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[Comparative study of left ventricular echocardiographic parameters in congenital aortic stenosis and coarctation]
Insights
Echocardiography revealed symmetric left ventricular hypertrophy in children with aortic stenosis or coarctation. This method accurately assessed left ventricular function and pressure gradients, aiding surgical decisions.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Physiology
- Diagnostic Imaging
Background:
- Left ventricular adaptation is crucial in congenital heart defects causing ejection obstruction.
- Aortic stenosis and coarctation are common conditions affecting pediatric populations.
- Accurate assessment of left ventricular function and pressures is vital for management.
Purpose of the Study:
- To evaluate left ventricular adaptation to aortic stenosis and coarctation in children using echocardiography.
- To compare echocardiographic findings with hemodynamic measurements from cardiac catheterization.
- To determine the utility of echocardiography in assessing the need for surgery.
Main Methods:
- Echocardiography was performed on 85 pediatric patients (1 month-20 years) with aortic stenosis or coarctation.
- Cardiac catheterization was conducted for comparison.
- A control group of 35 healthy subjects was included.
Main Results:
- Symmetric left ventricular hypertrophy was observed in both groups, more prevalent in aortic stenosis (92%) than coarctation (53%).
- Left ventricular function showed increased fractional shortening and velocity of circumferential fiber shortening in both patient groups.
- Echocardiographic measurements correlated well with hemodynamic data (pressure R=0.83, gradient R=0.73).
Conclusions:
- Echocardiography effectively demonstrates left ventricular hypertrophy and functional changes in pediatric aortic stenosis and coarctation.
- Echocardiographic parameters correlate well with invasive hemodynamic measurements.
- This non-invasive technique is valuable for surgical decision-making in these pediatric cardiac conditions.
Abstract:
Left ventricular adaptation to obstruction to ejection (aortic stenosis and coarctation) was studied by echocardiography in 85 patients from 1 month to 20 years of age. Group I: 40 children with pure congenital aortic stenosis. Group II: 45 children with coarctation at the aortic isthmus without associated shunts. All patients also underwent cardiac catheterisation. The results were compared with a control series of 35 normal subjects. Echocardiographic recordings of adequate quality for studying the left ventricle and parameters of myocardial performance were obtained in all patients. In Group I estimations of the left ventricular systolic pressure and the ventriculo-aortic pressure gradient were made and compared to the results of catheterisation. Symmetric left ventricular hypertrophy was recorded in both groups (h/R, p less than 0,001; myocardial mass, p less than 0,001) but this was more common in aortic stenosis (92%) than in coarctation (53%). Left ventricular function was similar in both groups with an increased fractional shortening (p less than 0,001) and velocity of circumferential fibre shortening (p less than 0,001). Good correlations were obtained between echocardiographic and hemodynamic measurements of left ventricular pressures and ventriculo-aortic pressure gradients (pressure R = 0,83, gradient R = 0,73) using the formula for systolic left ventricular pressure = SLV = 225 X PPs/Ds. This proved very useful in assessing which children needed surgery.