Regression of body compositional abnormalities of heart failure after intracardiac operations.

SUMMARY Alterations in body composition are present in patients with heart disease and conges-tive heart failure, and additional changes occur acutely after corrective surgery. The reversibility and time course of reversion to normal body composition have not been demonstrated. Nine patients were studied preoperatively and 2 to 4 weeks and 6 to 12 mo postoperatively. Measurements were made, using the isotope-dilution technic, of the volumes of total body water, extracellular water, plasma, and red cells, and of the amounts of total exchangeable sodium and potassium. Values were derived for body fat, indices of body cell mass, and the intracellular and extracellular distribution of water and potassium. Significant changes (P < 0.05) occurring 2 to 4 weeks after operation were increased in total body water (8.2%), intracellular water (15.0%), ex-changeable sodium (7.1%), and intracellular potassium content (7.7%), and decrease in body weight (4.6%) and body fat (21.6%); 6 to 12 mo postoperatively there was increase in exchangeable potassium (6.8%), body weight (7.8%), and decrease in ex-changeable sodium (16.1%), extracellular fluid (7.8%), plasma (8.0%), and the ratio of exchangeable sodium to exchangeable potassium (23.6%). Late postoperative values were similar to predicted normal values and indicate that postoperative recovery from valvular replacement in these patients is accompanied by resolution of most of the body compositional abnormalities of heart failure. Additional Indexing Words: Valvular heart disease Extracellular fluid volume Plasma volume Electrolytes Interstitial fluid volume Red cell mass ABNORMALITIES of body fluid and electrolyte composition have been previously studied in patients with valvular heart disease and congestive heart failure.1-Volumes of total body water, extracellular and interstitial fluid, plasma, and red cells are increased and are accompanied by an appropriate increase of total exchangeable sodium and a reduction of total exchangeable potassium. Average intracellular potassium concentration is reduced when studied by isotope-dilution methods, as is the potassium content of muscle biopsy specimens.5-9 Medical treatment of acute congestive heart failure reduces the volume of body water, predominantly the extracellular phase, and reduces total exchangeable sodium.'0-'2 Presumably these alterations of body composition are related to the hemodynamic abnormalities present in these patients. Open intracardiac correction of valvular defects results in additional acute changes in body composition. Increased volumes of extracellular and interstitial fluid are accom