Normalization of diastolic dysfunction in aortic stenosis late after valve replacement

Details

Serval ID
serval:BIB_365C29F648DC
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Normalization of diastolic dysfunction in aortic stenosis late after valve replacement
Journal
Circulation
Author(s)
Villari  B., Vassalli  G., Monrad  E. S., Chiariello  M., Turina  M., Hess  O. M.
ISSN
0009-7322 (Print)
Publication state
Published
Issued date
05/1995
Volume
91
Number
9
Pages
2353-8
Notes
Journal Article
Research Support, Non-U.S. Gov't --- Old month value: May 1
Abstract
BACKGROUND: The remodeling of the left ventricle in patients with aortic stenosis after aortic valve replacement (AVR) is a complex process involving structural and functional changes. METHODS AND RESULTS: Twenty-two patients were included in the present analysis. Twelve patients with severe aortic stenosis were studied before surgery, early (22 +/- 8 months) and late (81 +/- 22 months) after AVR using left ventricular biplane angiograms, high-fidelity pressure measurements, and endomyocardial biopsies. Ten healthy subjects were used as controls. Left ventricular systolic function was assessed from biplane ejection fraction; and diastolic function from the time constant of relaxation, the peak filling rate, and the myocardial stiffness constant. Left ventricular structure was evaluated from interstitial fibrosis, fibrous content, and muscle fiber diameter. Left ventricular muscle mass was significantly increased before surgery in patients with aortic stenosis and remained increased early after surgery, although there was a 35% decrease. Late after AVR, muscle mass decreased significantly but remained slightly (P = NS) elevated. Left ventricular ejection fraction increased slightly after AVR. Left ventricular relaxation was significantly prolonged before surgery and returned toward normal early and late after AVR. Peak filling rates remained unchanged before and after surgery. Myocardial stiffness constant was increased before surgery in patients with aortic stenosis compared with controls and increased even further early after AVR but was normalized late after surgery. Muscle fiber diameter was elevated in patients with aortic stenosis before and after surgery compared with controls; however, it decreased significantly early and late after AVR with respect to preoperative data but remained hypertrophied even late after surgery. Interstitial fibrosis and fibrous contents were larger before surgery than in control subjects and increased even more early but decreased significantly late after AVR. CONCLUSIONS: Diastolic stiffness increases in aortic stenosis early after AVR parallel to the increase in interstitial fibrosis, whereas relaxation rate decreases with a reduction in left ventricular muscle mass. Late after AVR, both diastolic stiffness and relaxation are normalized due to the regression of both muscular and nonmuscular tissue. Thus, reversal of diastolic dysfunction in aortic stenosis takes years and is accompanied by a slow regression of interstitial fibrosis.
Keywords
Adult Aortic Valve Stenosis/physiopathology/*surgery Follow-Up Studies Heart Ventricles/pathology Hemodynamic Processes Humans Middle Aged *Ventricular Function, Left
Pubmed
Web of science
Create date
28/01/2008 10:32
Last modification date
20/08/2019 13:24
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