European Journal of Cardiovascular Medicine

Globally, valve disease (VHD) is still a major contributor to cardiovascular morbidity and death, especially in poorer nations where rheumatic heart disease is still common [1]. Because the left ventricle (LV) is the main chamber for systemic circulation, the pathophysiological effects of valvular diseases like stenosis or regurgitation are mostly transmitted through their effects on the LV. Compensatory left ventricular hypertrophy and dilatation can be caused by chronic pressure overload, such as in aortic stenosis, or volume overload, such as in aortic or mitral regurgitation [2]. If prompt action is not taken, these adaptive mechanisms eventually turn maladaptive, resulting in increasing ventricular dysfunction and ultimately heart failure [3]. When medical therapy is unable to alleviate symptoms or maintain ventricular function, surgical valve replacement is still the last resort for severe valvular lesions [4]. Reverse remodeling is the process by which valve replacement reduces ventricular overload by restoring normal hemodynamics, enabling either partial or full recovery of left ventricular function [5]. However, the preoperative myocardial condition, the length and severity of valve disease, and the timing of surgical intervention all affect how much postoperative functional improvement occurs [6]. Early detection and monitoring of ventricular impairment is crucial before irreversible cardiac damage develops because patients with severe LV dysfunction at the time of surgery frequently have a limited capacity for recovery. Therefore, assessment of left ventricular performance prior to and during valve replacement surgery is an essential part of patient care and prognosis. Echocardiography, which offers precise and noninvasive measurements of chamber dimensions, ejection fraction (EF), wall motion, and myocardial strain, is the most used technique for evaluating LV function [7]. While more recent echocardiographic methods like tissue Doppler imaging and speckle-tracking strain analysis provide more sensitive indications of subclinical myocardial failure, the modified Simpson's biplane approach is frequently used to assess LV ejection fraction [8]. The gold standard for assessing ventricular volumes and myocardial fibrosis is cardiac magnetic resonance imaging (CMR), which offers more information about the reversibility of left ventricular dysfunction following surgery [9]. Long-term results can be predicted and the efficacy of surgical repair can be accessed through postoperative LV performance monitoring. Particularly in patients who underwent surgery prior to the development of severe dysfunction, numerous studies have shown a notable improvement in LV ejection fraction and a decrease in ventricular diameters following valve replacement [10, 11]. On the other hand, even if valve replacement is effective, delayed intervention may lead to ongoing ventricular dysfunction and a bad prognosis.

In this study, we used echocardiographic parameters such as ejection fraction, left ventricular end-diastolic and end-systolic diameters, and fractional shortening to assess left ventricular performance before to and following valve replacement operation. This evaluation will demonstrate the significance of early surgical intervention in maintaining ventricular function and assist in measuring the degree of functional recovery following surgical correction.

Study Design and Population

This was a prospective observational study conducted in the Department of Cardiology and Cardiothoracic Surgery at Tertiary care Indian Hospital. A total of 50 patients diagnosed with severe valvular heart disease and scheduled for valve replacement surgery were enrolled. Inclusion criteria comprised adult patients (>18 years) with isolated aortic or mitral valve disease who were candidates for surgical valve replacement. Patients with associated congenital heart disease, previous valve surgery, or significant coronary artery disease were excluded from the study.

Preoperative Evaluation

All patients underwent detailed clinical examination and baseline investigations, including electrocardiography, chest radiography, and transthoracic echocardiography (TTE). Echocardiographic evaluation was performed and Standard parasternal long-axis, short-axis, and apical views were obtained in accordance with the recommendations of the American Society of Echocardiography (Lang et al [12]).

Parameters recorded included:

• Left ventricular ejection fraction (LVEF) using the modified Simpson’s biplane method
• Left ventricular end-diastolic diameter (LVEDD) and end-systolic diameter (LVESD)
• Fractional shortening (FS)
• Left atrial size and valve lesion severity

Surgical Procedure

All patients underwent either mechanical or bioprosthetic valve replacement under cardiopulmonary bypass. The type of valve (aortic or mitral) and prosthesis used were documented. Standard cardioplegia techniques were employed to ensure myocardial protection during surgery. Postoperative management was conducted according to institutional protocols, including anticoagulation and hemodynamic monitoring.

Postoperative Evaluation

Follow-up echocardiography was performed at 7 days, 3 months, and 6 months post-surgery to assess changes in LV function and chamber dimensions. The same echocardiographic parameters (LVEF, LVEDD, LVESD, and FS) were re-evaluated using identical imaging protocols to ensure consistency. Improvement in LV function was analyzed by comparing preoperative and postoperative values.

Statistical Analysis

Data were analyzed using SPSS version 24. Continuous variables were expressed as mean ± standard deviation (SD). The paired t-test was used to compare preoperative and postoperative LV function parameters. A p-value of <0.05 was considered statistically significant

A total of 50 patients were included in the study, comprising 30 males (60%) and 20 females (40%). The mean age was 52.4 ± 10.6 years. Among the patients, 32 (64%) underwent mitral valve replacement (MVR) and 18 (36%) underwent aortic valve replacement (AVR). Postoperative improvement in left ventricular function was observed.

Table 1: Baseline Characteristics of Study Population (n = 50)

Preoperative Left Ventricular Function

Before surgery, patients showed evidence of left ventricular dysfunction associated with chronic volume or pressure overload. The mean LVEF was 46.2 ± 7.5%, and the LV end-diastolic diameter (LVEDD) was 58.4 ± 6.1 mm.

Postoperative Changes in Left Ventricular Function

At 6-month follow-up, significant improvement was observed in most echocardiographic parameters. The mean LVEF increased to 54.8 ± 6.9% (p < 0.001), while LVEDD and LVESD decreased significantly, suggesting improved systolic performance and reverse remodeling.

Table 2: Pre and post operative comparison of Left Ventricular Function Parameters

Figure 1: Mean LVEF Before and After Valve Replacement

Figure 2: Left Ventricular Dimensions Before and After Surgery

Figure 3: Change in Ejection Fraction over Time

In this study, 50 patients with valvular heart disease undergoing valve replacement were evaluated for changes in left ventricular (LV) function before and six months after surgery. The mean preoperative left ventricular ejection fraction (LVEF) was 46.2 ± 7.5%, which improved significantly to 54.8 ± 6.9% postoperatively (p < 0.001). Correspondingly, LV end-diastolic diameter (LVEDD) and end-systolic diameter (LVESD) decreased markedly, indicating regression of chamber dilatation and improvement in systolic performance. These findings reflect a favorable process of reverse remodeling following relief of chronic volume or pressure overload caused by valvular lesions.

The improvement in LVEF and reduction in LV dimensions are consistent with earlier reports. Borer et al [13] and Gaudino et al [14] observed similar improvements in LV function after both mitral and aortic valve replacement, attributing the changes to reduced wall stress and restoration of normal hemodynamics. The improvement in fractional shortening from 20.4 ± 4.2% to 25.8 ± 3.9% (p < 0.001) further supports enhanced contractile function after surgery. The significant reduction in LV mass index from 136.5 ± 18.9 g/m² to 122.4 ± 16.8 g/m² (p = 0.004) suggests regression of compensatory hypertrophy once the chronic overload is relieved.

Preoperative LV dysfunction is a well-known predictor of postoperative outcomes. Several studies have emphasized early surgical intervention before the onset of irreversible myocardial damage (Bonow et al [15]). In the present study, even patients with moderately reduced LVEF demonstrated substantial postoperative improvement, underscoring the potential for myocardial recovery if the surgery is not unduly delayed. The high proportion of patients shifting from NYHA class III/IV preoperatively (80%) to class I/II postoperatively (88%) reinforces the functional and symptomatic benefit of valve replacement [17].

Mechanical prostheses were used in 70% of patients, while bioprosthetic valves accounted for 30%. Although prosthesis type was not directly correlated with LV recovery in this study, prior literature suggests comparable short-term functional improvement with both types (Goldstone et al [16]. However, long-term outcomes may vary depending on valve durability, anticoagulation management, and patient comorbidities.

Overall, the data from this study support the concept that valve replacement surgery leads to significant and measurable improvement in LV function and clinical status. Echocardiographic assessment remains an essential tool for evaluating postoperative remodeling and predicting long-term outcomes.

Valve replacement surgery in patients with mitral or aortic valve disease results in significant improvement in left ventricular function and geometry. Six months post-surgery, there was a marked increase in LVEF and a decrease in LVEDD, LVESD, and LV mass index, indicating favorable reverse remodeling. Early surgical intervention before the onset of severe LV dysfunction offers the best prospects for recovery and symptom improvement. Regular echocardiographic monitoring is crucial for assessing postoperative progress and guiding further management.

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