title: Changes in Left Ventricular Torsion Early Postoperatively After Aortic Valve Replacement and at Long-Term Follow-up.
abstract: OBJECTIVE
  In patients with aortic stenosis, left ventricular systolic torsion (pT) is increased to overcome excessive afterload. This study assessed left ventricular torsion before and immediately after surgical valve replacement and tested the instant effect of fluid loading.
  
  
  METHODS
  Prospective, clinical single-center study.
  
  
  METHODS
  Intensive care unit of a university hospital.
  
  
  METHODS
  12 patients undergoing elective aortic valve replacement for aortic stenosis.
  
  
  METHODS
  Echocardiography was performed on the day before surgery, within 18 hours after surgery including a fluid challenge, and after 2.5 years.
  
  
  RESULTS
  pT decreased early postoperatively by 21.2% (23.4° ± 5.6° to 18.4° ± 6.9°; p = 0.012) and reached preoperative values at 2.5 years follow-up (24 ± 7). Peak diastolic untwisting velocity occurred later early postoperatively (13% ± 8% to 21% ± 9.4%; p = 0.019) and returned toward preoperative values at follow-up (10.2 ± 4.7°). The fluid challenge increased central venous pressure (8 ± 4 mmHg to 11 ± 4 mmHg; p = 0.003) and reduced peak systolic torsion velocity (138.7 ± 37.6/s to 121.3 ± 32/s; p = 0.032). pT decreased in 3 and increased in 8 patients after fluid loading. Patients whose pT increased had higher early mitral inflow velocity postoperatively (p = 0.04) than those with decreasing pT. Patients with reduced pT after fluid loading received more fluids (p = 0.04) and had a higher positive fluid balance during the intensive care unit stay (p = 0.03). Torsion after fluid loading correlated with total fluid input (p = 0.001) and cumulative fluid balance (p = 0.002).
  
  
  CONCLUSIONS
  pT decreased early after aortic valve replacement but remained elevated despite elimination of aortic stenosis. After 2.5 years, torsion had returned to preoperative levels.
authors.affiliation: Department of Intensive Care Medicine, Inselspital, University Hospital Bern & University of Bern, Bern, Switzerland; Department of Cardiology, Inselspital, University Hospital Bern & University of Bern, Bern, Switzerland. Electronic address: stefan.bloechlinger@insel.ch.
authors.forename: Stefan
authors.initials: S
authors.lastname: Bloechlinger
authors.affiliation: Department of Intensive Care Medicine, Inselspital, University Hospital Bern & University of Bern, Bern, Switzerland.
authors.forename: David
authors.initials: D
authors.lastname: Berger
authors.affiliation: Department of Intensive Care Medicine, Inselspital, University Hospital Bern & University of Bern, Bern, Switzerland.
authors.forename: Jürg
authors.initials: J
authors.lastname: Bryner
authors.affiliation: Department of Cardiovascular Surgery, Inselspital, University Hospital Bern & University of Bern, Bern, Switzerland.
authors.forename: Eva
authors.initials: E
authors.lastname: Roost
authors.affiliation: Department of Intensive Care Medicine, Inselspital, University Hospital Bern & University of Bern, Bern, Switzerland.
authors.forename: Stephan
authors.initials: S
authors.lastname: Jakob
authors.affiliation: Department of Intensive Care Medicine, Inselspital, University Hospital Bern & University of Bern, Bern, Switzerland.
authors.forename: Martin W
authors.initials: MW
authors.lastname: Dünser
authors.affiliation: Department of Intensive Care Medicine, Inselspital, University Hospital Bern & University of Bern, Bern, Switzerland; Department of Anaesthesiology, Perioperative and General Intensive Care Medicine, Salzburg General Hospital & Paracelsus Private Medical University, Salzburg, Austria.
authors.forename: Jukka
authors.initials: J
authors.lastname: Takala
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000639:trends*; D006352:Heart Ventricles / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013997:Time Factors; D014102:Torsion Abnormality / Q000000981:diagnostic imaging* / Q000209:etiology; D014463:Ultrasonography; D016277:Ventricular Function, Left / Q000502:physiology
keywords: aortic stenosis; aortic valve replacement; fluid challenge; intensive care unit; left ventricular torsion; transthoracic echocardiography