Clinical Research of Recovery of Left Ventricular Morphology and Function after Aortic Valve Replacement
|School||Ningxia Medical University|
|Keywords||Aortic Valve Stenosis Aortic Valve Insufficiency Aortic Valve Stenosis and Regurgitation Aortic Valve Replacement Left Ventricular Hypertrophy Left Ventricular Dilatation|
Objective By analysis of preoperative and postoperative echocardiography data, and dynamic follow-up study, in order to clarify disparity of recovery of left ventricular morphology and function after aortic valve replacement, with the different aortic valve disease, preoperative different sizes of left ventricle and the previous different left ventricular ejection fraction, revealing their changing patterns and to provide a theoretical basis in order to further guide the choice of preoperative timing of surgery and consolidated treatment after operation in the long-term clinical work.Methods A retrospective survey during Apr.2002 and Feb.2009 implemented in our hospital. 53 cases underwent simple aortic valve replacement surgery, whose preoperative and postoperative echocardiography data, to become a research group; 20 cases were selected random from health examination who do echocardiography in our hospital(exclude patients with cardiovascular disease).Cases in research group were required to do echocardiography in 2 weeks before operation, postoperative early stage(after 3-6 months) and postoperative mid-term (after 1-2 years) to measure left ventricular end-diastolic diameter (LVEDD) , end-systolic diameter (LVESD), end-diastolic inter ventricular septum thickness (IVSTd), end-diastolic left ventricular posterior wall thickness (LVPWTd), and in accordance with a uniform software to calculate left ventricular ejection fraction (EF) and left ventricular fractional shortening (FS). To observe the preoperative and postoperative changes of left ventricular morphology and function.Results Cases of the research group with preoperative aortic valve disease were divided into 26 cases of aortic insufficiency (AI group), 16 cases of aortic valve insufficiency and stenosis (AI + AS group) and 11 cases of aortic valve stenosis group (AS group). Postoperative left ventricular diameter of three groups showed significant retraction, and the retraction of AI group significantly higher than AS group and the AI + AS group. With preoperative left ventricular end-diastolic diameter (LVEDD) were divided into groups with giant left ventricle (LVEDD≥70mm) 15 cases and non-giant group (LVEDD <70mm group) 38 cases; LVEDD of two groups have significantly reduced in the early postoperative (after 3-6 months) and medium-term (after 1-2 years), LVEDD of the giant group respectively retract to (59.33±6.73) mm and (52.00±7.48) mm from preoperative (78.20±7.46) mm, significantly greater than the non-giant group (P<0.001) in the same period. With preoperative left ventricular ejection fraction (LVEF) were divided into groups to reduce left ventricular function (LVEF<50% group) 13 cases and normal left ventricular function (LVEF≥50% group) 40 cases, left ventricular diameter of the group of preoperative left ventricular function to reduce (LVEF<50%) were significantly larger than the normal group (P<0.05), the postoperative LVEDD and LVESD of two groups were significantly restored (P<0.001), but the group of preoperative left ventricular function to reduce is still larger than the normal group (P<0.01) in the early postoperative and medium-term, and the group is near the normal in postoperative mid-term. Left ventricular posterior wall and the interventricular septum of the AS group, the non-large group and preoperative normal left ventricular function group, the early and mid-term postoperative were significantly reduced compared with the preoperative, and subside more significantly (P<0.001) early postoperative compared with preoperative, the other groups before and after surgery in the AVR was no significant difference (P>0.05). LVEF and FS of different preoperative aortic valve disease group were lower than the control group, and were all increased to varying degrees, AI group increased significantly (P <0.001), LVEF and FS of AI + AS group increased significantly in the early postoperative than preoperative (P<0.05), but haved no significant difference in postoperative mid-term compared with the preoperative. EF and FS of AS unit also have increased in the early postoperative and mid-term compared with the preoperative, but there was no significant difference. EF and FS of giant left ventricle group increased larger than the non-large group, but still lower than the non-large group in the same period. EF and FS of preoperative left ventricular function to reduce increased bigger than the normal group, and is near normal after the operation in the medium-term.Conclusion 1. Recovery of left ventricular shape of different aortic valve disease is different after aortic valve replacement. Preoperative left ventricular shape of AI group is expanded mainly, and retracted significantly higher than AS group and AI+AS group; Preoperative left ventricular shape of AS group is hypertrophied mainly, and postoperative left ventricular posterior wall and interventricular septum thickness subsided significantly higher than the preoperative. 2. Preoperative LVEF and LVEDD is an important factor of impacting left ventricular function recovery, Left ventricular function of the patients of LVEDD≥70mm and LVEF <50% recovered poorly after valve replacement, and prognosis can be judged accordingly. 3. Postoperative 3-6 months is the critical period to determine the reverse of left ventricular shape and the recovery of left ventricular function, so to strengthen the support of heart function in this period is conducive to the reverse of postoperative left ventricular morphology and the recovery of left ventricular function.