A Study of Postoperative Aortic Valvular Function by Postmortem Perfusion

¹ Associate in Surgery, Harvard Medical School and Assistant Surgeon, Massachusetts General Hospital
² Assistant Clinical Professor of Surgery, Harvard Medical School and Visiting Surgeon, Massachusetts General Hospital
³ Departments of Surgery and Pathology, Harvard Medical School, and the General Surgical Services and the James Homer Wright Pathology Laboratories, Massachusetts General Hospital

Twenty patients who died following aortic surgery for calcific aortic stenosis and/or regurgitation were studied. Non-pulsatile and pulsatile postmortem perfusion experiments were carried out to determine the degree of stenosis and regurgitation present. The following conclusions seem justified:

(1) In patients who died in the immediate postoperative period following valvuloplasty, stenosis was adequately relieved, but significant regurgitation was present in half the cases. This data indicates that valvuloplasty can frequently result in an initial satisfactory relief of stenosis but also serves to emphasize the importance of correcting aortic regurgitation at operation to avoid fatality.

(2) In patients succumbing 12 to 24 months following valvuloplasty stenosis was noted in two of four cases. It seems clear that recurrent stenosis following valvuloplasty may occur with time.

(3) In patients dying 9 to 13 months following Muller-Littlefield valve replacement, both stenosis and regurgitation were noted. Regurgitation was due to fracture of the Teflon leaflets while stenosis was associated with leaflet stiffening.

(4) In patients with Starr-Edwards valve replacement who died in the immediate postoperative period, no evidence of stenosis or regurgitation was noted.