Download Congenital Heart Disease by R. H. Anderson, Siew Yen Ho (auth.), F. J. Macartney (eds.) PDF

By R. H. Anderson, Siew Yen Ho (auth.), F. J. Macartney (eds.)

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1 the right ventricle dependent circulation can tolerate a variety of haemodynamic loads imposed by organic valvular disease, systemic or pulmonary hypertension or ventricular dysfunction. g. increasing mitral stenosis causes a progressive rise in left atrial pressure which can approach the critical level. Further stenosis is then only accommodated by a fall in cardiac output which reduces the gradient across the mitral valve, maintaining the left atrial pressure within the tolerable range. 1, this circulation works under the additional constraint that the right atrial pressure must exceed the left atrial pressure by an amount related to the resistance to right atrial outflow.

G. tricuspid atresia). Ejection fraction at substantially elevated left ventricular end diastolic volumes in the absence of valvular incompetence can give a needlessly pessimistic impression of ventricular performance. Stenosis or incompetence of the left atrioventricular valve will also be associated with an elevated left and thus right atrial pressure. Though presently available prosthetic valves are all somewhat obstructive even at normal flow rates, mitral valve replacement may be neces41 CONGENITAL HEART DISEASE sary in the presence of dysfunction of the left atrioventricular valve and may still be compatible with tolerable left and thus right atrial pressure, if other variables are favourable.

Sinus rhythm Preoperative stable sinus rhythm is often demanded. A paroxysm of atrial fibrillation after an atriopulmonary connection results in acute loss of function of the subpulmonary 'pump' while the systemic ventricle contracts coordinately, though irregularly. It was thought that this would necessarily result in acute circulatory failure. The fact that atrial fibrillation after an atriopulmonary connection is in fact compatible with tolerable haemodynamics is interesting in itself, challenging the conception of the atrium as a useful pump.

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