Echocardiography in Chronic Aortic Insufficiency

To determine whether a ventricular (LV) end-systolic dimension (ESD) > 55 mm and LV left fractional shortening < 25% are risk factors for aortic valve replacement (AVR) in patients with aortic insufficiency, we analyzed the clinical course and M-mode echocardiograms in 47 consecutive patients who underwent AVR for isolated symptomatic Al. Group 1 patients (n = 27) had a preoperative ESD < 55 mm (mean 44 mm, range 30-52 mm) and group 2 patients (n = 20) had a preoperative ESD > 55 mm (mean 62 mm, range 55-85 mm). One patient in group 1 and 10 patients in group 2 had left ventricular fractional shortening < 25%. There were no perioperative or postoperative deaths during an average follow-up of 41 months (range 6-76 months). Five patients had perioperative myocardial infarctions (MIs), three in group 1 and two in group 2. Since myocardial protection with cold potassium cardioplegia was instituted, no patient has suffered a perioperative MI. The average preoperative New York Heart Association functional classification was 2.3 (group 1) and 2.6 (group 2). Postoperatively, it was 1.2 in group 1 and 1.1 in group 2. Thirty-three patients (20 in group 1 and 13 in group 2) had echocardiograms at least 1 year after AVR. Of these, LV-end diastolic dimension decreased from 67 + 6 to 53 + 6 mm (mean ± SD) in group 1 (p < 0.001) and from 79 3 to 55 ± 6 mm in group 2 (p < 0.001). The LVESD also decreased, but this is difficult to interpret because offrequent postoperative abnormal interventricular septal motion. The LV cross-sectional area, an index of LV mass, decreased in group 1 from 25 ± 5 to 20 ± 5 cm2 (p < 0.001) and in group 2 from 32 ± 9 to 20 + 5 cm2 (p < 0.001). Postoperative end-diastolic dimension and cross-sectional area were not significantly different between the two groups. We concluded that in aortic insufficiency, a preoperative ESD 2, 55 mm does not preclude successful AVR, as judged by long-term survival, symptomatic relief, and normalization of LV dimensions assessed by echocardiography.