Rest and exercise hemodynamics before and ... - Wiley Online Library

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AVP exercise. MVP exercise. FIG. 2 Mean pulmonary artery pressure before and after aortic valve replacement (AVP) (A) and mitral valve replacement (MVP).
Clin. Cardiol. 23,32-38 (2000)

Rest and Exercise Hernodynamics before and after Valve ReplacementA Combined DopplerKatheter Study U.NELLESSEN,M.D.,G.~SELMA",M.D.,* J. LUDWIG,M.D.,~ R. JAHNS,M.D.,* A.J. CMFLL,M.D.,* P.EIGFL,M.D.*

Johanniter-Krankenhaus der Altmark in Stendal gGmbH, Medizinische Klinik 11, Stendal; "Medizinische Poliklinik der Universitit Wiirzburg, Kardiologie, Wiirzburg; ?Carl Carus Universitat Dresden, Herz- und Kreislaufzentrum Dresden e. V., Dresden, Germany

Summary Background: Hemodynamic improvement is a common finding following valve replacement. However, despite a normally functioning prosthesis and normal left ventricular ejection fraction, some patients may show an abnormal hemodynamic response to exercise. Methods: In a combined catheterDoppler study, rest and exercise hemodynamics were evaluated in 23 patients following aortic (n = 12)(Group 1) or mitral valve (n = 11) (Group 2) replacement and compared with preoperativefindings.Patient selection was based on absence of coronary artery disease and left ventricular failure as shown by preoperative angiography. Cardiac output, pulmonary artery pressure, pulmonary capillary pressure, and pulmonary resistance were measured by right heart catheterization, whereas the gradient across the valve prosthesis was determined by Doppler echocardiography. Postoperative evaluation was done at rest and during exercise. The mean follow-upwas 8.2 2.2 years in Group 1and 4.2 f 1 years in Group 2. Results: With exercise, there was a significant rise in cardiac output in both groups. In Group 1, mean pulmonary pressure/capillarypressure decreased from 24 k 9 / 18 9 mmHg preoperatively to 18 f 2 / 12f 4 mmHg postoperatively (p < 0.05),and increased to 43 f 12 / 30 k 8 mmHg with exercise (p c 0.05). The corresponding values for Group 2 were 36 k 12/ 24 f 6 mmHg preoperatively,24 k 7 / 17 k 6 mmHg postoperatively (p < 0.05),and 5 1 2 / 38 4 mmHg with exercise (p < 0.05). Pulmonary vascular resistance was 109 f 56

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Address for reprints: Prof. Dr. med. U. Nellessen Johanniter-Krankenhaus der Altrnark in Stendal gGrnbH Medizinische Klinik I1 Wendstr. 30 D-39576 Stendal, Germany

Received: August 26, 1998 Accepted with revision: April 16, 1999

d y n e . s ~ m -preoperatively, ~ 70 k 39 d y n e . s ~ m -postopera~ tively (p