Absence of left ventricular volume loading in infants with coarctation of the aorta and a large ventricular septal defect

• Published in: Journal of the American College of Cardiology 1989-11, Vol.14 (6), p.1545-1552
• Main Authors: Graham, Thomas P., Burger, Judith, Boucek, Robert J., Johns, James A., Moreau, Gordon A., Hammon, John W., Bender, Harvey W.
• Format: Article
• Language: English
• Subjects: Abnormalities, Multiple - physiopathology; Aortic Coarctation - physiopathology; Aortic Coarctation - surgery; Biological and medical sciences; Cardiac Catheterization; Cardiac Volume - physiology; Cardiology. Vascular system; Cardiomegaly - epidemiology; Congenital heart diseases. Malformations of the aorta, pulmonary vessels and vena cava; Echocardiography; Heart; Heart Septal Defects, Ventricular - physiopathology; Humans; Infant; Infant, Newborn; Medical sciences; Stroke Volume
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/0735-1097(89)90396-3

Clinical characteristics and angiographic ventricular volume data were obtained in 25 infants aged 1 to 66 days who presented with coarctation of the aorta, ventricular septal defect and congestive heart failure to determine if left ventricular volume loading was present and if there were hemodynamic or volumetric variables that were predictive of operative mortality in this group. Pulmonary to systemic flow ratio averaged 2.8 ±0.8 and right ventricular/left ventricular peak pressure ratio was 0.96 ± 0.12. Left ventricular end-diastolic volume averaged 116 ± 49% of normal and was less than the investigators' lower limit of normal in 5 (20%) of 25 patients. In contrast, right ventricular end-diastolic volume, measured in eight patients, averaged 173 ± 47% of normal and was greater than the investigators' upper limit of normal in seven (88%) of eight. Left ventricular ejection fraction averaged 0.47 ± 0.17 and was below normal (12 mm Hg) in 12 (55%) of 24 patients. Early plus late mortality was related to left ventricular size: 3 of 5 patients with a small left ventricular end-diastolic volume died, compared with only 4 of 20 with a normal or increased volume (p < 0.05). Low left ventricular ejection fraction was not related to mortality; 2 of 14 patients with a low versus 3 of 10 with a normal ejection fraction died (p = NS). Repeat catheterization was carried out between 1.4 and 28 months after coarctation repair in 14 patients. Two patients with an initial small left ventricle had normal left ventricular size and five of seven patients with a prior low left ventricular ejection fraction had a normal ejection fraction. Left ventricular end-diastolic volume averaged 124 ± 60% of normal and left ventricular ejection fraction averaged 0.63 ± 0.11 (p < 0.01 versus preoperative value) for all 14 patients. Despite a marked increase in pulmonary to systemic flow ratio, left ventricular end-diastolic volume remains normal or small in the majority of infants with coarctation and a large ventricular septal defect. Normal or low left ventricular end-diastolic volume in