Heart Failure Caused by Congenital Heart Disease

Published on 21/06/2015 by admin

Filed under Cardiovascular

Last modified 21/06/2015

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11 Heart Failure Caused by Congenital Heart Disease

The Causes of Heart Failure in CHD

Left-to-Right Shunts

Key Points

Left Heart Obstructive Lesions

Left ventricular failure is a component of the diagnosis because of significant pressure overload from the diminutive aortic valve orifice (Figure 11-2; also see Video 11-2 on the Expert Consult website). In addition, some infants with critical aortic stenosis have marked mitral regurgitation, which adds a volume load to the already pressure-loaded left ventricle (see Video 11-2 on the Expert Consult website).
Critical aortic stenosis is often associated with endocardial fibroelastosis. Endocardial fibroelastosis is a poorly understood phenomenon whereby the left ventricular endocardium becomes fibrotic, likely as a result of long-standing subendocardial ischemia (Figure 11-3; also see Video 11-3 on the Expert Consult website). Children with endocardial fibroelastosis have poor ventricular systolic shortening and high end-diastolic and left atrial pressure, even after the aortic stenosis is relieved.
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Figure 11-3 Apical 4-chamber view in the same patient as Figure 11-2 with critical aortic stenosis demonstrates a dilated but hypoplastic left ventricle (non–apex forming), with echo-bright papillary muscles consistent with endocardial fibroelastosis. Color Doppler demonstrates mitral regurgitation.

Key Points