Perinatal Cardiology: A Multidisciplinary Approach: A Multidisciplinary Approach by Rao P. Syamasundar Vidyasagar Dharmapuri

Author:Rao, P. Syamasundar,Vidyasagar, Dharmapuri
Language: eng
Format: epub
ISBN: 9781935395935
Publisher: National Book Network International
Published: 2013-12-31T16:00:00+00:00

Critical AS

Critical AS progressively develops into HLHS in an indeterminate proportion of cases and, depending on this poorly defined time-line, fetuses will lie somewhere along this path at first detection. The triggers for growth failure have not been defined in the human, and retrospective definitions of the minimum size of aortic or mitral valves (MVs) and left ventricular length that might benefit from a fetal procedure have been proposed (Tables 22.1 and 22.2). The extent to which simple aortic valvuloplasty is able to influence developmental processes—for example, by improving growth velocities of the ventricle—seems limited; even if growth is improved, it is uncertain whether diastolic function will be normal in childhood. Persistent pulmonary hypertension is an important problem leading to significant long-term morbidity and childhood mortality.39 Echocardiographic prediction of myocardial mineralization or endocardial fibroelastosis (EFE) is not thought to be accurate, but there are cases where the LV appears to be highly mineralized and stiff. This is an additional risk factor for tamponade, implying such cases should be avoided? The rationale behind treatment is to allow improved diastolic function, ventricular filling, and promote normal division of myocardial cells during the remainder of fetal life, thus increasing the proportion of healthy myocardial cells in the myocardium before delivery that may alter future outcome.40 Such an improvement would theoretically be advantageous for a child, even if eventual left-sided morphology is too small for a biventricular management pathway after birth.

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