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European Heart Journal 1994 15(1):83-88;
Copyright © 1994 by the European Society of Cardiology.
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© 1994 The European Society of Cardiology

Acute effects of balloon valvuloplasty and pacing on left ventricular performance in children with moderate pulmonary valve stenosis, analysed by systolic and diastolic pressure—volume relationships

M. WITSENBURG, E. T. VAN DER VELDE*, R. J. M. KLAUTZ*, J. HESS and J. HESS

Department of Paediatrics, Division of Paediatric Cardiology Sophia Children's Hospital, Rotterdam
*Department of Cardiology University Hospital Leiden, The Netherlands

Received 1 April 1993; revised 14 July 1993; .

Correspondence: Manrten Witsenburg MD, Department of Paediatrics, Division of Paediatric Cardiology, Sophia Children's Hospital, Dr. Molewaterplein 60 3015 GJ Rotterdam, The Netherlands

Abstract

Right ventricular overload of volume and/or pressure type may affect left ventricular systolic and diastolic function. This has been shown in animal studies and has been suggested in non-invasive studies in man. Altered geometry of the left ventricle, myocardial hypertrophy and changes in contractile state may be responsible for the change in function. Balloon valvuloplasty is an effective treatment for isolated valvular pulmonary stenosis in children, and results in an immediate decrease of right ventricular systolic pressure. Whether this results in immediate changes in left ventricular performance is unknown. Eight children (age 5·2 to 13·9 years) with moderate pulmonary valve stenosis underwent pulmonary balloon valvuloplasty under general anaesthesia. Left ventricular function measurements before and after valvuloplasty were performed using a combined micromanometer-conductance catheter to obtain end-systolic (ESPVR) and end-diastolic (EDPVR) pressure-volume relationships employing inferior vena cava occlusion both at normal and pacing-induced increased heart rates.

Pulmonary valvuloplasty resulted in a decrease in peak systolic right ventricular pressure from 62·8±13·5 to 34·4 ± 7·3 mmHg (P<0·001), without significant changes in left ventricular systolic and end-diastolic pressure, or in cardiac index. The ESPVR was fitted to a linear function to obtain the slope (Ees and the volume intercept at 75 mmHg (V75 The EDPVR was fitted to an exponential function. At baseline, Ees was 1·68±0·99 mmHg. ml–1 and V75 was 33·6 ± 21·8 ml. Neither valvuloplasty nor pacing, which increased mean heart rate from 81 to 112 beats. min–1 (P<0·001) resulted in significant changes of the parameters Ees, or V75 The EDPVR was not affected by valvuloplasty either, but pacing resulted in a change of its stiffness constant from 0·042 ± 0·019 to 0·034 ± 0·018 mmHg . ml–1 (P<0·05) and pressure intercept from 0·97±0·51 to 1·37±0·86 mmHg (P<0·05). The effect of pacing on left ventricular function before and after valvuloplasty was comparable.

Neither balloon dilatation for moderate valvular pulmonary slenosis, nor pacing within the physiological range results in immediate changes in left ventricular contractile performance in children.

Key Words: Pulmonary valve stenosis • balloon valvuloplasty • left ventricular function • pressure-volume relationships • conductance catheter


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