Diastolic Dysfunction in Aortic Regurgitation
Diastolic Dysfunction in Aortic Regurgitation
Follow-up study in patients with severe aortic regurgitation after successful valve
 replacement. Systolic and diastolic function were assessed and persistent diastolic
 dysfunction was observed late (7-10 years) after operation.
Background

 Patients with severe aortic regurgitation show eccentric LV hypertrophy and structural
 changes of the myocardium. Reversibility of functional and structural changes after
 successful valve replacement may be limited. Persistent diastolic dysfunction has been
 observed in the present study late after aortic valve replacement. This finding has been
 explained by incomplete regression of the extra-cellular matrix 7 years after valve
 replacement. Interstitial fibrosis remains unchanged compared to the preoperative situation
 but was increased early after operation due to the reduction in LV muscle mass. Regression of
 LV hypertrophy was 40% after 2 and 55% after 7 years of valve replacement. Myocardial muscle
 fibers decreased slightly but remained hypertrophied even late after operation. Interstitital
 fibrosis was found to be positively correlated to myocardial stiffness and inversely to LV
 ejection fraction.

 Thus, persistent diastolic dysfunction with maintained systolic ejection performance can be
 observed late after successful valve replacement in patients with severe aortic
 regurgitation. Altered diastolic function has been associated with increased filling
 pressures during strenuous exercise with signs of dyspnea.

 Objective

 Evaluation of myocardial structure and function in patients with chronic volume overload
 before and after valve replacement(LV-remodeling).

 Methods

 Pressure-volume measurements and myocardial biopsy samples for assessing myocardial function
 and structure.
Inclusion Criteria:

 -  Severe aortic regurgitation

 -  Successful valve replacement

 -  Informed consent

 -  Sinus rhythm

 -  No comorbidities

 -  No bundle branch block

 -  No pregnancy

 Exclusion Criteria

 -  Unwillingness to undergo postop. cath

 -  diabetes mellitus

 -  arterial hypertension

 -  bleeding disorder

 -  pulmonary hypertension