Related Experiment Videos
Changes in patterns of left ventricular diastolic filling revealed by Doppler echocardiography in infants with
1Department of Paediatrics, Akita University School of Medicine, Hondo, Japan.
Insights
Left ventricular diastolic filling patterns differ in infants with ventricular septal defect (VSD). These abnormal patterns suggest the left ventricle may struggle to adapt to volume overload in VSD patients.
Area of Science:
- Pediatric Cardiology
- Echocardiography
- Cardiovascular Physiology
Background:
- Left ventricular diastolic filling in infants with ventricular septal defect (VSD) remains under-documented.
- Understanding these patterns is crucial for managing VSD in pediatric populations.
Purpose of the Study:
- To evaluate and document left ventricular diastolic filling characteristics in infants with VSD.
- To compare these patterns between infants with and without pulmonary hypertension and with healthy controls.
Main Methods:
- Doppler echocardiography was used to measure transmitral flow indexes in three groups: VSD without pulmonary hypertension (n=10), VSD with pulmonary hypertension (n=10), and normal infants (n=9).
- Key indexes included peak A wave, velocity time integrals, areas, E/A ratio, and filling fractions.
Main Results:
- Infants with VSD (without pulmonary hypertension) showed significantly increased peak A, total velocity time integral, E area, and A area compared to controls.
- Patients with VSD and pulmonary hypertension exhibited significantly larger peak A, A area, and deceleration time than both other groups.
- Elevated left ventricular mass and wall thickness correlated with specific diastolic filling parameters, as did the pulmonary-to-systemic pressure ratio.
Conclusions:
- Left ventricular diastolic filling patterns in infants with VSD are distinct from normal infants.
- Abnormal patterns suggest potential left ventricular compliance insufficiency in adapting to volume overload associated with VSD.
Abstract:
To evaluate left ventricular diastolic filling in infants with ventricular septal defect, which has yet to be documented, we measured various Doppler echocardiographic indexes from transmitral flow in the following groups: 10 infants with ventricular septal defect without pulmonary hypertension; 10 infants with ventricular septal defect with pulmonary hypertension; and 9 normal infants to serve as controls. The peak A, total velocity time integral, E area, and A area in patients without pulmonary hypertension were all significantly larger than those in controls. The peak ratio E/A, and 1/3 filling fraction, in patients without pulmonary hypertension were significantly lower than in controls. The peak A, A area, and deceleration time in patients with pulmonary hypertension were significantly larger than in patients without pulmonary hypertension and controls. The peak E/A, area E/A, and 1/3 filling fraction in patients with pulmonary hypertension were significantly lower than in those without pulmonary hypertension and controls. The index of left ventricular mass, as well as the index of end-diastolic left ventricular wall thickness, correlated strongly with peak A, A area, and deceleration time. The ratio between the systolic pulmonary and systemic pressures correlated strongly with peak A, A area, peak E/A, area E/A, and 1/3 filling fraction. These results demonstrated that the patterns of left ventricular filling in infants with ventricular septal defect were different from those in normal infants, and suggested that the abnormal patterns may indicate the insufficiency of adaptation of left ventricle (increase of left ventricular compliance) for volume overload in the presence of a ventricular septal defect.