Long-Term Hemodynamic Performance of the Aortic Valve After David I: An Echocardiographic Study
| Autor: | Angelo Giuffrida, Wanda Deste, S. Felis, Salvatore Di Stefano, Carmelo Mignosa, Antonino S. Rubino, Carlo Mariani |
|---|---|
| Přispěvatelé: | Mignosa, Carmelo, Mariani, Carlo, Deste, Wanda, Felis, Salvatore, Di Stefano, Salvatore, Giuffrida, Angelo, Rubino, As |
| Rok vydání: | 2015 |
| Předmět: |
Pulmonary and Respiratory Medicine
Aortic valve Male Reoperation medicine.medical_specialty Time Factors Aortic Valve Insufficiency Hemodynamics Aorta Thoracic Mitral valve incompetence Aortic valve repair Internal medicine Healthy volunteers medicine Humans Retrospective Studies Heart Valve Prosthesis Implantation business.industry Reproducibility of Results General Medicine Middle Aged Surgery medicine.anatomical_structure Treatment Outcome Aortic valve function Concomitant Aortic Valve Cardiology Female Stress conditions Cardiology and Cardiovascular Medicine business Vascular Surgical Procedures Echocardiography Stress Follow-Up Studies |
| Zdroj: | Seminars in thoracic and cardiovascular surgery. 27(3) |
| ISSN: | 1532-9488 |
| Popis: | Despite optimal hemodynamics at rest, the performance of the aortic valve under stress conditions long after David I procedure is still debated. From 2001-2014, 73 patients underwent reimplantation with David I technique. Aortic valve function of 13 patients (age 61.2 ± 8.72) with a follow-up of at least 5 years (6.3 ± 0.9 years) was assessed at exercise echocardiographic stress test on a stationary cycle. Patients who had undergone concomitant procedure, with recurrent aortic insufficiency or mitral valve incompetence, were excluded. In all, 8 healthy volunteers served as controls. Transvalvular gradients progressively increased during the steps in both groups (P-within < 0.001), being higher in David patients (P-between < 0.001), but never reaching a clinical significance (David Peak gradient 23.8 ± 9.3 mmHg; Mean gradient 13.2 ± 5.1 mmHg). Effective orifice area (EOA) and EOA index did not change during the test in David patients, whereas Controls showed a progressive increase of functional valve area to a peak at 50 W (Controls EOA 4.0 ± 0.5 cm(2); EOA index 2.0 ± 0.3 cm(2)/m(2)). In conclusion, David I procedure ensures good hemodynamics during high-flow conditions at long-term follow-up. The reimplantation of the functional aortic annulus inside a rigid tube determines a paradoxical reduction of functional aortic valve area, secondary to the increased stroke volume, without any clinically relevant increase in transvalvular gradients. These data confirm the reliability of David I in the long term, even under physical stress conditions. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full Text from ScienceDirect