authors.forename: Bedir M
authors.initials: BM
authors.lastname: Ibrahim
authors.affiliation: Cardiothoracic Surgery Department, Zagazig University, Egypt.
authors.forename: Nabil
authors.initials: N
authors.lastname: Elsadeck
mesh_terms: D000328:Adult; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D004452:Echocardiography; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011446:Prospective Studies; D011474:Prosthesis Design; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D020257:Ventricular Remodeling
keywords: Aortic valve stenosis; body size; heart valve prosthesis implantation; hypertrophy; left ventricular; prosthesis fitting