The hemodynamic results of surgery for aortic stenosis

1. 1. Nineteen patients with severe aortic stenosis have been studied by left heart catheterization before and after transaortic valvuloplasty. 2. 2. The cardiac index was normal in patients with pure aortic stenosis but tended to be reduced in the presence of associated aortic regurgitation, mitral or coronary disease. 3. 3. Severe aortic stenosis, as it progresses, may become associated with a reduced cardiac output and, therefore, a small systolic mean pressure difference across the aortic valve. 4. 4. There was a small but significant postoperative increase in calculated aortic valve area in 11 patients, associated with a marked fall of left ventricular systolic pressure, transvalvular pressure difference, and left ventricular work, while cardiac output remained unchanged. A residual pressure difference across the aortic valve persisted in all but one patient, who developed severe regurgitation. 5. 5. Eight patients showed no change in valve area. The left ventricular systolic pressure and transvalvular pressure difference in these was also decreased postoperatively, but this was found to be the result of reduced cardiac output. 6. 6. Associated mitral stenosis, mitral regurgitation, or coronary disease did not preclude successful surgery for aortic stenosis. 7. 7. Six of the 8 operative failures occurred among 7 patients with clinically “insignificant” preoperative aortic regurgitation as the only complicating lesion. Operation in this group either did not relieve the stenosis or increased the regurgitation in proportion to the relief of stenosis so that measurable benefit was not observed. 8. 8. The meaning of the term “insignificant” as it pertains to pure aortic regurgitation and to regurgitation associated with severe aortic stenosis is discussed. 9. 9. Indications and contraindications for surgery for aortic stenosis are discussed.