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Left ventricular size and function in double inlet left ventricle
G Isabella1, L Daliento, R Chioin
1Padua University School of Medicine, Division of Cardiology, Italy.
Insights
Left ventricular size and function in double inlet left ventricle patients change with age and surgery. Ventricular volume adequacy for septation varies, while ejection fraction remains stable in children up to 15 years.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease
- Cardiac Imaging
Background:
- Double inlet left ventricle (DILV) is a complex congenital heart defect.
- Understanding ventricular dynamics is crucial for surgical planning and patient management.
Purpose of the Study:
- To evaluate changes in left ventricular size and function in DILV patients.
- To assess the impact of age and palliative surgery on ventricular volume and performance.
- To differentiate outcomes based on pulmonary flow restriction.
Main Methods:
- Quantitative cineangiography in 15 DILV patients (1 day to 15 years).
- Calculation of ventricular volumes using Simpson's rule.
- Assessment of ejection fraction and systolic pressure to end-systolic volume ratio.
Main Results:
- Ventricular size inadequate for septation in pulmonary flow restriction, but improves post-shunting.
- Adequate volume for septation in non-restricted patients initially, but may decrease post-pulmonary artery banding.
- Ejection fraction is slightly lower than in biventricular hearts but stable with age.
- Systolic pressure to end-systolic volume ratio is stable with age but affected by excessive pulmonary flow or valvar regurgitation.
Conclusions:
- Ventricular volume dynamics in DILV are significantly influenced by pulmonary flow status and surgical interventions.
- Left ventricular function, assessed by ejection fraction, demonstrates resilience throughout childhood in DILV patients.
- Palliative surgical strategies require careful consideration of their impact on ventricular growth and hemodynamics.
Abstract:
Using quantitative cineangiography we studied left ventricular size and function in 15 patients (aged 1 day to 15 years) with double inlet left ventricle. Our purpose was to assess how ventricular volume and performance change with age and palliative surgery in patients with and without restriction to pulmonary flow. Ventricular volumes were calculated using Simpson's rule method; end-diastolic volume was also stated as a percentage of predicted total (combined right and left) ventricular volume. Ejection fraction and systolic pressure to end-systolic volume ratio were calculated as indexes of ventricular function. Our results suggest that ventricular size is inadequate for a septation procedure in patients with restriction to pulmonary flow but increases after shunting operation. In patients without restriction to pulmonary flow, ventricular volume is adequate for a septation procedure during the first months of life, but it tends towards reduction, along with obstruction of the interventricular communication, after pulmonary artery banding. Ejection fraction is slightly lower than in left ventricle of heart with biventricular atrioventricular connexion, but it does not decrease with age, at least during the first 15 years of life. Systolic pressure to end-systolic volume ratio also does not decrease with age, but it is lower in patients with excessive pulmonary flow or atrioventricular valvar regurgitation.