title: [Left ventricular adaptive response after surgery of aortic valve replacement for severe valvular stenosis].
abstract: BACKGROUND
  Myocardial hypertrophy is a compensatory mechanism in patients with severe aortic stenosis. The left ventricle fits the systolic pressure through a hypertrophic process with increased wall thickness. The effects of elevated ventricular afterload reduce ventricular myocardial elasticity and decrease coronary flow with increased myocardial work, oxygen consumption, and mortality. Aortic valve replacement surgery can cause regression of left ventricular hypertrophy and improve patient survival. The aim of this study was to evaluate left ventricular adaptive response after surgery of aortic valve replacement for severe valvular stenosis.
  
  
  METHODS
  An observational, analytical, longitudinal study that included patients with diagnosis of aortic stenosis with evidence of left ventricular hypertrophy undergoing valve replacement during the period January 2013 to September 2014. Echocardiographic studies were performed before surgery and six months thereafter. Pre- and postoperative means were compared with Student t test for related samples. Statistical significance was considered at p ≤ 0.05.
  
  
  RESULTS
  24 patients were included, with an average age of 57.5 years, with no gender predominance, of which 87.5% had history of smoking and 50% with hypertension. There was no statistically significant difference in diastolic and systolic diameter before and after surgery. The interventricular septum was 14.9 ± 2.3 mm preoperative and 12.8 ± 2.2 mm postoperative (p = 0.001). The back wall was 14.2 ± 1.8 mm preoperative and 12.5 ± 2.2 mm postoperative (p = 0.002). The ventricular mass before surgery was 154.8 ± 54.3 g/m(2) and then 123.2 ± 41.4 g/m(2) (p = 0.000). The maximum preoperative transvalvular gradient was 93 ± 35 mmHg and postoperative was 32.2 ± 14.4 mmHg (p = 0.00). The average preoperative transvalvular gradient was 56.3 ± 19 mmHg and postoperative was 7.5 ± 16.49 mmHg (p = 0.00).
  
  
  CONCLUSIONS
  The interventricular septum, posterior wall, and left ventricular mass decreased significantly after aortic valve replacement. The maximum and mean transvalvular gradient decreased significantly after surgery for aortic valve replacement.
authors.affiliation: Servicio de Cardiocirugía, UMAE No. 34, IMSS, Monterrey, N.L., México.
authors.forename: Ovidio
authors.initials: O
authors.lastname: García-Villarreal
authors.affiliation: Servicio de Cardiocirugía, UMAE No. 34, IMSS, Monterrey, N.L., México.
authors.forename: José Antonio
authors.initials: JA
authors.lastname: Heredia-Delgado
authors.affiliation: Servicio de Cardiocirugía, UMAE No. 34, IMSS, Monterrey, N.L., México.
authors.forename: Bertín
authors.initials: B
authors.lastname: Ramírez-González
authors.affiliation: Servicio de Cardiocirugía, UMAE No. 34, IMSS, Monterrey, N.L., México.
authors.forename: Martín Alfonso
authors.initials: MA
authors.lastname: Saldaña-Becerra
authors.affiliation: Servicio de Cardiocirugía, UMAE No. 34, IMSS, Monterrey, N.L., México.
authors.forename: Miguel Ángel
authors.initials: MÁ
authors.lastname: González-Alanis
authors.affiliation: Servicio de Cardiocirugía, UMAE No. 34, IMSS, Monterrey, N.L., México.
authors.forename: Mauricio Iván
authors.initials: MI
authors.lastname: García-Guevara
authors.affiliation: Servicio de Cardiocirugía, UMAE No. 34, IMSS, Monterrey, N.L., México.
authors.forename: Luz María
authors.initials: LM
authors.lastname: Sánchez-Sánchez
mesh_terms: D000222:Adaptation, Physiological; D000293:Adolescent; D000328:Adult; D000368:Aged; D001024:Aortic Valve Stenosis / Q000601:surgery*; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016277:Ventricular Function, Left / Q000502:physiology*; D055815:Young Adult