[Is echocardiography useful in assessing long term prognosis after valve replacement in patients with left ventricular volume overload?].

Echocardiographic recordings in 87 patients with chronic volume overload of the left ventricle (32 pure aortic incompetence, 18 mixed aortic lesions with predominating regurgitation, 17 mitral incompetence and 20 combined aortic and mitral incompetence) who underwent valve replacement between 1975 and 1976 were reassessed to determine the prognostic interest of echocardiography in the long-term postoperative period. The follow-up was a least 2.5 years (average 2.8 years). Patients with coronary artery disease or paravalvular leaks were excluded from the study. The evaluation of the echocardiogrammes comprised the measurement of the end diastolic left ventricular internal dimension (Dd) and the end systolic dimension (Ds) and the calculation of the percentage systolic shortening of the internal dimension (p. 100 Sh) and of the ratio, radius/thickness in end diastole (Dd/2th). A poor surgical result was defined by a postoperative work capacity of less than 60 p. 100 normal or by postoperative death (7 deaths, one of which was in the perioperative period). 21 patients had poor results (group I) and 66 patients, good results (group II). None of the individual echocardiographic parameters differed significantly in groups I and II. In a sub-group of 50 patients, with isolated aortic incompetence, the preoperative echocardiographic data could not distinguish between patients with good and poor postoperative courses. On the other hand, the 4 patients with chronic aortic incompetence who died before operation were characterised by a Dd > 80 mm and Ds > 60 mm, although p. 100 sh was only < 25 p. 100 in one of these 4 cases. In conclusion, M mode echocardiography in patients with chronic volume overload of the left ventricle did not appear to have any value in the prediction of the long-term postoperative result. In patients with chronic aortic incompetence, greatly increased left ventricular internal dimensions indicate a compromised natural prognosis and are an urgent indication for surgical intervention.