Left Ventricular Outflow Obstruction

Aboulhosn, Jamil; Child, John S.

doi:10.1161/circulationaha.105.592089

Cited by 208 publications

(57 citation statements)

References 136 publications

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“…If severe and left untreated, it may eventually result in consecutive ventricular hypertrophy and failure. 34 Similar adverse effects of surgical aortic repair and its detrimental effect on ventricular function were described previously for patients after the Ross procedure. 10 In patients with HLHS after the Norwood operation, the bioelastic properties of the reconstructed aorta are of particular concern because the RV is maladapted to function as a systemic pressure pump 7 and therefore is more sensitive to increased afterload than the left ventricle.…”

Section: Voges Et Al Aortic Properties In Hypoplastic Left Heartsupporting

confidence: 55%

Maladaptive Aortic Properties in Children After Palliation of Hypoplastic Left Heart Syndrome Assessed by Cardiovascular Magnetic Resonance Imaging

et al. 2010

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Background-The status of the reconstructed aorta in hypoplastic left heart syndrome is considered an important determinant of long-term prognosis. Therefore, we assessed the anatomy, elastic properties, and viability of the aorta and right ventricular function in patients with hypoplastic left heart syndrome by cardiovascular magnetic resonance imaging. Methods and Results-Cardiovascular magnetic resonance imaging was performed in 40 patients with hypoplastic left heart syndrome (age, 6.0Ϯ2.2 years) and 13 control subjects (age, 6.6Ϯ2.2 years). Aortic dimensions and distensibility were calculated at different locations of the aorta using gradient-echo cine imaging at 3.0 T. Additionally, pulse-wave velocity, right ventricular ejection fraction, and aortic late gadolinium enhancement for viability assessment were measured. Compared with control subjects, patients with hypoplastic left heart syndrome had increased axial diameters of the aortic root (36.0Ϯ5. 01).Pulse-wave velocity trended higher in patients (Pϭ0.06). Reduced distensibility in the ascending aorta correlated with the amount of late gadolinium enhancement in a volume that included the aortic root and the ascending aorta (rϭϪ0.72, PϽ0.01), and both parameters correlated with decreased right ventricular ejection fraction. Conclusions-Adverse aortic properties post palliation of hypoplastic left heart syndrome manifest themselves by aortic dilatation, decreased distensibility, and increased volume of nonviable aortic wall tissue. The negative association between aortic late gadolinium enhancement and right ventricular ejection fraction suggests unfavorable aortic-ventricular coupling. The potential impact of these findings on long-term right ventricular function should be evaluated in future studies.

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Section: Voges Et Al Aortic Properties In Hypoplastic Left Heartsupporting

confidence: 55%

Maladaptive Aortic Properties in Children After Palliation of Hypoplastic Left Heart Syndrome Assessed by Cardiovascular Magnetic Resonance Imaging

et al. 2010

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“…318 Obstruction can occur singly or at multiple levels, as an isolated lesion or in combination with septal defects or conotruncal anomalies.…”

Section: Left-sided Heart Obstructive Lesionsmentioning

confidence: 99%

ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease

Warnes¹,

Williams²,

Bashore³

et al. 2008

Circulation

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892

365

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“…Additionally the influence of physiological control mechanisms which are known to be involved in aortic coarctation were not included. An example of such a mechanism may be altered myocardial contraction [2] as resulting from ventricular hypertrophy. These mechanisms however are unlikely to alter our simulated outcomes or the agreement between the two analysis methods to a large extent.…”

Section: Study Limitationsmentioning

confidence: 99%

Comparison of arterial waves derived by classical wave separation and wave intensity analysis in a model of aortic coarctation

Wijngaard

Siebes

Westerhof

2008

Med Biol Eng Comput

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Coarctation of the aorta may develop during fetal life and impair quality of life in the adult because upper body hypertension and aneurysm formation in the descending aorta may develop. We used our computational model of the young adult arterial circulation, incorporated aorta coarctation over a range from 0 to 80% and evaluated the effects in terms of forward pressure (P ? ) and backward pressure (P -). Predictions at several sites proximal and distal to the coarctation using an impedance-based waveform separation method (WSA) and the time-domain technique of wave intensity analysis (WIA) yielded comparable outcomes. A large reflected backward compression wave was seen proximal to the coarctation. Both techniques, WSA and WIA, gave the same results in terms of P ? and P -. A descending index (DI) was formulated as the difference between peak systolic pressure and valve closure pressure, divided by the pulse pressure. DI increased with stenosis severity for mild to moderate aortic coarctations that did not yet cause evident hypertension. This index may allow for early diagnosis by noninvasive estimation of coarctation severity.

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Left Ventricular Outflow Obstruction

Cited by 208 publications

References 136 publications

Maladaptive Aortic Properties in Children After Palliation of Hypoplastic Left Heart Syndrome Assessed by Cardiovascular Magnetic Resonance Imaging

Maladaptive Aortic Properties in Children After Palliation of Hypoplastic Left Heart Syndrome Assessed by Cardiovascular Magnetic Resonance Imaging

ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease

Comparison of arterial waves derived by classical wave separation and wave intensity analysis in a model of aortic coarctation

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