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J Thorac Cardiovasc Surg 1997;113:901-909
© 1997 Mosby, Inc.

SURGERY FOR ACQUIRED HEART DISEASE

EXTENT AND PATTERN OF REGRESSION OF LEFT VENTRICULAR HYPERTROPHY IN PATIENTS WITH SMALL SIZE CARBOMEDICS AORTIC VALVES

Received for publication August 6, 1996 revisions requested Oct. 4, 1996; revisions received Nov. 1, 1996 accepted for publication Nov. 8, 1996. Address for reprints: Ruggero De Paulis, MD, Cattedra di Cardiochirurgia, Università di Roma, Tor Vergata, European Hospital, via Portuense 700, 00149 Rome, Italy.

Abstract

Objective: To assess the extent and pattern of regression of left ventricular hypertrophy after valve replacement for aortic stenosis, we studied 26 patients receiving either 19 or 21 mm CarboMedics valves (group I, 13 patients) or either 23 or 25 mm CarboMedics valves (group II, 13 patients). The studies were done before the operation and after 3 years, and results were compared with those of 10 control patients.Methods: Left ventricular end-diastolic and end-systolic diameters and volumes, ejection fraction and fractional shortening, and interventricular septum and posterior wall thickness were measured. The ratio between interventricular septum and posterior wall thickness, the ratio between left ventricular wall thickness and left ventricular chamber radius, and the left ventricular mass were then calculated.Results: At follow-up there was a significant reduction in the left ventricular mass, interventricular septum, and posterior wall thickness for both patient groups (p < 0.01). However, only the posterior wall thickness reached normal values; the interventricular septum and the left ventricular mass indices were still significantly greater than in the control group (p < 0.01). Because of the incomplete regression of interventricular septal hypertrophy, the ratio between interventricular septum and posterior wall thickness was similar between both patient groups but it was significantly higher than in control subjects (p < 0.01). The ratio between wall thickness and chamber radius did not decrease significantly in group II patients, in whom it remained above the control values.Conclusion: Having a bileaflet aortic prosthesis of one size larger did not seem to significantly influence the pattern and the extent of regression of left ventricular hypertrophy after an intermediate period of follow-up.

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