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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 29, No 6, November/December 2018
338
AFRICA
Cardiovascular Topics
Anatomical and functional changes after aortic valve
replacement with different sizes of mechanical valves
Gokhan Ilhan, Sahin Bozok, Berkan Ozpak, Hakan Kara, Serkan Yazman, Serdar Bayrak, Ibrahim
Ozsoyler, Ali Gurbuz
Abstract
Objective:
To date, there is no consensus on the selection of
type and size of prosthetic valve for aortic valve replacement
(AVR). The aim of this study was to compare anatomical and
functional changes occurring in the left ventricle after AVR
with different sizes of mechanical valves.
Methods:
A total of 92 patients with serious aortic valve
stenosis, who underwent AVR between March 2001 and
June 2008 using mechanical valves of different sizes, were
retrospectively analysed. The sizes of the mechanical valves
were 19, 21, 23 and 25 mm. All patients were assessed pre-
operatively, and at six months and in the first, third and fifth
years postoperatively. The left ventricle was assessed with
electrocardiography, echocardiography and telecardiography
and compared in the four patient groups, constituted accord-
ing to the mechanical valve size used.
Results:
In all groups, left ventricular mass and mass index,
transvalvular aortic gradient, thicknesses of the interventri-
cular septum and posterior wall, and left ventricular end-
systolic and end-diastolic diameters had decreased signifi-
cantly post surgery. Left ventricular ejection fraction and
exercise capacity had increased significantly (
p
<
0.001).
The most noteworthy anatomical and functional improve-
ments were seen in patients who had received 23- and 25-mm
mechanical valves.
Conclusion:
Mechanical valve replacement should not be
performed with small size valves because of the higher
residual gradient.
Keywords:
aortic valve stenosis, heart valve prosthesis implanta-
tion, heart ventricles
Submitted 18/10/16, accepted 24/6/18
Published online 17/7/18
Cardiovasc J Afr
2018;
29
: 338–343
www.cvja.co.zaDOI: 10.5830/CVJA-2018-037
Aortic stenosis results from narrowing of the aortic valve orifice,
which blocks the outflow from the left ventricle. Increased intra-
cavitary pressure causes elevated left ventricular pressure and
amplifies myocardial wall stress, which subsequently leads to left
ventricular concentric hypertrophy. Therefore, compensatory left
ventricular hypertrophy (LVH) is an adaptive mechanism against
elevated intra-cavitary pressure.
1
LVH is an independent factor for cardiovascular mortality,
and gradual thickening of the ventricle wall diminishes its
compliance and is reflected as increased left ventricular
end-diastolic pressure. In advanced stages of the disease,
decreases in cardiac output, ejection fraction and transaortic
gradient are observed.
2
Surgical treatment for aortic stenosis aims to correct the
valvular pathology and relieve the pressure load on the left
ventricle, resulting in reversal of the pathological anatomical
changes and restoration of function.
3
Regression of LVH and
other related anatomical changes after aortic valve replacement
(AVR) appears to affect long-term survival rates significantly.
4
To date, there is no consensus on the selection of type and size
of prosthetic valve for AVR. Ideally, a prosthetic valve should
have a long duration and should be similar to the original valve.
The aim of this study was to compare anatomical and functional
changes occurring in the left ventricle after AVR with different
sizes of mechanical valves.
Department of Cardiovascular Surgery, Faculty of
Medicine, Recep Tayyip Erdogan University, Rize, Turkey
Gokhan Ilhan, MD
Department of Cardiovascular Surgery, Faculty of
Medicine, Usak University, Usak, Turkey
Sahin Bozok, MD,
drsahinbozok@gmail.comDepartment of Cardiovascular Surgery, Çorlu State
Hospital, Tekirda
ğ
, Turkey
Berkan Ozpak, MD
Department of Cardiovascular Surgery, Ada Hospital,
Giresun, Turkey
Hakan Kara, MD
Department of Cardiovascular Surgery, Training and
Research Hospital, Mugla Sitki Kocman University, Mugla,
Turkey
Serkan Yazman MD
Department of Cardiovascular Surgery, Faculty of
Medicine, Dokuz Eylul University, Izmir, Turkey
Serdar Bayrak, MD
Department of Cardiovascular Surgery, Atatürk Training
and Research Hospital, Izmir Katip Celebi University, Izmir,
Turkey
Ibrahim Ozsoyler, MD
Ali Gurbuz, MD