Chronic Pressure-Overload Hypertrophy Attenuates Vortex Formation Time in Patients With Severe Aortic Stenosis and Preserved Left Ventricular Systolic Function Undergoing Aortic Valve Replacement

Objective: Transmitral blood flow produces a vortex ring that enhances the hydraulic efficiency of early left ventricular (LV) filling. The effect of pressure-overload hypertrophy on the duration of LV vortex ring formation (vortex formation time [VFT]) is unknown. The current investigation tested the hypothesis that chronic LV pressure-overload hypertrophy produced by severe aortic stenosis (AS) reduces VFT in patients with preserved LV systolic function undergoing aortic valve replacement.Design: Observational study.Setting: Veterans Affairs Medical Center.Participants: After the Institutional Review Board's approval, 8 patients (7 men and 1 woman; age, 62±5y; and ejection fraction, 59%±5%) with AS (peak pressure gradient, 81±22mmHg; aortic valve area, 0.78±0.25cm2) scheduled for aortic valve replacement were compared with 8 patients (all men; age, 63±3y; and ejection fraction, 60%±7%) without AS undergoing coronary artery bypass graft surgery.Interventions: None.Measurements and Main Results: Under general anesthesia, peak early LV filling (E) and atrial systole (A) blood flow velocities and their corresponding velocity-time integrals were obtained using pulse-wave Doppler echocardiography to determine E/A and atrial filling fraction (β). Mitral valve diameter (D) was calculated as the average of minor and major axis lengths obtained in the midesophageal bicommissural and long-axis transesophageal echocardiography imaging planes, respectively. Posterior wall thickne...
Source: Journal of Cardiothoracic and Vascular Anesthesia - Category: Anesthesiology Authors: Tags: Original Articles Source Type: research