The Annals of Thoracic Surgery, Vol 50, 779-785, Copyright © 1990 by The Society of Thoracic Surgeons
Timing of operation for aortic regurgitation: relation to postoperative contractile state
K Taniguchi, S Nakano, H Matsuda, Y Shimazaki, K Sakai, T Kawamoto, S Sakaki, J Kobayashi, H Shintani and M Mitsuno
First Department of Surgery, Osaka University Medical School, Japan.
With angiography and pressure measurement, we determined left ventricular
volume, wall stress, and systolic performance in 30 patients with aortic
regurgitation before and after successful aortic valve replacement.
End-systolic wall stress was greatly elevated preoperatively and decreased
to normal postoperatively. Systolic pump performance assessed as ejection
phase indexes was severely depressed preoperatively and improved to normal
or near-normal postoperatively in most patients. The ratio of end-systolic
wall stress to end-systolic volume index (ESS/ESVI), an index of myocardial
contractility, was greatly decreased before operation. Postoperatively, the
ratio increased in all patients, becoming normal in 12 of the 13 patients
who had a preoperative ESS/ESVI of 2.9 or greater. However, 15 of 17
patients in whom the ESS/ESVI ratio was less than 2.9 still had subnormal
ratios, which indicates the presence of irreversible contractile
dysfunction. Stepwise multivariate analysis showed that preoperative
ESS/ESVI was the only independent discriminator of postoperative
normalization of the contractile function as assessed by ESS/ESVI. After
aortic valve replacement, myocardial contractile state does not return to
normal in a considerable number of patients. It is important to offer
aortic valve replacement for aortic regurgitation before the chance for a
good functional result is lost. The ESS/ESVI ratio may be a useful index in
determining the timing of operation in patients with aortic regurgitation.
