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At least 631 records · Page 35Linked to original sources
PubMed1997

Effects of aortic valve replacement on exercise duration and functional status in adults with valvular aortic stenosis.

OBJECTIVE: To evaluate the effect of aortic valve replacement on left ventricular function, functional status and exercise duration in an adult population with valvular aortic stenosis. DESIGN: Prospective study of initially asymptomatic patients with pre- and postvalve replacement echocardiography, functional status score and exercise data. SETTING: University-affiliated, tertiary care teaching hospital. PATIENTS: Valvular aortic stenosis patients referred from academic and private practice internists and cardiologists (n = 34, 65% men, mean age 68 +/- 11 years, preoperative aortic valve area 0.9 +/- 0.4 cm2). INTERVENTIONS: Annual Doppler echocardiography, functional status questionnaires and, if possible, Bruce protocol maximal exercise tolerance tests. MAIN RESULTS: Aortic valve replacement resulted in a decrease in maximum jet velocity (pre 4.7 +/- 0.7 versus post 2.9 +/- 0.7 m/s, P = 0.0001) and left ventricular mass (pre 167 +/- 37 versus post 134 +/- 32 g, P = 0.0001) and an increase in left ventricular ejection fraction (pre 65 +/- 11 versus post 69 +/- 10%, P = 0.05) at rest. However, there was no change in the ratio of early to atrial diastolic filling velocities (pre 1.2 +/- 0.5 versus post 1.4 +/- 0.8, not significant), exercise tolerance as assessed by estimated functional aerobic impairment (pre 26 +/- 32 versus post 22 +/- 27%, not significant) or functional status score (pre 89 +/- 13 versus post 91 +/- 11, not significant). CONCLUSIONS: When the aortic valve is replaced promptly at symptom onset, despite improvement in resting left ventricular systolic performance, there is no evidence of improvement in exercise capacity or functional status.

Aged↗
PubMed2003

Psychological Readiness for Anterior Cruciate Ligament Surgery: Describing and Comparing the Adolescent and Adult Experiences.

OBJECTIVE: Our objectives were to describe the preoperative mood levels and psychological readiness levels of patients undergoing primary reconstruction of the anterior cruciate ligament (ACL) and to examine differences between adolescent and adult sports medicine patients relative to psychological readiness for ACL surgery. DESIGN AND SETTING: Subjects prospectively completed assessments of preoperative mood and psychological readiness for ACL surgery and rehabilitation. SUBJECTS: The sample consisted of subjects (N = 121) involved, on average, in sport or exercise participation 12.5 h/wk (SD = 7.5); subgroups included adolescents (15-19 years of age, n = 67) and adults (>/=30 years of age, n = 32). MEASUREMENTS: Subjects preoperatively provided self-reported assessments of demographics, mood disturbances, 10 psychological processes of change (consciousness raising, dramatic relief, environmental reevaluation, social liberation, self-reevaluation, counterconditioning, helping relationships, reinforcement management, stimulus control, and self-liberation), decisional balance (pros versus cons of surgery), and self-efficacy. RESULTS: Relative to the first objective, subjects reported more pros than cons associated with surgery and relatively high levels of self-efficacy. Relative to the second objective, a significant main effect was noted (Wilks lambda = 0.58, P <.01), with 42% of the variance in the dependent variables being attributed to differences among adolescents as compared with adults. Follow-up analyses indicated that, as compared with adults, adolescents reported higher mood disturbances, more pros associated with surgery, and greater use of dramatic relief, environmental reevaluation, social liberation, helping relationships, and self-liberation. CONCLUSIONS: It may be advantageous to screen patients preoperatively relative to their psychological readiness for surgery and rehabilitation. Also, adolescents reported higher preoperative mood-disturbance levels than adults but higher levels of what would be considered "psychological readiness" for surgery.

Journal Article↗
PubMed1992

Determinants of subsequent late postoperative left ventricular function and reversal of ventricular dilatation after mitral valve replacement for chronic mitral regurgitation.

We studied 16 patients with chronic mitral regurgitation by echocardiography before, and at 3 weeks, at 6-8 months and at 1-9 years after mitral valve replacement (MVR) to investigate serial changes in left ventricular (LV) function and reversal of ventricular dilatation. All patients at an average of 2.6 years after, and 8 patients before MVR were also studied by echocardiography and, except for 3 patients by measuring plasma catecholamines from the right atrium during bicycle exercise. Before operation, all patients were divided into group A (n = 12) with end-systolic dimension (ESD) < 4 cm and systolic blood pressure (SBP)/ESD > 3, and group B (n = 4) with ESD > 4 cm and SBP/ESD < 3. Maximum reduction in end-diastolic dimension (EDD) occurred at 3 weeks in all patients after MVR (from 60.5 +/- 3.7 to 49.0 +/- 4.5 mm, p < 0.05). ESD was reduced significantly (p < 0.5) only in group A. LV function was normal in group A, but it was depressed in group B at early and late periods after MVR. The slopes of the relationship between the mean velocity of circumferential fiber shortening (Vcf) and plasma norepinephrine (NE) during exercise in all patients in group B decreased along with the depression in LV function. After operation, all patients in group A reached New York Heart Association (NYHA) functional class I, while patients in group B were in NYHA class II. It is concluded that the surgical outcome after MVR for chronic MR will be better if preoperative ESD < 4 cm and SBP/ESD > 3. The relationship between mean Vcf and plasma NE during exercise seemed to be a useful index to evaluate the inotropic reserve of the LV.

Echocardiography↗
PubMed1981

Effect of valve replacement for chronic mitral insufficiency on left ventricular function during rest and exercise.

In this study we measured left ventricular function at rest and during exercise before and after operation in 18 patients who underwent mitral valve replacement (MVR) for chronic mitral insufficiency. First-transit radionuclide angiocardiography was employed a week before operation and 5 to 19 months after operation to calculate left ventricular ejection fraction, volumes, output, filling, and emptying rates. Preoperatively, left ventricular ejection fraction increased from 0.56 +/- 0.09 (mean +/- S.D.) at rest to 0.62 +/- 0.11 during exercise, and this response was not altered for the group after operation. After valve replacement, there was no consistent change in end-diastolic volume (EDV), and cardiac function was not related to an alteration in filling rates of the left ventricle. After operation, the patient group achieved a maximal ventricular filling rate during exercise comparable to that measured before operation. In addition, postoperative maximal filling rates did not correlate with prosthetic valve size. These data suggest that the hemodynamic changes elicited by MVR for chronic insufficiency are primarily related to the elimination of the regurgitant flow but no attributable to alterations of the myocardium. It is suggested that limitation in exercise performance after operation may be primarily related to the functional status of the myocardium prior to operation.

Adult↗
PubMed1981

Postoperative exercise capacity following nutritional support with hypotonic glucose.

Patients subjected to exercise testing following extensive uncomplicated abdominal operations and maintained postoperatively with hypotonic glucose infusions were capable of performing at a mean of 77 +/- 5 per cent of their preoperative maximum work levels. No change was noted in the over-all efficiency or oxygen uptake, of the muscle groups involved. The exercising blood lactate curve can be used to verify the work capacity of large muscle masses and to predict changes in maximum work capacity from submaximal postoperative testing. The maintenance and improvement of the functional integrity of large muscle masses should be one of the primary goals of postoperative surgical nutrition.

Abdomen↗
PubMed2000

Effect of preoperative biofeedback/pelvic floor training on continence in men undergoing radical prostatectomy.

OBJECTIVES: To determine whether preoperative biofeedback training improves urinary continence overall or the rate of return of continence in men undergoing radical prostatectomy. METHODS: One hundred men scheduled to undergo radical prostatectomy were randomized to receive graded pelvic muscle exercise training with biofeedback 2 to 4 weeks before surgery or to a control group performing pelvic muscle exercises without biofeedback. The biofeedback group was instructed to continue exercises four times per day until surgery and to resume exercises when the urethral catheter was removed following surgery. The control group received written and brief verbal instructions in pelvic muscle exercises before surgery and again after catheter removal. Urinary continence was assessed by personal or phone interviews. RESULTS: Six months following surgery, the continence rates, as defined by the use of one pad or less per day, were 94% (44 of 47) and 96% (48 of 50) in the biofeedback and control groups, respectively (P = 0.596). Also, the rate of return as determined at time points 1, 2, 3, and 4 months after surgery was not significantly different between the two groups. CONCLUSIONS: Preoperative biofeedback training did not improve the outcome of pelvic muscle exercises on overall continence or the rate of return of urinary control in men undergoing radical prostatectomy.

Biofeedback, Psychology↗
PubMed1990

[Postoperative course of systolic and diastolic indices of left ventricular function in aortic valve stenosis in adults. Exercise test with radionuclide angiography].

Resting and stress radionuclide angiography was performed before and, on average, one year after surgery for adult aortic stenosis in 26 patients. The left ventricular ejection fraction, ventricular volumes, left ventricular stroke volume and peak velocity of ventricular filling were studied under basal conditions and at the peak of exercise. Right and left heart catheterisation and coronary angiography were performed before surgery with determination of the conventional indices of left ventricular function. Investigations were completed by pre and postoperative echocardiography. The same procedures were carried out in a control population of the same age. Before surgery, hemodynamic adaptation to exercise, judged by the change in left ventricular stroke volume, solicits the passive properties of the left ventricle: the left ventricular stroke volume increases by an increase in the end diastolic volume. In the control group, the increase in stroke volume is obtained by a decrease in end systolic volume, that is to say by increasing systolic shortening. The peak velocity of ventricular filling increases on exercise but to a lesser degree than in the control population. After surgery the hemodynamic adaptation to exercise results from an improved systolic shortening of the left ventricle but also from an increase in end diastolic volume. The peak velocity of left ventricular filling increases with respect to the preoperative values but remains less than that observed in the control population. No relationship was observed between the hemodynamic adaptation to exercise, the peak velocity of ventricular filling and myocardial mass whichever method was used for calculating the latter parameter.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

Abnormal exercise hemodynamics in patients with normal systolic function late after aortic valve replacement.

We studied the hemodynamic response to supine bicycle exercise in 20 patients late (10 +/- 2 years) after aortic valve replacement (for aortic stenosis in 12 patients, aortic insufficiency in six patients, and for combined stenosis and insufficiency in two patients). The pulmonary artery wedge pressure was obtained with a pulmonary artery balloon catheter, and left ventriculography was performed by digital-subtraction angiography after injection of radiographic contrast into the pulmonary artery. These patients were compared with 11 control subjects with no or minimal cardiac disease studied routinely for evaluation of chest pain in whom left ventricular end-diastolic pressure and a direct contrast ventriculogram were obtained. Compared with the control population, the study population had similar left heart filling pressures (7 +/- 3 vs 9 +/- 3 mm Hg, NS), but higher left ventricular ejection fractions (75 +/- 7% vs 67 +/- 7%, p less than .02) and higher left ventricular muscle mass indexes (106 +/- 28 vs 85 +/- 9 g/m2, p less than .01). Elevated myocardial muscle mass led to lower systolic wall stress in the study population than in the control subjects (254 +/- 65 vs 320 +/- 49 10(3).dynes/cm2, p less than .01) and might explain the higher ejection fraction observed. Fourteen patients had a normal response to exercise (with left heart filling pressures of 16 +/- 4 vs 18 +/- 2 mm Hg for control subjects, NS; and left ventricular ejection fraction of 77 +/- 8% vs 73 +/- 5% for control subjects, NS). However, while the remaining six patients had a normal exercise left ventricular ejection fraction (72 +/- 9%, NS), they had an abnormal rise in left heart filling pressure (33 +/- 8 mm Hg, p less than .01). Preoperatively these patients also had higher left ventricular mid- and end-diastolic pressures at similar diastolic volumes, suggesting a decrease in chamber compliance. Thus, late after aortic valve replacement there is a subgroup of patients who, despite normal hemodynamics and normal left ventricular systolic function as assessed by the left ventricular ejection fraction at rest, have an abnormal response to exercise characterized primarily by a substantial rise in left heart filling pressures. Preoperatively this group also has a decrease in diastolic chamber compliance despite nearly normal left ventricular ejection fractions. This abnormality appears to result from a primary derangement of diastolic function that is not evident at rest.

Aortic Valve↗
PubMed1993

[Cardiac function following left ventricular aneurysm repair--comparison between patch reconstruction and direct closure methods].

Left ventricular function was compared between two groups of patients who underwent patch reconstruction or direct closure of the ventricular wall following resection of a post-infarction left ventricular aneurysm (LVA). There were 15 and 9 patients in the respective groups. Coronary artery bypass grafting was additionally performed in 8 patients (53%) in the patch reconstruction group and 5 patients (56%) in the direct closure group. The size of the patch used for patch reconstruction (including the suture line) was 57 +/- 19% of the resected area. Before and 1-2 months after surgery, equilibrium RI angiography and cardiac catheterization were performed to assess the following hemodynamic parameters: ejection fraction (EF) at rest and during exercise, left ventricular end-diastolic pressure (LVEDP), left ventricular end-diastolic volume index (LVEDVI), cardiac index (CI) and mean pulmonary artery pressure (m-PAP). Preoperatively, there were no differences in each parameter between the two groups. Postoperatively, there were significant improvements in the EF at rest and during exercise (p < 0.01), LVEDVI (p < 0.01) and the LVEDP (p < 0.05). However there no significant changes in CI or m-PAP following the operation. There were also no significant differences observed in the postoperative values between the two groups. However, based upon postoperative left ventriculograms, patch reconstruction was significantly superior to direct closure for reconstruction of a septal aneurysm.

Aged↗
PubMed2000

Limitation of physical activity, dyspnoea and chest pain before and two years after coronary artery bypass grafting in relation to preoperative ejection fraction.

To investigate the relationships between limitation of physical activity and dyspnoea and chest pain before and 2 years after coronary artery bypass grafting (CABG) and preoperative left ventricular ejection fraction (LVEF), questionnaires were issued to all patients from Western Sweden who underwent CABG during 1988-1991. The analysis comprised 985 patients. Physical activity improved significantly after CABG regardless of the preoperative LVEF. No significant association was found between LVEF and degree of limitation of physical activity before or after surgery. Dyspnoea and chest pain improved markedly, irrespective of LVEF. There was significant association between freedom from dyspnoea and LVEF preoperatively (less dyspnoea with higher LVEF), but not after CABG. The frequency of chest-pain attacks was not related to LVEF, before or after the operation. Thus physical activity, dyspnoea and chest pain improved in the 2 years after CABG irrespective of preoperative LVEF. Absence of dyspnoea was related to LVEF before, but not after surgery, and there was no association between preoperative LVEF and frequency of anginal attacks before or after CABG.

Cause of Death↗
PubMed1992

Exercise tolerance and working capacity after valve replacement.

Between 1978 and 1987, 1270 patients who survived single aortic or mitral valve replacement at the Rehabilitation Center in Bad Krozingen, Germany, underwent a comprehensive rehabilitation program. The preoperative diagnosis was isolated aortic stenosis in 425, isolated aortic regurgitation in 159, mixed aortic lesion in 211, isolated mitral stenosis in 208, isolated mitral insufficiency in 137 and mixed mitral lesion in 130 cases. Follow up examinations were carried out one and six months after surgery, and at yearly intervals thereafter. Exercise testing was performed with an electrically braked bicycle ergometer in the supine position, and the load was increased by 25 or 50 watts every two minutes until fatigue, severe angina, more than 0.3 mV ST-segment depression, or 80% of the age predicted maximum heart rate was achieved. Patients after aortic valve replacement had a better exercise performance one month after operation than did those after mitral valve replacement. Those with mitral stenosis showed more severe impairment of exercise tolerance than did the mitral insufficiency group. There was a steady increase in exercise tolerance between one and six months postoperatively, both in patients with aortic and those with mitral valve replacement, but the difference in performance between the two groups was still present (72% versus 57% of normal). The results of univariate and multivariate analyses showed that the preoperative employment status was the most important factor for postoperative return to work, followed by gender (male > female), exercise tolerance and valualar lesion (aortic > mitral).(ABSTRACT TRUNCATED AT 250 WORDS)

Aortic Valve↗
PubMed1996

[Good results of fasciotomy in chronic compartment syndrome of the lower leg].

OBJECTIVE: To assess the results of fasciotomy in patients with a chronic compartmental syndrome. DESIGN: Retrospective study. SETTING: Department of Surgery, Central Military Hospital, Utrecht, the Netherlands. METHOD: Closed fasciotomy was performed in 81 patients (151 compartments) after standardized measurement of the pressure of the symptomatic compartment during exercise. The anterior compartment was affected 149 times and the lateral compartment twice. The pressure reading was repeated at least 3 months after the operation. All operated patients 6 months postoperatively were sent a written questionnaire inquiring about the results of the operation. RESULTS: Postoperative complications included a neurinoma (3 times) and a seroma (once). The mean postoperative intramuscular pressures were lower than the preoperative ones: the pressure at rest fell from 22.1 to 14.0 mm Hg (p < 0.05), the exercise pressure from 57.5 to 25.4 mm Hg (p < 0.01) and the relaxation pressure from 34.4 to 25.2 mm Hg (p < 0.05). Ten patients had an unchanged increased pressure after the operation, for which a second fasciotomy was performed 4 times. Attenuation of symptoms was reported by 59 patients (76%). Nine patients with poor results had already had a combination with some other hyperpressure injury before the operation. CONCLUSION: Closed fasciotomy in a demonstrated chronic compartmental syndrome in most cases gave good results, viz. attenuation of symptoms and a decrease of the intramuscular pressure, especially after exercise.

Adolescent↗
PubMed1991

Reduced exercise capacity in patients with tricuspid regurgitation after successful mitral valve replacement for rheumatic mitral valve disease.

OBJECTIVE: To determine how severe tricuspid regurgitation influences exercise capacity and functional state in patients who have undergone successful mitral valve replacement for rheumatic mitral valve disease. DESIGN: 9 patients in whom clinically significant tricuspid regurgitation developed late after mitral valve replacement were compared with 9 patients with no clinical evidence of tricuspid regurgitation. The two groups were matched for preoperative clinical and haemodynamic variables. Patients were assessed by conventional echocardiography, Doppler echocardiography, and a maximal treadmill exercise test in which expired gas was monitored by mass spectrometry. SETTING: University Hospital of Wales, Cardiff. SUBJECTS: 18 patients who had been reviewed regularly since mitral valve replacement. MAIN OUTCOME MEASURE: Objective indices of exercise performance including exercise duration, maximal oxygen consumption, anaerobic threshold, and ventilatory response to exercise. RESULTS: Mitral valve prosthetic function was normal in all patients and estimated pulmonary artery systolic pressure and left ventricular function were similar in the two groups. Right ventricular diameter (median (range) 5.0 (4.3-5.6) v 3.7 (3.0-5.4) cm, p less than 0.01) and the incidence of paradoxical septal motion (9/9 v 3/9, p less than 0.01) were greater in the group with severe tricuspid regurgitation. Exercise performance--assessed by exercise duration (6.3 (5.0-10.7) v 12.7 (7.2-16.0) min, p less than 0.01), maximum oxygen consumption (11.2 (7.3-17.8) v 17.7 (11.8-21.4) ml min-1 kg-1, p less than 0.01), and anaerobic threshold (8.3 (4.6-11.4) v 0.7 (7.3-15.5) ml min-1 kg-1, p less than 0.05)--was significantly reduced in the group with severe tricuspid regurgitation. The ventilatory response to exercise was greater in patients with tricuspid regurgitation (minute ventilation at the same minute carbon dioxide production (41.0 (29.9-59.5) v 33.6 (26.8-39.3) l/min, p less than 0.01). CONCLUSIONS: Clinically significant tricuspid regurgitation may develop late after successful mitral valve replacement and in the absence of residual pulmonary hypertension, prosthetic dysfunction, or significant left ventricular impairment. Patients in whom severe tricuspid regurgitation developed had a considerable reduction in exercise capacity caused by an impaired cardiac output response to exercise and therefore experienced a poor functional outcome. The extent to which this was attributable to the tricuspid regurgitation itself or alternatively to the consequences of right ventricular dysfunction was not clear and requires further investigation.

Aged↗
PubMed2004

Segmental resection spares pulmonary function in patients with stage I lung cancer.

BACKGROUND: Segmental resection for stage I non-small cell lung cancer remains controversial. Reports suggest that segmentectomy confers no advantage in preserving lung function and compromises survival. This study was undertaken to assess the validity of those assertions. METHODS: We retrospectively analyzed patients undergoing lobectomy (n = 147) or segmentectomy (n = 54) for stage I non-small cell lung cancer between March 1996 and June 2001. All patients were included in the survival analysis. Pulmonary function testing was obtained preoperatively and at 1 year and included forced vital capacity, forced expiratory volume in 1 second, maximum voluntary ventilation, diffusing capacity, and stair-stepper exercise. Patients with recurrent disease (lobectomy, n = 32; segmentectomy, n = 10) were excluded in the pulmonary function testing analysis to avoid the confounding variables of tumor or treatments. RESULTS: Preoperative pulmonary function tests in segmentectomy patients were significantly reduced compared with lobectomy (forced expiratory volume in 1 second, 75.1% versus 55.3%; p < 0.001). At 1 year, lobectomy patients experienced significant declines in forced vital capacity (85.5% to 81.1%), forced expiratory volume in 1 second (75.1% to 66.7%), maximum voluntary ventilation (72.8% to 65.2%), and diffusing capacity (79.3% to 69.6%). In contrast, a decline in diffusing capacity was the only significant change seen after segmental resection. Oxygen saturations at rest and with exercise were maintained in both groups. Actuarial survival in both groups was similar (p = 0.406) with a 1-year survival of 95% for lobectomy and 92% for segmentectomy. Four-year survivals were 67% and 62%, respectively. CONCLUSIONS: For patients with stage I non-small cell lung cancer, segmental resection offers preservation of pulmonary function compared with lobectomy and does not compromise survival. Segmentectomy should be considered whenever permitted by anatomic location.

Aged↗
PubMed1977

Effectiveness of breathing exercises in preventing pulmonary complications following open heart surgery.

The effectiveness of breathing exercises in preventing pulmonary complications was studied in 40 patients undergoing open-heart surgery. Both high- and low-risk patients in the experimental group received one preoperative teaching session and treatment twice a day for the first four days postextubation. Routine postoperative care was given to all 40 patients. Breathing exercises reduced the incidence of pulmonary complications and the necessity for percutaneous endotracheal catheters in the high-risk group. These results justify the use of breathing exercises with the high-risk open-heart surgical patient.

Adult↗
PubMedDate not supplied

A survey of exercise testing: methods, utilization, interpretation, and safety in the VAHCS.

BACKGROUND: Healthcare organizations are being graded in terms of their adherence to practice guidelines. The authors sought information on practice patterns of exercise testing within the Veterans Affairs Health Care System (VAHCS) to determine how well current practice patterns adhere to current guidelines. In addition, we sought to update past surveys to determine methods, indications, utilization of alternative diagnostic modalities, criteria for interpretation, safety, and physician supervision of exercise testing within the VAHCS. METHODS: Questionnaires were sent to 72 of the largest Veterans Affairs Medical Centers with cardiology divisions. The centers were queried regarding volume and type of exercise testing (standard, nuclear, and echocardiographic), indications, safety, protocols used, and criteria for interpretation. RESULTS: Seventy-one questionnaires were returned, comprising a total of 75,828 exercise tests performed within the last year. Virtually all indications for exercise testing fit the American Heart Association/American College of Cardiology (AHA/ACC) guidelines Class I criteria; 46% of patients were tested for the evaluation of chest pain; 14% were tested to evaluate patients at high risk for coronary artery disease; 10% were preoperative evaluations; and 8% were post-myocardial infarction evaluations. The most commonly used diagnostic test was the standard exercise electrocardiogram; a patient was five times more likely to undergo a standard exercise electrocardiogram or nuclear exercise test than an exercise or pharmacologic echocardiogram. The largest proportion of centers (49%) used 1.0-mm horizontal or downsloping ST depression as a criterion for an abnormal test, although 22% considered 1.5-mm upsloping ST depression to be abnormal, and 25% relied on a treadmill score. Seventy-eight percent of respondents used the treadmill, and of these, 82% used the Bruce or modified Bruce protocol. Four major cardiac events were reported (three myocardial infarctions, one sustained ventricular tachycardia) representing an event rate of 1.2/10,000. A physician was present during 73% of all standard exercise tests; 21% of respondents reported that a physician was required to be present "only for high-risk patients." CONCLUSION: Indications for exercise testing are in close agreement with the AHA/ACC guidelines; thus, the test continues to have an important role in diagnosis and prognosis among patients with or suspected of having coronary artery disease. The exercise test is an extremely safe procedure, with an event rate similar to other recent surveys. However, a great deal of variation exists in terms of criteria for abnormal results and whether physician presence is required during exercise testing.

Coronary Disease↗
PubMed1992

[Left ventricular performance after patch reconstruction of the left ventricular wall for postinfarction left ventricular aneurysms].

Left ventricular performance in patients with a left ventricular aneurysm (LVA) treated with patch reconstruction is largely unknown. This study consisted of 15 patients, 14 men and 1 woman, with the average age of 59 +/- 8.5 years. The resected area of LVA was 40 +/- 27 cm2. The area of the woven Dacron patch used for reconstruction was 57 +/- 19% of the resected area including the sewing rim. The EF (Ejection Fraction, 1/3FF (Filling Fraction) and PFR (Peak Filling Rate) were calculated by 99mTc equilibrium cardiac pool scintigraphic images. The A/R ratio (peak velocity during atrial kick phase/peak velocity during the rapid filling phase) was measured using Doppler echocardiography, at the mitral orifice level. These parameters were determined before and 1 to 2 months after the operation. The time course was followed for A/R ratios. The preoperative resting global EF was 0.28 +/- 0.14 (0.44 +/- 0.13 for the contractile area) and the EF during exercise was 0.31 +/- 0.14. Resting and exercise EFs improved significantly (p < 0.01) to 0.40 +/- 0.11 and 0.43 +/- 0.10 postoperatively. The 1/3FF (%) and PFR (/sec) were low before operation (1/3FF, 11.3 +/- 8.3; PFR, 1.2 +/- 0.47). Postoperatively, the 1/3FF rose to 14.8 +/- 9.3 and the PFR showed a significant (p < 0.05) increase to 1.6 +/- 0.6. The A/R ratio significantly (p < 0.05) improved from preoperative 1.76 +/- 0.46 to 0.95 +/- 0.11 on the 3rd postoperative day. This improvement was maintained until the late postoperative period, with a value of 1.14 +/- 0.29 at month 16.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗