univentricular correction

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Critical left ventricular volume in aortic stenosis in first year of life: its importance in patients selection candidates to univentricular surgical correction pos-valvotomy

Marco Aurélio Santos et al. Vitor Manuel Pereira Azevedo Maria Ourinda Mesquita da Cunha

OBJECTIVE: Analysis of critical end diastolic left ventricular volume (EDLVV), defined as the lowest acceptable volume to keep cardiac output, in the selection of patients with post-valvotomy aortic stenosis, candidates to univentricular correction. METHODS: A retrospective study in 21 patients with aortic stenosis, during the first year of life, and 232 patients compiled from literature. Values of end diastolic volume (EDLVV), from 20 to 60 ml/m2 were determined as normal. The EDLVV of deceased patients was compared to that from survival patients. A correlation between the age and EDLVV was carried out at the time of valvotomy, between the groups. Finally, the critical EDLVV through the theoretical relationship between the EDLVV and heart rate for different ejection fractions and designated cardiac indexes (CI): 2,000 and 2,500 20-60 ml/min/m2 was determined. RESULTS: For EDLVV values 60 ml/m2, there was statistical significance between deceased and survival patients (p< 0.0001). However, in the range between 20 and 60 ml/m2, that significance was lower (p=0.0309). A greater incidence of death took place among those who showed it in the first week of life. For a CI of 2,500 ml/min/m2 and a heart rate (HR) of 140 bpm, critical EDLVV will be 26 ml/m2 if left ventricular ejection fraction (LVEF) is 0.70, and 44.5 ml/m2, if LVFE is 0.40. CONCLUSION: The analysis of critical end diastolic left ventricular volume (EDLVV) can add another parameter in the indication of univentricular correction in patients with post-valvotomy aortic stenosis, during the first year of life.

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Critical left ventricular volume in aortic stenosis in first year of life: its importance in patients selection candidates to univentricular surgical correction pos-valvotomy

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