Improvement in left ventricular function assessed by tissue Doppler imaging after aortic valve replacement for severe aortic stenosis

• Published in: Singapore medical journal Vol. 56; no. 12; pp. 672 - 676
• Main Authors: Nieh, CC, Teo, AY, Soo, WM, Lee, GK, Singh, D, Poh, KK
• Format: Journal Article
• Language: English
• Published: Singapore Singapore Medical Association 01.12.2015
• Subjects: Aged; Aortic Valve - surgery; Aortic Valve Stenosis - diagnosis; Aortic Valve Stenosis - surgery; Coronary Artery Bypass; Diastole; Echocardiography; Echocardiography, Doppler; Female; Heart Valve Prosthesis; Humans; Male; Middle Aged; Original; Postoperative Period; Systole; Ventricular Function, Left; aortic valve stenosis; aortic valve replacement; left ventricular function; tissue Doppler imaging; coronary artery bypass grafting
• ISSN: 0037-5675
• DOI: 10.11622/smedj.2015187

The effects of reduction of left ventricular (LV) systemic afterload following aortic valve replacement (AVR) for severe aortic valve stenosis (AS) were investigated, using echocardiography and tissue Doppler imaging (TDI). We compared the preoperative and postoperative echocardiographic assessments of 23 patients with severe AS who had undergone isolated AVR (n = 13) or concomitant AVR with coronary artery bypass grafting (CABG) (n = 10). Conventional echocardiographic evaluations and TDI at the lateral mitral annulus were performed. Echocardiography was performed at a median of 120 (interquartile range: 66-141) days after AVR. There was significant reduction in aortic transvalvular mean pressure gradient after AVR. Although LV dimensions, mass and ejection fraction remained unchanged, LV diastolic and systolic functions improved (as observed on TDI). Early diastolic (E'), late diastolic (A') and systolic (S') mitral annular velocities increased significantly (p < 0.05). There was significant improvement in TDI-derived parameters among the patients who had isolated AVR, while among the patients who had concomitant AVR with CABG, only S' had significant improvement (p = 0.028). TDI was able to detect improvements in LV systolic and diastolic function after AVR for severe AS. There was less improvement in the TDI-derived diastolic parameters among patients who underwent concomitant AVR with CABG than among patients who underwent isolated AVR.