Document Detail


Left ventricular wall stress in patients with severe aortic insufficiency with finite element analysis.
MedLine Citation:
PMID:  16928495     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Severe aortic insufficiency (AI) with preserved left ventricular (LV) function may be associated with a long asymptomatic period and unpredictable course on medical therapy. Since myocardial wall stress is closely related to both pathologic cardiac remodeling and ultimately to LV decompensation, a more accurate description of regional wall stress may improve our ability to appropriately manage these patients. The objective of this study was to define differences in instantaneous global and regional three-dimensional end-systolic maximum principal stress (ESS) between normal patients and patients with AI, both before and after aortic valve replacement (AVR) using magnetic resonance imaging (MRI) and finite element analysis (FEA). METHODS: Magnetic resonance imaging was performed on 20 normal volunteers and 14 patients with moderate to severe AI with normal systolic function (ejection fraction: 57 +/- 0.6) before and after AVR. Finite element analysis was utilized to estimate global and regional ESS. RESULTS: Both global (p < 0.001) and regional (p < 0.001 in all segments) ESS were significantly higher in the preoperative AI patients when compared with their postoperative values and normal controls. Postoperative ESS was significantly lower than the normal controls (p = 0.002). CONCLUSIONS: Three-dimensional regional and global end-systolic LV wall stress can be determined by MRI and finite element analysis. Values of ESS in patients with chronic AI were elevated prior to AVR and normalized after AVR. This method may have considerable potential as a noninvasive, clinically applicable index of regional LV geometry and function that may help with the serial evaluation of patients with AI.
Authors:
Jason R Wollmuth; Douglas R Bree; Brian P Cupps; Marc D Krock; Benjamin J Pomerantz; Robert P Pasque; Analyn Howells; Nader Moazami; Nicholas T Kouchoukos; Michael K Pasque
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  82     ISSN:  1552-6259     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2006 Sep 
Date Detail:
Created Date:  2006-08-24     Completed Date:  2006-09-13     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  840-6     Citation Subset:  AIM; IM    
Affiliation:
Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, Missouri 63110-1013, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aortic Valve Insufficiency / pathology,  physiopathology*
Disease Progression
Female
Finite Element Analysis
Heart Valve Prosthesis Implantation
Heart Ventricles / pathology,  physiopathology*
Humans
Imaging, Three-Dimensional
Magnetic Resonance Imaging
Male
Middle Aged
Postoperative Period
Stress, Mechanical
Stroke Volume
Systole
Grant Support
ID/Acronym/Agency:
R01 HL64869/HL/NHLBI NIH HHS

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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