Background-Prosthesis-patient mismatch (PPM) occurs when the effective orifice area (EOA) of the prosthesis being implanted is too small in relation to body size, thus causing abnormally high transvalvular pressure gradients. The objective of this study was to examine the midterm impact of PPM on overall mortality and cardiac events after aortic valve replacement in patients with pure aortic stenosis. Methods and Results-The indexed EOA (EOAi) was estimated for each type and size of prosthesis being implanted in 315 consecutive patients with pure aortic stenosis. PPM was defined as an EOAi Յ0.80 cm 2 /m 2 and was correlated with overall mortality and cardiac events. PPM was present in 47% of patients. The 5-year overall survival and cardiac event-free survival were 82Ϯ3% and 75Ϯ4%, respectively, in patients with PPM compared with 93Ϯ3% and 87Ϯ4% in patients with no PPM (PՅ0.01). In multivariate analysis, PPM was associated with a 4.2-fold (95% CI, 1.6 to 11.3) increase in the risk of overall mortality and 3.2-fold (95% CI, 1.5 to 6.8) increase in the risk of cardiac events. The other independent risk factors were history of heart failure, NHYA class III-IV, severe left ventricular hypertrophy, and absence of normal sinus rhythm before operation. Conclusions-PPM is an independent predictor of cardiac events and midterm mortality in patients with pure aortic stenosis undergoing aortic valve replacement. As opposed to other risk factors, PPM may be avoided or its severity may be reduced with the use of a preventive strategy at the time of operation. (Circulation. 2006;113:570-576.)

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Gastric myoelectric and manometric activities were studied by means of a peroral probe in six patients with chronic idiopathic gastroparesis characterized by a marked delay in gastric emptying at scintigraphy and by interdigestive gastric hypokinesia at manometry. Six normal subjects were examined as controls. The study was carried out by means of a probe with Ag‐AgCl suction‐needle electrodes and an open‐tip manometric catheter. In normal subjects this method was able to record in the distal gastric antrum a regular occurrence of pacesetter potentials at a frequency of about three per minute associated with bursts of spikes or secondary waves in correspondence with the pressure waves. In patients with chronic idiopathic gastroparesis a large variety of electric arrhythmias ranging from premature control potentials to tachygastria, tachyarrhythmia, bradygastria, and bradyarrhythmia and to a complete disorganization of electric control activity were recorded. As no pressure waves were recorded during these myoelectric disturbances, the antral motor impairment that characterizes chronic idiopathic gastroparesis may be considered pathogenetically related to the absence of a regular occurrence of gastric control potentials.

The fact that the postprandial antral distention was more marked in the dyspeptic patients with more severe symptoms suggests that this motor pattern could play a more important role in the genesis of dyspeptic symptoms than the delay in gastric emptying time, which was similar in the two groups.