Effect of surgical aortic valvuloplasty for aortic insufficiency using echocardiography one year after surgery in 25 patients

doi:10.16150/j.1671-2870.2022.03.018

Abstract

Abstract:

Objective: To investigate effect of surgical aortic valvuloplasty(AVP) for aortic insufficiency in patients using transthoracic echocardiography (TTE). Methods: A total of 25 patients underwent AVP surgery for aortic insufficiency(AI) were enrolled, and TTE was performed to evaluate effects of AVP. Cardiac chamber size, left ventricular(LV) systolic and diastolic function, AI grade, systolic transvalvular blood flow velocity and pressure gradient were measured one year after surgery, and results were compared to those before operation. Results: Echocardiographic measurements show that AVP, LV overload was reversed, Left ventricular end-diastolic diameter [(54.4±4.6) mm preoperatively vs ( 50.0±4.9) mm postoperatively, P=0.003), left ventricular end-diastolic volume[(145.7±28.8) mL preoperatively vs (120.4±27.8) mL pos-toperatively, P<0.001), left ventricular end-systolic diameter [34.0(31.0, 38.0) mm preoperatively vs 31.0(29.5, 34.0) mm postoperatively, P<0.001], left ventricular end-systolic volume [47.0(37.5, 63.0) mL preoperatively vs 37.0(32.5, 48.5) mL postoperatively, P=0.005], left ventricular stroke volume [(92.6±18.4) mL preoperatively vs (78.4±17.8) mL postoperatively, P<0.001] were significantly decreased, and the degree of aortic valve regurgitation was also significantly relieved (chi-square value is 21.000, P=0.021). However, there were no significant changes in aortic transvalvular flow velocity and pressure gradient [(1.8±0.4) m/s preoperatively vs (1.7±0.4) m/s postoperatively, P=0.086) and [(13.4±5.2) mmHg preoperatively vs (11.6±5.7) mmHg postoperatively, P=0.152). Postoperative regurgitation score ≥3 points were found in 5 cases. Conclusions: One year after AVP, the rate of moderate regurgitation in these patients is 20%. All AI is signifi-cantly alleviated after AVP, with reversed LV overload and accompanied by favorable LV remodelling, which is consistent with clinical manifestations.

Key words: Aortic valvuloplasty, Echocardiography, Recurrent aortic insufficiency

CLC Number:

R542.5

WANG Chenchen, FANG Yuehua, SHI Zhongwei, QU Xuezheng. Effect of surgical aortic valvuloplasty for aortic insufficiency using echocardiography one year after surgery in 25 patients[J]. Journal of Diagnostics Concepts & Practice, 2022, 21(03): 395-398.

Figures/Tables 4

References 16

[1]	Rimmer L, Ahmad MU, Chaplin G, et al. Aortic Valve Repair: Where Are We Now?[J]. Heart Lung Circ, 2019, 28(7):988-999. doi: S1443-9506(19)30083-6 pmid: 30871890
[2]	Gravel JA. Surgical treatment of aortic insufficiency[J]. Can Med Assoc J, 1955, 72(8):599-601.
[3]	Taylor WJ, Thrower WB, Black H, The surgical correction of aortic insufficiency by circumclusion[J]. J Thorac Surg, 1958, 35(2):192-205. doi: 10.1016/S0096-5588(20)30272-5 URL
[4]	Youssefi P, Pepper J. A new age of aortic valve repair[J]. Eur J Cardiothorac Surg, 2021, 60(5):1062-1063. doi: 10.1093/ejcts/ezab258 URL
[5]	Guglielmo M, Rovera C, Rabbat MG, et al. The role of cardiac magnetic resonance in aortic stenosis and regurgitation[J]. J Cardiovasc Dev Dis, 2022, 9(4):108.
[6]	Committee for Scientific Affairs, The Japanese Association for Thoracic Surgery, Masuda M, et al. Thoracic and cardiovascular surgery in Japan during 2012: annual report by The Japanese Association for Thoracic Surgery[J]. Gen Thorac Cardiovasc Surg, 2014, 62(12):734-764. doi: 10.1007/s11748-014-0464-0 URL
[7]	Salem R, Zierer A, Karimian-Tabrizi A, et al. Aortic valve repair for aortic insufficiency or dilatation: technical evolution and long-term outcomes[J]. Ann Thorac Surg, 2020, 110(6):1967-1973. doi: 10.1016/j.athoracsur.2020.03.105 URL
[8]	Ram E, Orlov B, Shinfeld A, et al. Clinical and echocardiographic outcomes after aortic valve repair surgery[J]. Innovations (Phila), 2019, 14(3):209-217. doi: 10.1177/1556984519845657 URL
[9]	Zoghbi WA, Adams D, Bonow RO, et al. Recommendations for noninvasive evaluation of native valvular regurgitation: a report from the American Society of Echocardiography Developed in Collaboration with the Society for Cardiovascular Magnetic Resonance[J]. J Am Soc Echocardiogr, 2017, 30(4):303-371. doi: 10.1016/j.echo.2017.01.007 URL
[10]	Nishimura RA, Otto CM, Bonow RO, et al. 2017 AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the management of patients with valvular heart di-sease: a report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines[J]. J Am Coll Cardiol, 2017, 70(2):252-289. doi: S0735-1097(17)36019-9 pmid: 28315732
[11]	Vahanian A, Beyersdorf F, Praz F, et al. 2021 ESC/EACTS Guidelines for the management of valvular heart disease[J]. Eur Heart J, 2022, 43(7):561-632. doi: 10.1093/eurheartj/ehab395 URL
[12]	盛卫勇, 赵国昌, 孙福强, 等. 主动脉瓣成形术治疗主动脉瓣关闭不全临床效果分析[J]. 郑州大学学报(医学版), 2019, 54(2):298-301.
	Sheng WY, Zhao GC, Sun FQ, et al. Clinical analysis of aortic valvuloplasty for aortic insufficiency[J]. J Zhengzhou Univ(Med Sci), 2019, 54(2):298-301.
[13]	Mangini A, Contino M, Romagnoni C, et al. Aortic valve repair: a ten-year single-centre experience[J]. Interact Cardiovasc Thorac Surg, 2014, 19(1):28-35. doi: 10.1093/icvts/ivu058 URL
[14]	Zeeshan A, Idrees JJ, Johnston DR, et al. Durability of aortic valve cusp repair with and without annular support[J]. Ann Thorac Surg, 2018, 105(3):739-748. doi: S0003-4975(17)31251-1 pmid: 29273323
[15]	Yanagawa B, Mazine A, El-Hamamsy I. Predictors of Aortic Valve Repair Failure[J]. Innovations (Phila), 2019, 14(3):199-208. doi: 10.1177/1556984519845905 pmid: 31084444
[16]	Bouhout I, Ghoneim A, Poirier N, et al. Impact of the Learning Curve on Early Outcomes Following the Ross Procedure[J]. Can J Cardiol, 2017, 33(4):493-500. doi: S0828-282X(16)31116-3 pmid: 28256428

指标	患者（n=25）
男性（%）	18（72）
年龄（岁）	47.8±3.6
心率（次/分）	73.1±3.1
收缩压（mmHg）	133.0±3.6
舒张压（mmHg）	69.1±3.1
糖尿病（%）	2（8）
高血压（%）	15（60）
心房颤动（%）	0（0）
体质量指数（kg/m²）	23.0±0.7
体表面积（m²）	1.77±0.04

指标	手术前	手术后1年	t/z值	P值
心率（次/min）	73.1±3.1	78.6±2.0	1.756	0.092
左心房内径（mm）	34.8±3.2	37.6±4.9	-2.903	0.008
左心室舒张末期内径（mm）	54.4±4.6	50.0±4.9	5.036	<0.001
左心室收缩末期内径（mm）	34.0（31.0,38.0）	31.0（29.5,34.0）	-2.945	0.003
左心室舒张末期容积（mL）	145.7±28.8	120.4±27.8	4.856	<0.001
左心室收缩末期容积（mL）	47.0（37.5,63.0）	37.0（32.5,48.5）	-2.828	0.005
左心室每搏输出量（mL）	92.6±18.4	78.4±17.8	4.039	<0.001
左心室射血分数（%）	64.0（60.5,70.0）	65.0（63.5,68.0）	-0.404	0.686
肺动脉收缩压（mm Hg）	33.0（30.0,36.0）	31.0（29.5,33.3）	-0.832	0.405
E峰（cm/s）	69.8±21.6	66.6±10.4	1.047	0.314
A峰（cm/s）	57.3±13.2	66.1±17.3	-2.193	0.047
E/A	1.24±0.43	1.05±0.23	2.274	0.041
e'间隔侧（cm/s）	8.0±2.7	6.8±2.4	1.085	0.298
e'侧壁侧（cm/s）	11.9±4.7	12.6±3.1	-0.46	0.653
E/e'间隔侧	7.9（6.6,13.0）	10.9（8.6,12.0）	-0.879	0.379
E/e'侧壁侧	5.3（4.1,9.7）	6.5（5.0,7.8）	-0.722	0.470
E/e'平均值	6.4（5.4,11.6）	8.7（7.5,9.3）	0.157	0.875
主动脉瓣口流速（cm/s）	1.8±0.4	1.7±0.4	1.793	0.086
跨主动脉瓣压差（mmHg）	13.4±5.2	11.6±5.7	1.480	0.152

术前AI评分（分）	术后AI评分（分）	人数	χ²值	P值
0	0	1	21.000	0.021
1	0	1
1	2	1
2	0	1
2	1	1
3	0	2
3	1	4
3	2	1
4	0	3
4	1	2
4	2	3
4	3	4
4	4	1