Echocardiographic and hemodynamic characteristics of reconstructed bicuspid aortic valves at rest and exercise.

Echocardiographic and hemodynamic characteristics of reconstructed bicuspid aortic valves at rest and exercise.

MedLine Citation:	PMID: 15997344 Owner: NLM Status: MEDLINE
Abstract/OtherAbstract:	Repair of diseased bicuspid aortic valves has gained increasing interest as an alternative to conventional valve replacement. Hemodynamic data at exercise have not been reported before. The aim of this study was to investigate the clinical and echocardiographic status of patients after bicuspid aortic valve repair at rest and exercise. Between 03/94 and 09/02 a reconstruction of an incompetent bicuspid aortic valve was performed in 25 patients (mean age 35+/-12.1 years, group A, mean insufficiency 2.8 preoperatively). Patients were investigated clinically and echocardiographically after 2.1+/-2.4 (0.1-8.9) years at rest and exercise and compared to 20 controls (group B). Clinical followup was complete. There were no deaths, reoperations, thromboembolic or bleeding complications. At last examination 21 patients were in NYHA class I, n=4 in NYHA class II and mean aortic valve insufficiency (AI) was 1.0 with one patient having an AI>II degrees. Maximum and mean pressure gradient (dPmax/mean) across the aortic valve at rest were 14+/-5.5/7+/-2.6 mmHg for patients of group A and 7+/-2.5/3.6+/-1.1 mmHg in group B. Mean AVA at rest was 2.6+/-0.8 (group A) vs 2.9+/-0.6 cm(2) (group B, p=0.025), valvular resistance 13.4+/-4.8 (group A) vs 13.6+/-2.9 dyn x s x cm(-5) (group B, p>0.05). All individuals were stressed up to 100 W (dPmax/mean 21+/-6.8/11+/-3.6, group A vs 11+/-2.9/6+/-1.3 mmHg, group B). 56% of group A and 85% of group B could be stressed up to 175 W with dPmax/mean 24.5+/-8.3/12+/-4.2 and 16+/-3.6/8+/-1.4 mmHg, respectively (p<0. 01). Heart rate and blood pressure behavior were comparable. Left ventricular mass regression (preoperatively 369.3+/-76.4 vs 277.3+/-80.7 g at last examination, p<0.01) was significant in group A but did not reach normal values (group B, 227.8+/-71.1; p<0.01). Bicuspid aortic valve reconstruction reduces left ventricular volume load significantly. Although residual mild subclinical obstruction and incompetence were observed, the behavior of hemodynamics at exercise was comparable to controls. The clinical relevance of these findings in long term follow-up has to be evaluated.

Authors:	C Schmidtke; D Poppe; G Dahmen; H-H Sievers
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Publication Detail:	Type: Clinical Trial; Journal Article
Journal Detail:	Title: Zeitschrift für Kardiologie Volume: 94 ISSN: 0300-5860 ISO Abbreviation: Z Kardiol Publication Date: 2005 Jul
Date Detail:	Created Date: 2005-07-05 Completed Date: 2005-10-27 Revised Date: 2009-11-03
Medline Journal Info:	Nlm Unique ID: 0360430 Medline TA: Z Kardiol Country: Germany
Other Details:	Languages: eng Pagination: 437-44 Citation Subset: IM
Affiliation:	Klinik für Herzchirurgie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany. claudia.schmidtke@uni-luebeck.de
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MeSH Terms
Descriptor/Qualifier:	Adolescent Adult Aortic Valve / abnormalities, surgery, ultrasonography Aortic Valve Insufficiency / complications, diagnosis, surgery, ultrasonography Blood Pressure Cardiac Surgical Procedures / methods* Echocardiography Evidence-Based Medicine Exercise Test Female Humans Male Middle Aged Reconstructive Surgical Procedures / methods* Rest Treatment Outcome Ventricular Dysfunction, Left / etiology, surgery, ultrasonography

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