Cardiac Function and Aortic Valve Intervention : Echocardiographic Studies of Myocardial Recovery in Patients with Severe Aortic Valve Disease

• In patients with severe aortic valve disease, aortic valve intervention is performed when the risk for mortality or morbidity with conservative management is significantly increased. Left ventricular (LV) longitudinal motion decreases before conventional echocardiographic measures such as ejection fraction, are influenced in patients with severe aortic valve disease. This thesis is devoted to the assessment of cardiac function, including ventricular longitudinal motion, by echocardiography before and after aortic valve intervention in patients with chronic severe aortic regurgitation (AR) or severe aortic stenosis (AS).Patients with chronic AR (n=29) were studied preoperatively, and 6 months and 4 years postoperatively by echocardiography, including tissue Doppler imaging, at rest and during exercise. LV longitudinal function (atrioventricular plane displacement, AVPD, and peak systolic velocity, PSV) decreased postoperatively, and patients with low PSV continued to show reduced longitudinal function 6 months after surgery. Preoperative exercise echocardiographic variables showed a strong correlation to late LV function variables, while preoperative variables obtained at rest were not useful for prediction. Exercise echocardiography and longitudinal LV function could therefore be useful complements in the timing of aortic valve surgery for AR.Patients with chronic AR (n=29) were studied preoperatively, and 6 months and 4 years postoperatively by echocardiography, including tissue Doppler imaging, at rest and during exercise. LV longitudinal function (atrioventricular plane displacement, AVPD, and peak systolic velocity, PSV) decreased postoperatively, and patients with low PSV continued to show reduced longitudinal function 6 months after surgery. Preoperative exercise echocardiographic variables showed a strong correlation to late LV function variables, while preoperative variables obtained at rest were not useful for prediction. Exercise echocardiography and longitudinal LV function could therefore be useful complements in the timing of aortic valve surgery for AR.

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