The Association Between Ascending Aortic and Left Ventricular Dimensions in Patients After Aortic Valve Replacement

ABSTRACT Introduction: Aortic valve replacement (AVR) is often recommended for patients with severe aortic stenosis or chronic aortic regurgitation. These conditions result in remodeling of the left ventricle, including increased interstitial fibrosis that may persist even after AVR. These structural changes impact left ventricular (LV) mechanics, causing compromised LV diameter to occur earlier than reduced LV ejection fraction (LVEF). The aim of this study was to examine the effect of left ventricular end-diastolic diameter (LVEDD) and its role in aortic expansion one year after AVR. Methods: Sixty-three patients who underwent AVR were evaluated. All patients underwent standard transthoracic echocardiography, which included measurements of the ascending aorta, aortic root, LVEF, and LVEDD before the surgery and one year postoperatively. Correlations between these variables were calculated. Results: All patients underwent AVR with either a mechanical or biological prosthetic aortic valve. Following AVR, there was a significant decrease in the dimensions of the ascending aorta and aortic root (both P=0.001). However, no significant changes were observed in LVEDD and LVEF. Correlations were found between the preoperative ascending aortic size and the preoperative and one-year postoperative LVEDD (r=0.419, P=0.001 and r=0.320, P=0.314, respectively). Additionally, there was a correlation between the postoperative ascending aortic size and the preoperative and one-year postoperative LVEDD (r=0.320, P=0.003 and r=0.136, P=0.335, respectively). Conclusion: The study findings demonstrate a significant correlation between the size of the aortic root and ascending aorta, before and after AVR. Additionally, a notable correlation was observed between postoperative LVEDD and the size of the aortic root.

A rare cause of left ventricular assist device (lvad) obstruction: left atrial dissection

Abstract Left atrial dissection is a rare factor that may cause left ventricular assist device obstruction. Prompt diagnosis and surgical repair are essential. This case report describes our experience and a successful surgical management in a patient after HeartMate 3 implantation and mitral valve inflow obstruction due to a left atrial dissection.

The Role of Cardiopulmonary Bypass on the Early Postoperative IgG levels, Effect on the Postoperative Outcome in Cardiac Surgery Patients - A Pilot Study.

Objective: This study tried to elucidate the role of the cardiopulmonary bypass on the early postoperative immunoglobulin G levels and any probable effects on the postoperative outcome of the patients. Methods: 99 consecutive patients were studied. The evening after surgery the level of the immunoglobulin G was obtained. The postoperative course of each patient during the first three days was followed. One way ANOVA was used for statistical analysis. Results: 20 (20.2%) patients had decreased early postoperative immunoglobulin G levels. 87 (87.87%) patients were operated with cardiopulmonary bypass and 17 (19.54%) of them had lower levels of postoperative immunoglobulin G without any significantly increased clinically adverse events. The statistical analysis between the two groups included: pulmonary infiltrations, leukocytosis >15x103/mm3, pulmonary dysfunction, mechanical ventilation >24h, renal and hepatic dysfunction, postoperative ileus, postoperative delirium, sternal wound infection, thrombocytopenia <60x103/ mm3 and sepsis. The statistical results were: p=0.815, p=0.88, p=0.93, p=0.30, p=0.67, p=0.13, p=0.84, p=0.38, p=0.76 respectively. Conclusion: In this pilot study we tried to explore the role of cardiopulmonary bypass on the early postoperative levels of immunoglobulin G and to establish any correlation with the postoperative outcome. The use of cardiopulmonary bypass and its duration did not prove to be risk factors for low early postoperative immunoglobulin G levels. In our opinion the prophylactic use of IVIG in this group of patients has no benefit.