Left ventricular mass, volume and biopsy analysis in prediction of ventricular function after surgery for chronic aortic regurgitation.

The serial application of electrocardiography and echocardiography to 67 selected patients undergoing valve replacement for chronic severe aortic regurgitation, documented regression of hypertrophy and chamber size within six to twelve months of surgery in all cases experiencing haemodynamic improvement. Those patients who had persistently increased patterns of myocardial hypertrophy and abnormal end-diastolic dimensions in the presence of normal prosthetic (homograft) function usually had persistent, irreversibly depressed myocardial function postoperatively. Preoperative noninvasive and angiographic characteristics could not predict ventricular function after surgery. Thus we could not precisely define what level of depressed ventricular performance or what degree of dilatation and myocardial hypertrophy constituted an irreversible state from this data. Although operative factors such as myocardial protection during cardiopulmonary bypass may influence postoperative cardiac performance, preoperative histological and histochemical data was useful in delineating irreversible morphological and function changes contributing to a depressed cardiac function, and therefore may be of prognostic importance.