[Study of the etiologic mechanism of valvular regurgitation using Doppler echography]. / Etude du mécanisme étiologique des régurgitations valvulaires en écho-Doppler.

Doppler echocardiography is currently the method of choice for diagnosing and determining the mechanism and etiology of valvular regurgitation. The recent introduction of transesophageal echo coupled with color Doppler has increased the value of these ultrasonic methods. The analysis of the valvular lesion should be particularly precise and accurate in severe mitral insufficiency because of the possibility of surgical valvuloplasty, the indications of which are now much broader than was the case at the beginning of the nineteen eighties.

Prognosis and long-term results of surgically treated aortic stenosis.

A total of 675 patients (mean age 60 +/- 11 years, range 22-85, 71% males) with calcified pure aortic stenosis (490) or mixed lesions (185) had an aortic prosthesis: 290 Starr-Edwards, 147 Bjork, 18 other mechanical valves, 163 pericardial xenografts, 57 porcine xenografts; 76 patients simultaneously underwent a coronary bypass, 12 a replacement of ascending aorta, and six a mitral valvuloplasty. Preoperatively, 67% were in functional class III or IV (NYHA); 69.5% had a coronary arteriography: significant coronary stenosis was observed in 27% of patients. The operative mortality was 6.8% depending on the functional class at surgery, age (4.9% before 70 years, vs. 12.5% after), and the date of surgery (8.1% before 1983 vs. 3.7% after). The 10- and 15-year actuarial survival rates were 62 +/- 3% and 44 +/- 4%, respectively. No significant differences were observed between patients with pure aortic stenosis and mixed aortic lesions. In patients over 70 years, the survival rates were 71 +/- 5% at five years and 51 +/- 10% at 10 years. Age, functional class, degree of congestive heart failure, and degree of cardiomegaly were the main preoperative predictors of late death. At 10 years, 88% of patients were free from myocardial dysfunction, 87% from thromboembolic events, and 89% from haemorrhages. We conclude that in this type of valvulopathy, short- and long-term surgical results are good despite the fact that most patients are elderly and in an advanced functional class.