Document Detail

Symptoms, left ventricular function, and timing of valve replacement surgery in patients with aortic regurgitation.
MedLine Citation:
PMID:  10467198     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Because cardiac decompensation is subtle, the best time to perform aortic valve replacement surgery may be difficult to determine. We investigated the relation of symptoms to left ventricular (LV) function and the timing of valve replacement in patients with aortic regurgitation (AR) of largely rheumatic origin. METHODS: Sixty-eight initially asymptomatic patients (mean age 29 years) with severe chronic AR were monitored for 36 months. Assessments included baseline and yearly echocardiograms and radioisotope ventriculography (resting and exercise) and clinical examinations every 6 months. RESULTS: Forty-seven patients (69%) remained asymptomatic and 21 (31%) had symptoms develop after 24 to 36 months. Compared with symptomatic patients, asymptomatic patients had significantly (P <.05) lower baseline LV end-diastolic diameter, end-systolic diameter, end-systolic stress, and volume/mass ratio but greater shortening fraction and ejection fraction (EF) at rest. These variables remained stable without statistically significant change until surgical correction in symptomatic patients. Percent variation of EF from rest to exercise increased in patients who remained asymptomatic (EF 2.8% +/- 10.6%) but decreased in those who became symptomatic (EF -4.2% +/- 13%; P <.05). Twenty symptomatic patients (New York Heart Association class III/IV, angina and/or syncope) had valve replacement surgery, after which all were in New York Heart Association class I/II and had significant decreases of LV end-diastolic and end-systolic diameters and an increase on percent variation of EF from rest to exercise (P <.0001). CONCLUSIONS: Development of symptoms did not correlate with change in any ventricular function indexes. Surgery on appearance of symptoms restored LV function to near normal.
F Tarasoutchi; M Grinberg; J P Filho; M Izaki; L F Cardoso; P Pomerantezeff; A Nuschbacher; P L da Luz
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  American heart journal     Volume:  138     ISSN:  0002-8703     ISO Abbreviation:  Am. Heart J.     Publication Date:  1999 Sep 
Date Detail:
Created Date:  1999-09-22     Completed Date:  1999-09-22     Revised Date:  2006-02-27    
Medline Journal Info:
Nlm Unique ID:  0370465     Medline TA:  Am Heart J     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  477-85     Citation Subset:  AIM; IM    
Heart Institute, School of Medicine, University of São Paulo, SP, Brazil.
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MeSH Terms
Aortic Valve / surgery
Aortic Valve Insufficiency / physiopathology,  surgery*,  ultrasonography
Exercise Test
Follow-Up Studies
Heart Valve Prosthesis*
Heart Valve Prosthesis Implantation*
Patient Selection
Rheumatic Diseases / complications
Ventricular Function, Left*

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

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