[Chronic aortic insufficiency: prediction of postoperative course based on preoperative relations of left ventricular end-diastolic volume to regurgitated blood volume].

The range of appropriate left ventricular dilatation due to volume overload was defined in 21 patients with a stable course of chronic aortic regurgitation, by correlating the scintigraphically determined left ventricular end-diastolic volume with the regurgitated blood volume. 25 other patients with chronic aortic regurgitation, who were scheduled for valve replacement, were within this normal range (group 1); in nine patients, left ventricular end-diastolic volume exceeded the amount expected from the amount of regurgitation (group 2). Patients were followed up between 2 and 62 months postoperatively (average: 26 +/- 13 months). No patients from group 1, but four out of nine patients from group 2 (45%) died postoperatively from congestive heart failure. In 23 out of 24 patients from group 1, left ventricular ejection fraction was postoperatively within the normal range, although preoperative values had been severely depressed in three cases (lower than 40%). Ejection fraction remained depressed in one patient with persistent mitral regurgitation and in all patients from group 2. Global heart volume significantly decreased by 20% in group 1, whereas only minor changes (-15%) were observed in group 2 (group 1: from 1184 +/- 186 to 954 +/- 120 ml, 2p less than 0.001; group 2: from 1402 +/- 300 to 1185 +/- 294 ml). This was compared to the course of left ventricular end-diastolic diameter (group 1: from 7.1 +/- 0.9 to 5.5 +/- 0.7 cm (-23%), 2p less than 0.001; group 2: from 7.6 +/- 0.7 to 6.9 +/- 1.3 cm (-9%). In group 1, left ventricular ejection fraction significantly increased, whereas no significant changes were observed in group 2 (group 1: from 53 +/- 13 to 64 +/- 13% (+21%), 2p less than 0.001; group 2: from 29 +/- 7 to 32 +/- 14% (+10%]. It is concluded that the scintigraphically determined ratio of left ventricular end-diastolic volume to regurgitated blood volume provides important prognostic and functional information regarding the postoperative course of chronic aortic regurgitation. This ratio is more reliable than single radionuclide, electrocardiographic, roentgenographic or echocardiographic parameters.