Left ventricular remodeling after pulmonary autograft aortic valve replacement: evaluation with color-Doppler echocardiography and magnetic resonance imaging.

The superior hemodynamic performance of the pulmonary autograft in aortic position is expected to reflect complete regression of hypertrophy and improved ventricular function. We evaluated and compared early and midterm transthoracic color-Doppler echocardiography (TTE) and magnetic resonance imaging (MRI) assessment concerning left ventricular (LV) function, LV mass regression, and performance of the semilunar valves. A total of 42 consecutive patients, mean age 36 +/- 6 years (range 15 to 56 years), were studied. TTE and MRI were performed preoperatively, at discharge, and at 6 and 12 months postoperatively. Left ventricular diameters and function and LV wall thickness and mass were assessed. There was no early and one late postoperative death. Maximum and mean LV outflow gradients were significantly reduced (p = 0.0001 and p = 0.0001, respectively). There was a significant reduction in left ventricular mass to near normal for all patients (p = 0.001) seen after 6 months. This was paralleled by significant reductions in the interventricular septum and posterior wall thickness, but difference was slight during further follow-up. There was a strong correlation between the results obtained by TTE and MRI for LV mass and ejection fraction (r = 0.86 and 0. 87, respectively). The pulmonary autograft operation gives excellent results that are translated into greater, rapid, and near complete regression of LV hypertrophy. Magnetic resonance imaging is a sensitive and noninvasive methodology that provides reliable visualization and quantification of ventricular performance.

[1]  M. De Carlo,et al.  Hemodynamic performance of stented and stentless aortic bioprostheses. , 2001, The Annals of thoracic surgery.

[2]  R. Siegel,et al.  Regression of hypertrophy after Carpentier-Edwards pericardial aortic valve replacement. , 2000, The Annals of thoracic surgery.

[3]  C. Duran,et al.  Cardiopulmonary response to maximal exercise in young athletes following the Ross procedure. , 1998, The Annals of thoracic surgery.

[4]  F. Tomai,et al.  Regression of left ventricular hypertrophy after aortic valve replacement for aortic stenosis with different valve substitutes. , 1998, The Journal of thoracic and cardiovascular surgery.

[5]  B A Szabo,et al.  MRI-radiofrequency tissue tagging in patients with aortic insufficiency before and after operation. , 1998, The Annals of thoracic surgery.

[6]  D G Gibson,et al.  Effects of valve substitute on changes in left ventricular function and hypertrophy after aortic valve replacement. , 1996, The Annals of thoracic surgery.

[7]  A. Roos,et al.  Magnetic resonance measurement of velocity and flow: technique, validation, and cardiovascular applications. , 1993, American heart journal.

[8]  A. Hoffmann,et al.  Patients at risk for cardiac death late after aortic valve replacement. , 1990, American heart journal.

[9]  H. Matsuda,et al.  Left ventricular ejection performance, wall stress, and contractile state in aortic regurgitation before and after aortic valve replacement. , 1990, Circulation.

[10]  O. Hess,et al.  Left ventricular myocardial structure in aortic valve disease before, intermediate, and late after aortic valve replacement. , 1989, Circulation.

[11]  T. Ohe,et al.  The role of initial minimum potentials on body surface maps in predicting the site of accessory pathways in patients with Wolff-Parkinson-White syndrome. , 1986, Circulation.

[12]  J. Ross,et al.  Development and regression of left ventricular hypertrophy. , 1984, Journal of the American College of Cardiology.

[13]  L. Cohn.  The long-term results of aortic valve replacement. , 1984, Chest.

[14]  J. Carroll,et al.  Serial changes in left ventricular function after correction of chronic aortic regurgitation. Dependence on early changes in preload and subsequent regression of hypertrophy. , 1983, The American journal of cardiology.