CHANGES IN PATTERNS OF LEFT-VENTRICULAR DIASTOLIC FILLING REVEALED BYDOPPLER-ECHOCARDIOGRAPHY IN INFANTS WITH VENTRICULAR SEPTAL-DEFECT

To evaluate left ventricular diastolic filling in infants with ventric ular sept-al defect, which has yet to be documented, we measured vario us Doppler echocardiographic indexes from transmitral flow in the foll owing groups: 10 infants with ventricular septal defect without pulmon ary hypertension; 10 infants with ventricular septal defect with pulmo nary hypertension; and 9 normal infants to serve as controls. The peak A, total velocity lime integral, E area: and A area in patients witho ut pulmonary hypertension were all significantly larger than those in controls. The peak ratio E/A, and 1/3 filling fraction, in patients wi thout pulmonary hypertension were significantly lower than in controls . The peak A, A area, and deceleration time in patients with pulmonary hypertension were significantly larger than in patients without pulmo nary hypertension and controls. The peak E/A, area E/A, and 1/3 fillin g fraction in patients with pulmonary hypertension were significantly lower than in those without pulmonary hypertension and controls. The i ndex of left ventricular mass, as well as the index of end-diastolic l eft ventricular wall thickness, correlated strongly with peak A, A are a, and deceleration time. The ratio between the systolic pulmonary and systemic pressures correlated strongly with peak A, A area, peak E/A, area E/A, and 1/3 filling fraction. These results demonstrated that t he patterns of left ventricular filling in infants with ventricular se ptal defect were different from those in normal infants, and suggested that the abnormal patterns may indicate the insufficiency of adaptati on of left ventricle (increase of left ventricular compliance) for vol ume overload in the presence of a ventricular septal defect..