9 / 74
CARDIOVASCULAR JOURNAL OF AFRICA • Volume 29, No 6, November/December 2018
AFRICA
341
Cases operated on with no 19 valves displayed a less prominent
improvement (Table 4).
The functional improvements and anatomical changes were
observed most clearly in the sixth month postoperatively. These
changes were less evident after the first year in patients receiving
no 19 prosthetic valves. Correspondingly, improvements seemed
to be less clear after the third year for cases operated on with no
23 valves (Table 4).
Table 4. Functional and anatomical changes observed after AVR in patient groups operated on with different sized prostheses
Mechanical
valve size
Time period
Functional and anatomical changes
EF
(%)
PAG
(mmHg)
MAG
(mmHg)
LVESD
(mm)
LVEDD
(mm)
IVST
(mm)
PWT
(mm)
LVMI
(g/m
2
)
NYHA
Score
No 19 (
n
=
8)
Pre-operative
56.6
±
3.5* 78.6
±
5.5* 38.8
±
4.5* 35.5
±
3.5* 54.2
±
4.6* 14.6
±
1.9* 13.8
±
1.7* 216.0
±
24.4* 2.9
±
0.4*
Postoperative 6th month
60
±
3 36.2
±
2.5 22.2
±
2.1 32.7
±
3.2 50.3
±
5.0 12.8
±
1.5 12.5
±
1.2 162.8
±
19.1 2.1
±
0.3
Postoperative 1st year
62.5
±
4 30.3
±
2.1
†
19.4
±
2.3
†
30.1
±
3.0
†
47.5
±
2.3
†
12.3
±
1.3
†
11.8
±
1.0
†
139.1
±
12.9
†
2.0
±
0.3
Postoperative 3rd year
61.3
±
5 31.6
±
3.2
†
20.5
±
1.9† 30.9
±
2.5
†
48.0
±
3.0
†
12.6
±
1.2
†
12.0
±
1.3
†
141.8
±
14.7
†
1.9
±
0.2
Postoperative 5th year
60
±
3.2 33.5
±
4.0
†
21
±
4.5
†
31.7
±
3.7
†
48.5
±
4.5
†
12.7
±
1.3
†
12.3
±
1.1
†
147.5
±
17.3
†
2.0
±
0.4
No 21 (
n
=
38) Pre-operative
54.5
±
3.2* 80.3
±
5.2* 49.7
±
5.0* 37.2
±
3.3* 55.8
±
5.2* 15.5
±
1.8* 14.5
±
1.8* 224.7
±
36.4* 3.2
±
0.3*
Postoperative 6th month 60.8
±
2.6 32.2
±
2.2 22.4
±
1.9 34.5
±
2.5 51.3
±
4.0 13.8
±
1.7 12.7
±
1.5 164.7
±
32.5 1.9
±
0.2
Postoperative 1st year
62
±
4.5 26.3
±
2.6 18.4
±
2.5 32.4
±
3.0 48.7
±
3.7 12.9
±
1.5 12.3
±
1.3 141.1
±
26.8 1.7
±
0.2
Postoperative 3rd year
62
±
4 23.0
±
1.9 16.5
±
1.5 31.2
±
2.3 48.0
±
4.3 12.4
±
1.3 11.8
±
1.2 130.5
±
18.7 1.6
±
0.4
Postoperative 5th year
61
±
3
25.2
±
2.6
‡
17
±
3.2
‡
31.3
±
3.2
‡
48.5
±
3.5
‡
12.6
±
1.1
‡
11.9
±
1.0
‡
135.8
±
20.5
‡
1.6
±
0.3
No 23 (
n
=
40) Pre-operative
53.6
±
3.5* 83.5
±
4.5* 47.8
±
6.0* 38.1
±
3.3* 56.5
±
6.3* 15.7
±
2.2* 14.8
±
1.7* 226.1
±
45.3* 3.2
±
0.3*
Postoperative 6th month 60.5
±
3 34.2
±
2.9 23.2
±
2.7 35.3
±
2.2 51.7
±
5.4 13.8
±
1.8 12.9
±
1.3 163.0
±
35.3 1.8
±
0.3
Postoperative 1st year
62.3
±
4 28.5
±
2.3 17.4
±
1.5 33.4
±
2.5 49.8
±
4.7 12.7
±
1.6 12.3
±
1.4 139.7
±
28.7 1.5
±
0.2
Postoperative 3rd year
62.5
±
3.5 26
±
3.5 15.2
±
1.8 32.8
±
3.1 48.4
±
3.5 12.3
±
1.3 11.8
±
1.2 126.8
±
23.5 1.3
±
0.3
Postoperative 5th year
62.2
±
3.2 21
±
2.7 14.1
±
2.5 31.2
±
3.0 47.5
±
3.0 11.8
±
1.1 11.5
±
1.3 117.6
±
21.6 1.2
±
0.4
No 25 (
n
=
6)
Pre-operative
54.8
±
4.5* 85.2
±
4.7* 48.5
±
5.8* 39.5
±
4.0* 57.8
±
6.0* 15.9
±
2.0* 15.1
±
2.0* 235
±
53.6* 3.2
±
0.2*
Postoperative 6th month 61.7
±
3 33.4
±
2.6 22.6
±
2.2 36.3
±
2.5 52.0
±
5.4 14.0
±
1.5 13.1
±
1.2 164.3
±
38.7 1.8
±
0.3
Postoperative 1st year
63
±
4 24.5
±
2.8 16.0
±
2.1 33.2
±
2.0 49.5
±
4.5 13.0
±
1.5 12.3
±
1.3 137.8
±
33.5 1.5
±
0.4
Postoperative 3rd year
64
±
5 22.5
±
3.0 14.7
±
1.6 31.5
±
3.0 48.7
±
4.3 12.5
±
1.2 11.9
±
1.2 127.2
±
30.7 1.3
±
0.3
Postoperative 5th year
63.3
±
2.8 19.3
±
2.4 13.2
±
2.5 30.2
±
2.7 47.3
±
3.5 11.8
±
1.0 11.5
±
1.3 113.8
±
25.4 1.2
±
0.2
EF
=
ejection fraction; PAG
=
peak aortic gradient; MAG
=
mean aortic gradient; LVESD
=
left ventricular end-systolic diameter; LVEDD
=
left ventricular end-
diastolic diameter; IVST
=
interventricular septum thickness; PWT
=
posterior wall thickness; LVMI
=
left ventricular mass index; NYHA
=
New York Heart Associa-
tion.
*Statistically significant difference between all groups with regard to pre- and postoperative values.
†
p
=
0.005, significant difference between patients with no 19 prosthesis and patients receiving other sizes in terms of pre- and postoperative values.
‡
p
=
0.05, significant difference between patients receiving no 21 prosthesis and patients receiving no 23 and no 25 prostheses.
Table 3. Electrocardiogram and cardiothoracic index values of patients operated on with different sized mechanical valves
Mechanical valve size Time period
ECG derivation
VR
+
VS
> 40 mm
V12S
+
V6R
> 40 mm
DIR
+
DIIIS
> 2 5 mm
aVL R
> 13 mm
aVR S
> 14 mm
CTI
No 19 (
n
=
8)
Pre-operative
43.5
±
7.8*
42.1
±
4.6*
25.8
±
3.7*
13.5
±
2.1*
15.8
±
2.3*
0.5
±
0.02*
Postoperative 6th month
40.3
±
3.9**
39.7
±
2.2**
21.7
±
2.6**
10.5
±
1.7**
12.4
±
1.8**
0.5
±
0.01
Postoperative 1st year
38.5
±
3.2**
37.5
±
2.1**
20.5
±
2.3**
9.6
±
1.2**
11.5
±
1.5**
0.5
±
0.01
Postoperative 3rd year
38.7
±
3.0**
38.0
±
1.9**
21.0
±
2.2**
9.3
±
1.3**
11.7
±
1.3**
0.5
±
0.01
Postoperative 5th year
39.0
±
3.3**
38.7
±
2.4**
21.3
±
2.1**
10.1
±
1.3**
12.0
±
1.2**
0.5
±
0.01
No 21 (
n
=
38)
Pre-operative
44.5
±
6.9*
42.5
±
4.8*
26.3
±
4.0*
14.6
±
2.2*
16.3
±
2.4*
0.5
±
0.02*
Postoperative 6th month
39.3
±
5.1
36.3
±
3.2
19.5
±
3.1
9.3
±
1.9
11.7
±
1.8
0.5
±
0.01
Postoperative 1st year
37
±
4.6
35.8
±
2.4
17.3
±
2.9
8.7
±
1.3
10.2
±
1.4
0.5
±
0.01
Postoperative 3rd year
38.1
±
4.3
37
±
2.0
17.1
±
2.5
8.0
±
1.1
9.8
±
1.2
0.5
±
0.01
Postoperative 5th year
40.3
±
4.8
38
±
1.8
18
±
2.1
8.6
±
1.0
10.5
±
1.1
0.5
±
0.01
No 23 (
n
=
40)
Pre-operative
46.3
±
8.4*
46.4
±
5.2*
27
±
4.2*
15.2
±
2.3*
17.3
±
2.4*
0.5
±
0.02*
Postoperative 6th month
38.9
±
4.6
39.5
±
3.5
21
±
3.3
10.8
±
1.8
11.2
±
1.6
0.5
±
0.01
Postoperative 1st year
37.5
±
3.2
36.7
±
3.0
19.8
±
2.5
9.6
±
1.4
9.7
±
1.3
0.5
±
0.01
Postoperative 3rd year
36.2
±
2.5
35.8
±
2.7
19
±
2.2
8.7
±
1.1
8.9
±
1.0
0.5
±
0.01
Postoperative 5th year
37.3
±
3.6
37
±
2.2
19.2
±
2.0
9.1
±
0.9
8.3
±
0.9
0.5
±
0.01
No 25 (
n
=
6)
Pre-operative
47.5
±
8.2*
45
±
5.0*
28
±
4.3*
16.3
±
2.3*
18
±
2.5*
0.6
±
0.03*
Postoperative 6th month
37
±
4.5
38.3
±
3.8
20.7
±
2.7
11
±
1.7
10.7
±
1.7
0.5
±
0.01
Postoperative 1st year
36.8
±
3.7
35.6
±
3.0
18.7
±
2.1
9.5
±
1.3
8.9
±
1.3
0.5
±
0.01
Postoperative 3rd year
35.9
±
3.2
34.8
±
2.4
17.8
±
1.9
8.5
±
1.0
8.5
±
1.0
0.5
±
0.01
Postoperative 5th year
36
±
3.0
35.2
±
2.1
17.2
±
1.8
8.1
±
0.8
8.2
±
0.8
0.5
±
0.01
CTI
=
cardiothoracic index; ECG
=
electrocardiogram.
*
p
=
0.05, statistically significant difference between pre-operative and postoperative periods with regard to ECG findings.
**
p
=
0.05, statistically significant difference between patients with no 19 valves and the other groups in the postoperative period with regard to ECG findings.