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eComment: Additional techniques and parameters for left ventricular performance assessement in aortic valve replacement

Bakoulev Center for Cardiovascular Surgery,121553 Moscow, Russia

Left ventricular performance in aortic valve replacement

In recent years the interrelation of the form, various variants of the left ventricular (LV) remodeling and its functions have been actively studied. These questions were widely covered in the matter of pharmacology effect as well as surgical treatment of patients with ischemic heart disease. Studies of remodeling variants, hemodynamics in patients with valve diseases, in particular, aortic valve diseases, allow us to understand the processes occurring both during formation of the disease and as a response to aortic valve replacement (AVR).

The main advantage of this study was in the revealing of real difference in hemodynamics and contractility after AVR in aortic stenosis and aortic regurgitation patients. The reduction in EDV in aortic regurgitation patients after AVR led to an improvement in contractility, the abrupt volume change also brought an increase in afterload. This caused a sufficient reduction of LV efficiency in early postoperative period. In aortic stenosis after AVR the decrease in afterload and LV contractility occured, the normalization of LV efficiency was evident within a year after the operation. In aortic regurgitation patients LV efficiency remains lowered. On the basis of the following data – the absence of restoration of LV sufficiency after AVR – there is a necessity in earlier selection of patients with aortic regurgitation for the operation [1]. The differences in hemodynamics which were determined by means of the represented parameters will help to find an approach for management of the patients in the postoperative period. The findings did not contradict other remodeling LV, hemodynamics studies in aortic disease patients after AVR.

At the Bakoulev Center for CVS, detailed studies with the use of echocardiography with TDI and CT with intravenous bolus contrasting for estimation of hemodynamics in aortic disease patients were carried out. According to our data non-adaptive LV remodeling and reduction of ejection fraction (EF) were developed in aortic regurgitation patients early after AVR. Initial index LV mass >206 g/m² predicted an unfavourable prognosis [2].

Other studies demonstrated that the abrupt decline of circumferential wall stress as the LV pressure falls after AVR for aortic stenosis resulted in an immediate reciprocal increase in peak circumferential shortening velocity (Vcf). Myocardial stroke work fell significantly due to the shortening of LV systolic duration and LV diastolic time increased towards normal level. In aortic regurgitation neither Vcf nor myocardial wall stress were changed. Fundamental physiological benefits of AVR to myocardial contraction consisted of restoration of relationship between systolic and diastolic time, that prevented the further myocardium damage. Thus, successful results of AVR depend on the time when the operation was performed [3, 4]. The new parameters used for an estimation of LV function and afterload require the further investigation for its introduction into clinical practice. The present study was retrospective and allows to collect data and receive results in a faster way. Application of Simpson's method or magnetic resonance tomography in calculation of the LV volume index in prospective study will increase the accuracy of represented parameters.

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1. Tanoue Y, Maeda T, Oda S, Baba H, Oishi Y, Tokunaga S, Nakashima A, Tominaga R. Left ventricular performance in aortic valve replacement. Interact CardioVasc Thorac Surg 2009;9:255–259.[Abstract/Free Full Text]
2. Bockeria LA, Bockeria OL. Left ventricle remodeling assessment in patients with aortic valve diseases after aortic valve replacement. Abstract 122 for The European Society for Cardiovascular Surgery 56th International Congress, Venice, Italy, May 17–20, 2007. Interact CardioVasc Thorac Surg 2007;6(Suppl_1):S133.[CrossRef]
3. Jin XY. Elucidation of cardiac physiology in aortic valve replacement: what should we know? J Heart Valve Dis 2004;13:S70–S75.[Medline]
4. Lamb HJ, Beyerbacht HP, de Roos A, van der Laarse A, Vliegen HW, Leujes F, Bax JJ, van der Wall EE. Left ventricular remodeling early after aortic valve replacement: differential effects on diastolic function in aortic valve stenosis and aortic regurgitation. J Am Coll Cardiol 2002;40:2182–2188.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Leo A. Bockeria Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Bockeria, L. A. Articles by Averina, I. I. Search for Related Content PubMed PubMed Citation Articles by Bockeria, L. A. Articles by Averina, I. I. Related Collections Related Article