Valve prosthesis-patient mismatch: hemodynamic, echocardiographicand clinical consequences

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Abstract

Objectives: The purpose is to evaluate in vivo at rest and under stress conditions hemodynamic performance of the small size St. JudeMedical Regent (SJMR) prosthetic valve in patients with a body surface area (BSA) of 1.8±0.11 m2 and to define the role of valve prosthesispatientmismatch on left ventricular mass regression following aortic valve replacement. Methods: We evaluated 25 cases (12 males and13 females, mean age 65.2±8 years) of aortic valve replacement (17 mm SJMR in three cases and 19 mm SJMR in 22 cases). All the patientsunderwent at rest Doppler echocardiography before and after surgery and both basal and dobutamine stress echocardiography (DSE) atfollow-up. The mean duration of follow-up was 41.3±24 months. Results: A significant reduction in mean and peak transaortic gradients andpeak transaortic velocity over time following valve replacement has been identified. After surgery, there was a significant increase of ejectionfraction. DSE significantly increased heart rate, ejection fraction, peak transaortic gradient and peak transaortic velocity. All patientspassed DSE without complication. Even if a significant mismatch was present in 76% of cases, the left ventricular mass decreased significantlyfrom preoperative value of 278.7±51.1 g to 181.5±52.73 g, respectively. Conclusion: Aortic valve replacement with 17 mm SJMR or 19 mmSJMR prostheses appear to provide satisfactory clinical and hemodynamic results at rest and under DSE, even in those patients with BSA of1.8±0.11 m2 where it was not possible to enlarge the aortic annulus. Prosthesis-patient mismatch is not associated with lesser regression ofleft ventricular mass. Dobutamine stress echocardiography should be a useful and effective means for evaluating prosthesis hemodynamicaspects.
Lingua originaleEnglish
pagine (da-a)606-610
Numero di pagine5
RivistaINTERACTIVE CARDIOVASCULAR AND THORACIC SURGERY
Volume13
Stato di pubblicazionePublished - 2011

All Science Journal Classification (ASJC) codes

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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