Immediate and Late Results of Aortic Ball Valve Replacement

During the 5-year period 1965 to 1970, 243 patients with aortic valvular disease were subjected to aortic ball valve replacement. Most of the patients had combined aortic stenosis and insufficiency. Pure aortic insufficiency was found in 51 patients. The main aetiological factors in pure insufficiency were aortic wall and cusp weakness, previous rheumatic infection and bacterial endocarditis. Angina pectoris was one of the most common symptoms, and was found in 49% of these patients. Angina pectoris is most often functional in aortic stenosis, being produced by reduced coronary blood supply and increased myo-cardial oxygen demand due to left ventricular hypertrophy. Hospital mortality was 17% and late mortality during the follow-up period, which ranged from 1 to 5 years, was 8% (total 25%). The main causes of death were arrhythmia, myocardial failure and septicaemia. Myocardial infarction was the cause of death in 9 patients, while 6 patients suffered from myocardial infarction, which they survived. Thrombo-embolism occurred in 17, i.e. an incidence of 9.4%, in spite of strict adherence to anticoagulant therapy. Haemolysis was evaluated. It was found in 90% of patients after ball valve replacement, and in 15% before operation. The haemolysis causes urinary iron loss. Therefore, these patients should be treated with iron supplements. The functional results in the surviving patients are gratifying as 70% of them have returned to work. The symptom of angina pectoris has disappeared in 90% of the survivors, illustrating the functional genesis of this symptom.