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Pulmonary insufficiency: preparing the patient with ventricular dysfunction for surgery

Published online by Cambridge University Press:  08 September 2005

Beatriz Bouzas ,
Anthony C. Chang  and
Michael A. Gatzoulis
Beatriz Bouzas
Affiliation:
Adult Congenital Heart Program, Royal Brompton Hospital, London, United Kingdom
Anthony C. Chang
Affiliation:
Pediatric Cardiology, Texas Children's Hospital, Houston, Texas, United States of America
Michael A. Gatzoulis
Affiliation:
Adult Congenital Heart Program, Royal Brompton Hospital, London, United Kingdom
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Extract

Insufficiency of any of the four cardiac valves is a common cause of heart failure in children. Progression of ventricular dysfunction can be predictable, but requires thorough understanding of valvar disease. In valvar regurgitation, the heart has to cope with an increased volume of blood. The pathophysiological sequence is similar for both the right and the left heart. There is initially an increase in end-diastolic volume, followed by an increase in end-systolic volume, and at the end, a decrease in the shortening and ejection fractions. Different compensatory mechanisms and pathophysiologic adaptations develop to maintain the stroke volume for each type of valvar insufficiency, but heart failure eventually ensues. When symptoms of heart failure develop, irreversible ventricular dysfunction is often established, and outcome after surgery may ultimately be compromised. Discerning the optimal time for intervention, before irreversible ventricular dysfunction develops, is a key point in the management of regurgitant valvar heart disease.

Type
PART 2: TETRALOGY OF FALLOT
Information
Cardiology in the Young , Volume 15 , Issue S1 , February 2005 , pp. 51 - 57
Copyright
© 2005 Cambridge University Press

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Footnotes

Based, with permission, on the chapter by Bouzas-Zubeldia B and Gatzoulis MA. “Valvular Insufficiency and Heart Failure” to be published in Chang AC and Towbin JA (eds). Heart Failure in Children and Young Adults: From Molecular Mechanisms to Medical and Surgical Strategies. In press.

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