Comparison of Exercise Echocardiography in Patients with 18mm ATS-AP Aortic Prosthesis

There have been various arguments concerning the patient-prosthesis mismatch (PPM) after aortic valve replacement (AVR) for small valves. The objective of this study was to evaluate the postoperative hemodynamics in patients. Methods: The subjects were 6 patients [6 females aged 64 (17~74) years, with a median body surface area (BSA) of 1.37 (1.29~1.51) m2] who underwent AVR at our facility using the 18-mm ATS-AP and tolerated exercise loading. We estimated pressure gradient(PG) ,ejection fraction(EF), left ventricular mass Index(LVMI)at pre-operation and post-operation. Exercise echocardiography on an ergometer was performed before and 29.0 ± 14.4 months after surgery. We estimated PG and effective orifice area(EOAI) at rest and at exercise. We compared echo data between pre-operation and post-operation, between at rest and at exercise. Results: The effective orifice area index(EOAI) at rest was 0.92(0.75~1.06) cm2/m2. There was a significant change in the LVMI between pre-operation and post-operation[158.5(104.0~222.2) g/m2 versus 102.4(92.3~146.4) g/m2; P 0.05] and mean PG[11.0(6.6~16) mmHg versus 14.0(6.3~16) mmHg; P > 0.05], on maximal exercise. Conclusion: In patients whose BSA were 1.37(1.29~1.51) m2,the 18-mm ATS-AP was suggested to be a prosthetic valve that improves myocardial remodeling and provides stable hemodynamics even during exercise

Surgical experience with chronic constrictive pericarditis

Objective: Constrictive pericarditis is a disease characterized by marked thickening of the pericardium which causes restriction of diastolic cardiac function. The purpose of this report is to review the outcome of pericardiectomy for constrictive pericarditis and to discuss its problems. Methods: Sixteen consecutive patients who underwent pericardiectomy for constrictive pericarditis in our institution between March 2000 and June 2011 were reviewed. All patients underwent decortication including at least the anterior surface from the right atrium to the left phrenic nerve and the diaphragmatic surface of the heart. The epicardium was concomitantly resectioned because it was usually sclerotic and constrictive. Results: Postoperatively, mean central venous pressure decreased to 8.8 ± 3.1 mmHg and was significantly lower than the preoperative value 15.3 ± 3.7 mmHg (p < 0.001). The mean postoperative duration of hospitalization was 25.6 ± 13.5 days. There were 2 in-hospital deaths and early mortality rate was 12.5 %; however, excluding hospital deaths, there were no significant postoperative complications and all survivors recovered and maintained good cardiac function during the mean follow-up period of 3.7 ± 2.8 years. Conclusion: For an acceptable outcome, surgical intervention should be performed at an appropriate time and the pericardiectomy should have proper scope and depth to prevent irreversible changes in the heart, liver, and other organs

Quality of life following aortic valve replacement in octogenarians

【Purpose】We aimed to evaluate the outcomes of and the quality of life (QOL) after conventional aortic valve replacement (AVR) amongst octogenarians.【Methods】We enrolled 48 patients aged ≥80 years who underwent conventional aortic valve replacement between May 1999 and November 2012. Patient conditions were assessed before surgery, at 6 and 12 months after surgery, and during the late period regarding the need for nursing care, degree of independent living, and living willingness.【Results】The follow-up rate was 100% with 45.6 ± 41.3 months follow-up. Two patients (4%) died during hospitalization and 11 (23%) died during the follow-up period. The 1-, 5-, and 10-year survival rates were 84.9, 76.9, and 39.6%, respectively. During the late period, of 35 surviving patients, 31 (88%) were living at home. The degree of independent living score decreased after surgery. However, scores of the need for nursing care and living willingness remained preoperative level.【Conclusions】QOL following conventional aortic valve replacement for elderly patients aged ≥80 years who showed independence in activities of daily living (ADL) before surgery were satisfactory. Therefore, aortic valve replacement could be a viable option for elderly patients aged ≥80 years after accounting for preoperative ADL levels