Skip to main content
Log in

Reduced left ventricular size and endocardial fibroelastosis as correlates of mortality in newborns and young infants with severe aortic valve stenosis

  • Published:
Pediatric Cardiology Aims and scope Submit manuscript

Summary

30 patients with severe aortic valve stenosis presented in severe congestive heart failure within the first 2 months of life. In 25 of them, left ventricular volume and contractility were assessed; five of them had a left ventricle of normal size, in 11 left ventricular size was diminished, and in nine patients it was enlarged. Eleven of the infants had extensive endocardial fibroelastosis (EFE) evidenced angiographically by myocardial sinusoids in ten of them and established at autopsy in six. The presence of EFE correlated with the size of the left ventricle; eight of 11 with a small left ventricle, two of five with a normal-sized left ventricle, and one of nine with an enlarged left ventricle displayed EFE. The severe depression of left ventricular function associated with EFE was documented by left ventricular volume determinations on exclusion of the myocardial sinusoids. Of 30 patients, 12 (including eight of 26 who underwent surgery) did not survive. Mortality, severity, and early onset of symptoms were associated mainly with small size of the left ventricle and with the severe left ventricular dysfunction associated with EFE.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Bellet S, Gouley BA (1932) Congenital heart disease with multiple cardiac anomalies: report of a case showing aortic atresia, fibrous scar in myocardium and embryonal sinusoidal remains.Am J Med Sci 183:458

    Google Scholar 

  2. Bernhard WF, Keane JF, Fellows KE, Litwin SB, Gross RE (1973): Progress and problems in the surgical management of congenital aortic stenosis.J Thorac Cardiovasc Surg 66:404

    PubMed  Google Scholar 

  3. Bühlmeyer K, Simon B, Mocellin R, Sauer U (1979) Clinical, angiocardiographic and functional studies in the assessment of critical valvular aortic stenosis: In: Goddman MJ, Marquis RM (eds)Paediatric cardiology, vol 2:Heart disease in the newborn. Churchill Livingstone, Edinburgh

    Google Scholar 

  4. Blakeway H (1917/18) A hitherto undescribed malformation of the heart.J Anat 52:354

    Google Scholar 

  5. Bryan CS, Oppenheimer EH (1969) Ventricular endocardial fibroelastosis: basis for its presence or absence in cases of pulmonic and aortic atresia.Arch Pathol 87:82

    PubMed  Google Scholar 

  6. Chiarello L, Vlad P, Subramanian S (1976) Surgical treatment of congenital valvular aortic stenosis.Thorax 31:398

    PubMed  Google Scholar 

  7. Coran AG, Bernhard WF (1969) The surgical management of valvular aortic stenosis during infancy. J Thorac Cardiovasc Surg58:401

    PubMed  Google Scholar 

  8. Dodge HT, Baxley WA (1969) Left ventricular volume and mass and their significance in heart disease.Am J Cardiol 23:528

    Article  PubMed  Google Scholar 

  9. Edmunds LH, Wagner HR, Heymann MA (1980) Aortic valvulotomy in neonates.Circulation 61:421

    PubMed  Google Scholar 

  10. Fishman NH, Hof R, Rudolph AM, Heymann MA (1972) Effect of banding ascending aorta on cardiovascular function and development in fetal lambs.Circulation (Suppl 2)46:5

    PubMed  Google Scholar 

  11. Gaasch WH, Battle WE, Obolev AA, Banas JS, Levine HJ (1972) Left ventricular stress and compliance in man.Circulation 45:746

    PubMed  Google Scholar 

  12. Graham TP, Jarmakani JM, Canent RV, Morrow MN (1971) Left heart volume estimation in infancy and childhood: reevaluation of methodology and normal values.Circulation 43:895

    PubMed  Google Scholar 

  13. Hallmann K, Mocellin R, Gössner W, Bühlmeyer K (1983) Ungewöhnliche Kontrastmittelverteilung im linksventrikulären Myokard bei Säuglingen mit hochgradiger valvulärer Aortenstenose und Endokardfibroelastose. Pathologisch-morphologische Befunde.Z Kardiol (in press)

  14. Hastreiter AR, Oshima M, Miller RA, Lev M, Paul M (1962) Congenital aortic stenosis syndrome in infancy.Circulation 28:1084

    Google Scholar 

  15. Keane JF, Bernhard WF, Nadas AS (1975) Aortic stenosis surgery in infancy.Circulation 52:1138

    PubMed  Google Scholar 

  16. Kennedy JW, Twiss RD, Blackmon JR, Dodge HT (1968) Quantitative angiography: 3. Relationships of left ventricular pressure, volume and mass in aortic valve disease.Circulation 38:838

    PubMed  Google Scholar 

  17. Lakier JB, Lewis AB, Heymann MA, Stanger P, Hoffman JIE, Rudolph AM (1974) Isolated aortic stenosis in the neonate: natural history and hemodynamic considerations.Circulation 50:801

    PubMed  Google Scholar 

  18. Liedke AJ, Gentzler RD, Babb JD, Hunter AS, Gault JH (1976) Determinants of cardiac performance in severe aortic stenosis.Chest 69:192

    PubMed  Google Scholar 

  19. Mody MR, Nadas AS, Bernhard WF (1967) Aortic stenosis in infants.N Engl J Med 276:832

    PubMed  Google Scholar 

  20. Nakazawa M, Marks RA, Isabel-Jones J, Jarmakani JM (1976) Right and left ventricular volume characteristics in children with pulmonary stenosis and intact ventricular septum.Circulation 53:884

    PubMed  Google Scholar 

  21. Neutze JM (1973) Congenital heart disease in infancy [panel discussion]. In: Barratt-Boyes BG, Neutze JM, Harris EA (eds)Heart disease in infancy: diagnosis and surgical treatment. Churchill Livingstone, London, p. 303

    Google Scholar 

  22. Raghib G, Bloemendaal RD, Kanjah VI, Edwards JE (1965) Aortic atresia and premature closure of the foramen ovale: myocardial sinusoids and coronary arteriovenous fistula serving as outflow channel.Am Heart J 70:476

    Article  PubMed  Google Scholar 

  23. Simon B, Sauer U, Mocellin R, Sebening F (1977) Aortenklappenstenose im Säuglingsalter: Diagnostik und Behandlungsergebnisse.Herz 2:420

    Google Scholar 

  24. Weber KT, Janicke JS (1975) The calculation of the mean pressure gradient in aortic valve stenosis: a simplified approach.Am Heart J 89:126

    Article  PubMed  Google Scholar 

  25. Worms AM, Stehlin H, Didier F, Plenat F, Neveux JY, Pernot C (1977) La sténose aortique valvulaire à expression néonatale: a propos de 8 observations.Arch Mal Coeur 70:329A0946016 00004 CS-SPJRNPDF [HEADSUP]

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Mocellin, R., Sauer, U., Simon, B. et al. Reduced left ventricular size and endocardial fibroelastosis as correlates of mortality in newborns and young infants with severe aortic valve stenosis. Pediatr Cardiol 4, 265–272 (1983). https://doi.org/10.1007/BF02278872

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02278872

Key words

Navigation