[Persisting volume overload of the left ventricle following surgical correction of chronic aortic insufficiency]

After aortic valve replacement for chronic aortic regurgitation, complete normalization of the left ventricular end-diastolic volume can rarely be observed. We therefore investigated the role of continual volume overload caused by persisting concomitant mitral regurgitation. 20 patients who received an aortic valve for chronic aortic regurgitation (group 1), 5 patients after operation for aortic stenosis (group 2) and 6 patients with double valve replacement because of aortic and mitral valve lesions were included in the study 1 to 108 months after operation. All patients were examined clinically and by combined first pass/equilibrium radionuclide ventriculography. In the case of significant regurgitation (greater than 20%) 2-dimensional colour-coded Doppler-echocardiography was performed in patients of group 1 to localize the regurgitant lesion. 15 patients of group 1 had a typical systolic murmur indicating mitral regurgitation. 14 of these patients had significant scintigraphic left-sided heart regurgitation: 7 patients had regurgitant fractions between 21 and 40%; 6 patients between 41 and 60%; in 1 patient RF was 64%. Echocardiography confirmed mitral regurgitation in 9 of 11 of these cases. No significant regurgitation was observed in patients of group 2; mild regurgitation was measured in 5 of 6 patients of group 3 (26 to 31%). We conclude that in patients with chronic aortic regurgitation complete normalization of the left ventricular end-diastolic volume after valve replacement may not occur in some patients because of persisting mitral regurgitation.