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Significance of left ventricular inflow gradients in patients with ventricular septal defect
P Jain1, S Shrivastava, A Saxena
1Department of Cardiology, All India Institute of Medical Sciences, New Delhi.
Insights
In patients with ventricular septal defect (VSD), left ventricular inflow gradients are uncommon. Organic left ventricular inflow obstruction is rare, even with moderate gradients, suggesting VSD is not typically associated with significant inflow issues.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Hemodynamics
Background:
- Ventricular septal defect (VSD) is a common congenital heart defect.
- Left ventricular inflow gradients can indicate potential obstruction.
- Understanding the relationship between VSD and inflow gradients is crucial for patient management.
Purpose of the Study:
- To investigate the prevalence and significance of left ventricular inflow gradients in patients with isolated VSD.
- To determine if these gradients correlate with the severity of the left-to-right shunt in VSD.
- To assess the association between left ventricular inflow gradients and organic left ventricular inflow obstruction in VSD patients.
Main Methods:
- Retrospective analysis of hemodynamic data from 167 patients with isolated VSD.
- Measurement of end-diastolic pressure gradients between pulmonary artery wedge pressure and left ventricular end-diastolic pressure.
- Correlation analysis with echocardiographic or operative findings and shunt degree.
Main Results:
- Left ventricular inflow gradients (> 5 mm Hg) were found in 40 of 167 patients (24%).
- No statistical correlation was observed between inflow gradients and the degree of left-to-right shunt.
- Organic left ventricular inflow obstruction was rare, identified only in cases with gradients > 11 mm Hg, including two instances of congenital mitral stenosis.
Conclusions:
- Left ventricular inflow gradients are not a common finding in isolated VSD.
- The presence and degree of these gradients do not correlate with shunt severity.
- Significant organic left ventricular inflow obstruction is infrequent in VSD patients with gradients up to 15 mm Hg.
Abstract:
Hemodynamic data of 167 patients of isolated ventricular septal defect (VSD) was retrospectively analyzed for the presence of left ventricular inflow gradients. End diastolic gradients of > 5 mm Hg between the pulmonary artery wedge pressure and the left ventricular end diastolic pressure were recorded in 40 of these patients. In three of these cases, left atrium was also entered and identical pressure gradients were recorded between the left atrial pressure and the left ventricular end diastolic pressure. Two dimensional and Doppler echocardiographic or operative findings were available in 32 of the 40 patients. No statistical correlation was found between the presence and degree of left ventricular inflow gradients at end diastole and the degree of left to right shunt. Out of a total of 40 patients with left ventricular inflow gradients, gradients of 6-10 mm Hg were present in 24 patients. Echocardiographic or operative findings available in 19 of these did not show any left ventricular inflow obstruction. Enddiastolic gradients of 11-15 mm Hg were present in 14 patients. Echocardiographic or operative findings were available in 11 of these and one of these had congenital mitral stenosis at surgery. End diastolic gradients of more than 15 mm Hg were present in 2 patients and one of these had congenital mitral stenosis at surgery. Thus organic left ventricular inflow obstruction is rare with inflow mitral gradients of upto 15 mm Hg in patients of VSD.