Postoperative regression of left ventricular dimensions in aortic insufficiency: A long-term echocardiographic study

• Published in: Journal of the American College of Cardiology 1985-04, Vol.5 (4), p.856-861
• Main Authors: Fioretti, Paolo, Roelandt, Jos, Sclavo, Mariagrazia, Domenicucci, Stefano, Haalebos, Max, Bos, Egbert, Hugenholtz, Paul G.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aortic Valve Insufficiency - physiopathology; Aortic Valve Insufficiency - surgery; Biological and medical sciences; Cardiology. Vascular system; Cardiomegaly - physiopathology; Echocardiography; Endocardial and cardiac valvular diseases; Female; Follow-Up Studies; Heart; Heart Valve Prosthesis; Heart Ventricles - physiopathology; Humans; Male; Medical sciences; Middle Aged; Postoperative Period; Preoperative Care; Prognosis; Time Factors
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/S0735-1097(85)80423-X

The ability of preoperative M-mode echocardiography to predict the clinical course and the decrease in left ventricular size was assessed in 42 patients after uncomplicated valve replacement for isolated aortic insufficiency. During follow-up study, one patient died of chronic heart failure. The New York Heart Association functional class of the 41 survivors improved from 2.4 to 1.2. All patients had a preoperative M-mode echocardiogram. Serial echocardiography measurements, available in 33 patients, showed a sustained decrease in left ventricular end-diastolic dimension after the first postoperative year from 73 ± 8 to 57 ± 9 mm at 6 to 12 months and to 53 ± 9 mm at 3 years postoperatively (p < 0.01). Left ventricular cross-sectional area decreased from 31 ± 8 to 26 ± 7 cm2and then to 23 ± 5 cm2at the latest follow-up study (p < 0.01). At 3 years postoperatively, M-mode echocardiograms were available in 37 patients: 24 had a normal left ventricular dimension (group 1), while 13 still had an enlarged left ventricle (group 2). The clinical course in these two groups was similar. The best preoperative predictor of persistent left ventricular enlargement was the end-diastolic dimension (p < 0.05), whereas fractional shortening and the end-diastolic radius/thickness ratio were not predictive. It is concluded that: 1) uncomplicated valve replacement for chronic aortic insufficiency is followed by a benign clinical course; 2) the reduction in left ventricular size may continue beyond the first postoperative year; 3) persistence of moderate left ventricular enlargement after surgery does not indicate a poor clinical prognosis; and 4) preoperative M-mode echocardiography variables are poor predictors of clinical outcome and regression in left ventricular size.