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European Heart Journal 1981 2(6):479-486;
Copyright © 1981 by the European Society of Cardiology.
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© 1981 The European Society Of Cardiology

Left ventricular function before and following double valve replacement by Björk-Shiley prostheses

F. SCHWARZ, M. SESTO, M. SCHLEPPER, P. WALTER and W. KüRIER

Medizinische Universitaütsklinki, Abteilung Innere Medizin III (Kardiologie) 6900 Heidleberg
Kerchoff-Klinik, Max-Planck Gesellschaft, 6350 Bad Nauheim and Chirugische Universitätsklinik 6300 Gissen, West Germany

Received 30 March 1981; revised 15 May 1981; .

Request for reprint to: Franz Schwarz, MD, Medizinische Universitaütsklinik, Abteillung Innere Medizin III (Kardiologie), Bergheimer Strasse 58, 6900 Heidelberg, West Germany

Abstract

Postoperative survival and cardiac function were studied in 45 patients who underwent combined mitral and aortic valve replacement by Bjork-Shiley prostheses between 1971 and 1977. The average follow-up was three years. Pre-operative left ventricular ejection fraction ranged from 28 to 78% (mean 57%). The hospital mortality rate for the entire series was 18%, the five year survival rate 58%. Hospital mortality decreased from 22% in 1971/72 to 8% in 1976/77. Sixteen patients were restudied 12 to 60 months after operation. In these patients functional class improved significantly, pulmonary arteriolar resistance decreased (255 to 122 dynes s cm-5, P < 0.05), left ventricular end-diastolic volume (159 to 103 ml/m2, P < 0-01), muscle mass (198 to 134ml/m2, P < 0.05) and ejection fraction improved (50 to 61%, P < 0.05). Postoperatively, mean pulmonary artery pressure increased with exercise (23 to 41 mm Hg, P < 0.001), and pulmonary artery pressure during exercise was linearly related to pulmonary arteriolar resistance at rest (r=0.72, P < 0.05). Patients with successful repair of mitral and aortic valve without a paravalvular leak achieved normal pulmonary arteriolar resistance, left ventricular end-diastolic volume, muscle mass and ejection fraction, but cardiac index remained slightly reduced as compared to a control group (2.8 v. 3.3l/min m2, P < 0.05). This study shows (1) early and late mortality rates remained high after double valve replacement by Bjork-Shiley prostheses, but hospital mortality decreased in the time period analysed, and (2) late survivors revealed normalization of left ventricular dilation, hypertrophy and ejection fraction when the prosthesis functioned well.

Key Words: Catheterization studies • double valve replacement • postoperative survival • cardiac function • ejection fraction


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