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Two-dimensional echocardiographic recognition of papillary muscle fibrosis in pediatric patients
Insights
Infants with anomalous left coronary artery from the pulmonary artery (ALCA) or critical aortic stenosis (AS) showed increased echo density in left ventricular papillary muscles, indicating fibrosis from ischemia. This finding is a useful indicator of severe subendocardial ischemia.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Imaging
- Neonatal Echocardiography
Background:
- Anomalous origin of the left coronary artery from the pulmonary artery (ALCA) and critical valvar aortic stenosis (AS) are serious pediatric cardiac conditions.
- Subendocardial ischemia can result from these conditions, potentially affecting myocardial function.
- Papillary muscle health is crucial for valvular function and overall cardiac performance.
Purpose of the Study:
- To investigate echocardiographic findings in the left ventricular papillary muscles of infants with ALCA and critical AS.
- To determine if increased echo density in papillary muscles correlates with myocardial ischemia and fibrosis.
- To assess the utility of echocardiography in identifying subendocardial ischemia in these pediatric populations.
Main Methods:
- Two-dimensional echocardiography was performed on infants diagnosed with ALCA, myocardial infarction with left main coronary obstruction, and critical AS.
- Comparative qualitative assessment of echo density in left ventricular papillary muscles was conducted.
- Pathologic examination and fluoroscopy were used for confirmation in select cases.
Main Results:
- All infants studied exhibited a marked increase in the echo density of one or both left ventricular papillary muscles.
- This increased echo density was interpreted as fibrosis and scar formation secondary to ischemia and infarction.
- Pathologic confirmation of papillary muscle fibrosis was achieved in three cases, with calcification noted in another.
Conclusions:
- The echocardiographic finding of increased papillary muscle echo density is a significant indicator of fibrosis.
- This finding suggests severe subendocardial ischemia in infants with ALCA or critical AS.
- Echocardiography provides a valuable, non-invasive method for detecting myocardial damage in these critical pediatric cardiac conditions.
Abstract:
Two-dimensional echocardiographic examinations were performed in seven infants with anomalous origin of the left coronary artery from the pulmonary artery (ALCA), in one infant with myocardial infarction and left main coronary obstruction, and in eight with critical valvar aortic stenosis (AS). Comparative qualitative echo density assessment demonstrated that each infant had a marked increase in the echo density of one or both left ventricular papillary muscles. The increased echo density was considered to represent fibrosis and scar formation as a result of ischemia and infarction. Pathologic proof of excessive fibrosis of the papillary muscles was obtained in three cases. In an additional case, calcification of the papillary muscle was noted on fluoroscopic examination. The echocardiographic appearance of papillary muscle fibrosis provides a useful indicator of severe subendocardial ischemia in patients with either critical AS or ALCA.