Kardiochirurgia dorosłych
Assessment of postoperative remodelling of left ventricle in randomized trial comparing aortic stentless prosthesis and aortic stent prosthesis using cardiac magnetic resonance (CMR)

Background: Cardiovascular magnetic resonance has become a new method of imaging the heart with wide advantages coming from high quality scans using non-invasive radio frequency waves.
Aim: The introduction of segmental analysis of the left ventricle in CMR has created the opportunity to assess its regional function.
Material and Methods: 26 patients who underwent AVR due to significant aortic stenosis were randomized to stented or stentless prosthesis. The patients were examined before the surgery and 6 months after the surgery. Demographic data, NYHA class, 6MWT and CMR parameters (left ventricle mass, EDD, ESV) were taken into analysis. In segmental analysis of CMR the left ventricle was divided into three horizontal planes: mitral valve (No. 1), midventricular plane (No. 2) and papillary muscles (No. 3). Each of them was divided into 16 segments (\'ECHO-CMR consensus\'). Planes 1 and 2 were divided into 6 segments (anterior, anterio-septal, posterio-septal, posterior, posterio-lateral, anterio-lateral); plane 3 was divided into 4 segments (anterior, septal, posterior and lateral). Thickness and regional contractility of these segments were analysed.
Results: Overall at six months after the surgery, significant reduction in left ventricular mass was noticed: 222.2±88 g to 183.7±77g (p<0.05), particularly in the stentless aortic valve subgroup: 226±68 to 167.2±56 (p<0.03); additionally there was a statistically significant reduction in EDD from 168±77 to 133.45±54 (p<0.05). In segmental analysis there was significant improvement in regional contractility in anterior segments corresponding to basal and intraventricular planes.
Conclusions: There were found markers of reverse left ventricular remodelling in the form of a reduction of left ventricular mass and improvement of segmental contractility.