[Echocardiographic study of chronic aortic insufficiency. Hemodynamic, angiographic and total clinical correlates. II. Evaluation of left ventricular function]. / Estudio ecocardiográfico de la insuficiencia aortica crónica. Correlacion hemodinámica, angiográfica y clínica integral. Segunda parte: evaluación de la funcion ventricular izquierda.

An important point in the evolution of chronic aortic insufficiency (CAI) is the degree of disturbance of left ventricular performance (LVP), from which the surgical risk and the prognosis depend. Is possible by M mode Echocardiography (M-Echo) to evaluate the different elements that regulate the LVP, with the known measurements and by ratios of integral appraisal that are described here. We studied 14 patients with pure CAI at the National Institute of Cardiology, all of them had left catherization, ventriculography aortography, M-Echo, Chest X ray and EKG. The end systolic diameter (ESD) of the left ventricle (LV) and the fractional shortening (FS) showed good correlation with the end diastolic pressure (EDP) of the LV (r = 0.86 and -0.74 respectively). The percentage of aortic regurgitation (%AR) did not show significative correlation with the parameters of LV function. The ratios of integral appraisal showed good correlation with the EDP of the LV, the left atrium diameter over ejection fraction ratio (LAD/EF) was r = 0.764; the E point-septum separation over the fractional shortening ratio (E-S/FE) was r = 0.776, and for the ESD over the normalized velocity of the posterior wall of the LV ratio (ESD/NVPW) was r = 0.85. The relationship of the ESD/NVPW ratio with the EF was good (r = 0.95), with the mean velocity of circunferential shortening (r = -0.94) and with the cardiothoracic index (r = 0.88). We did not find a relationship between the functional class (NYHA) and the LVP, evaluated hemodynamic and echocardiographic methods used here. The M-Echo is an useful procedure for the sequential study of CAI, that permits recognition of the initiation and severity of the LV dysfunction, and it is of great help to signal the right moment for the surgical treatment.

[New echocardiographic (M-mode) index for evaluation of left ventricular end-diastolic pressure in chronic aortic regurgitation (author's transl)]. / Nuevo índice for ecocardiografía modo-m para la evaluación de la presión diastólica final del ventrículo izquierdo en la insuficiencia aórtica crónica.

The clinical evaluation of the best time for the surgical treatment of chronic aortic insufficiency is difficult to be assessed. Several invasive and non invasive procedures had been used, but there is no definitive solution yet. At the National Institute of Cardiology Ignacio Chávez, 13 patients wih pure, chronic and isolated cortic regurgitation (AR) were studied by echocardiography M mode (Echo M) to determine the state of left ventricular performance and the correlation with the valves of the end diastolic pressure of left ventricle (LVEDP). Besides catheterism of the left side, aortography and ventriculography were performed to all the patients. Catheterism, X-nay and electrocardiogram were done within a period no longer than 24 hours after the Echo M record. The function of the left ventricle (LV) was evaluated by measures and calculations published by other authors. With the purpose of integrating the functional characteristics of the LV in one expression, the indices left ventricle and systolic diameter divided by left ventricular normalized velocity of posterior wall (LVESD/LVPWNV) was created. It showed good correlation with LVEDP (r = 0.92). The index also had good correlation with the cardiothoracic ratio (r = 0.86) and the mean velocity of circumferential shortening of the LV by Echo M (r = 0.91). We consider important the LVESD/LVPWNV index proposed here, to determine the LVEDP of these patients; together with the whole clinical information, it makes easier the identification of the most appropriate time for surgical treatment making possible to evade the phase of myocardial damage which is risky to patients with chronic aortic insufficiency.