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PubMed1992

[Role of coronary collateral circulation in the compensation of disorders of myocardial perfusion and left ventricular function in patients with newly appearing angina pectoris].

The myocardial perfusion and left ventricular function were evaluated by bicycle ergometry and myocardial scintigraphy in 23 patients with primary angina taking into account the status of coronary collateral circulation in response to stenotic and occlusive atherosclerosis. In addition to severe occlusive disease of the coronary bed, most patients had significant disturbances of myocardial perfusion and left ventricular function, which were detected during exercise tests. In patients with compensatory collateral circulation in the coronary bed, such disturbances were less marked than in those without anastomoses. However collateral coronary circulation cannot be regarded to be of real value as it compensates impaired perfusion incompletely, but in some cases it can result in impaired myocardial vascularization apparently due to the steal syndrome.

Adult↗

PubMed2002

Comparison of techniques for the measurement of left ventricular function following cardiac transplantation.

BACKGROUND: Assessment of graft function after cardiac transplantation is essential for patient management and clinical research. Previous studies have found that the left ventricular (LV) ejection fraction (EF) by echocardiography (echo), radionuclide ventriculography (RNV), and cardiovascular magnetic resonance (CMR) is discrepant in patients with heart failure. METHOD: Twelve patients underwent LV EF assessment by echo, angiography (angio), RNV, and CMR one year following heart transplantation. The scans were analyzed independently in blinded fashion. RESULTS: The mean EF was 63 +/- 6% by RNV, 66 +/- 6% by CMR, 70 +/- 12% by angio, and 74 +/- 4% by echo. Significant differences were found between CMR and echo (p < 0.001), RNV and echo (p < 0.001), and RNV and angio (p < 0.05). The correlation between the techniques was poor (r = 0.3-0.6), and the scatter plots also suggested considerable variations between techniques. This was confirmed by the wide Bland-Altman limits of agreement (ranging from 22 to 45%). These were particularly wide for comparisons with angiography (43-45%). CONCLUSION: The EF measurement by echo, angio, RNV, and CMR are not interchangeable in patients following heart transplantation. The CMR and RNV provided the best agreement in EF and appear preferable for research studies. Echocardiography systematically overestimated LV EF and showed poor agreement with other techniques. Angiography overestimated LV function, and its routine use did not add to information gained from noninvasive studies.

Coronary Angiography↗

PubMed1983

[Complete revascularization surgery in patients with coronary disease with severely reduced left ventricular function. Discrepancies in the evaluation of results].

Clinical data, function and compliance of left ventricle as well as regional wall motion were analysed in 17 patients with preoperatively limited left-ventricular function and signs of myocardial ischaemia after complete revascularisation surgery. Recatheterisation after 5.2 months on average after surgery showed improvement by one NYHA class, an increase of mean left-ventricular enddiastolic pressure, which was interpreted as "improved status of ischaemia", a decrease of left-ventricular compliance by 30%, of enddiastolic volume by 14% and of endsystolic volume by 20% (P less than 0.05). Loss of function occurred in 3 out of 92 bypasses. Up to the time of reporting, 22.4 months postoperatively, all patients have survived in a relatively satisfactory clinical state. All parameters of left-ventricular function as well as regional wall motion showed a tendency for improvement after surgery in the majority of patients. However, pre- and postoperative mean values were not significantly different (P greater than 0.05). Thus, despite clearcut improvement of clinical state and "ischaemia index", improvement of left-ventricular function and regional wall motion are not consistently demonstrable. The reasons of this discrepancy cannot be ascertained by this investigation. The quality of the surgical intervention and the sensitivity of parameter assessment cannot be held responsible.

Blood Pressure↗

PubMed1996

-Recanalization of chronic coronary artery occlusions: effect on clinical symptoms and left ventricular function-.

UNLABELLED: Angioplasty of chronically occluded coronary arteries is discussed controversially. This study was performed to investigate the potential benefit of recanalization procedures. Between 1/91 and 10/93 occlusion angioplasty was attempted in 408 patients. 322 persons were followed with repeat angiography performed in 177 patients. Quantitative analysis of left ventricular function was performed in 34 patients before and after successful occlusion angioplasty. Primary reopening rate was about 71% with highest success rate for occluded LAD (82%). Angiographic controls showed open arteries in 80 (45.2%) patients, 53 (30.0%) had restenosis and 44 (24.8%) reocclusion. Anginal status was improved by one CCS-class or more in 197 patients (61%), mean exercise workload increased from 115.8 watts to 136.1 watts (p < 0.0001). Out of 34 patients, 25 (73.5%) showed improvement of regional ventricular function, mean ejection fraction increased from 56.9% to 64.1% (p < 0.001). Follow-up angiography revealed open arteries in 58% of patients if dissection was absent. When dissection type B, C or D NHLBI was present, only 32% of the vessels were open. CONCLUSION: In selected patients occlusion angioplasty is feasible with acceptable primary results. Anginal complaints and functional status were influenced positively, left ventricular function showed improvement indicating the presence of hibernating myocardium. In patients with suboptimal primary results (dissection) repeat angiography may be indicated.

Adult↗

PubMed1994

Echocardiographic prediction of left ventricular function after correction of mitral regurgitation: results and clinical implications.

OBJECTIVES: This study attempted to determine the incidence, prognosis and predictability of postoperative left ventricular dysfunction in patients undergoing correction of mitral regurgitation. BACKGROUND: Left ventricular function in patients with mitral regurgitation is altered by loading conditions and is difficult to assess. Predictive value of preoperative variables on postoperative left ventricular function and the role of echocardiography are uncertain. METHODS: In 266 patients undergoing correction of mitral regurgitation between 1980 and 1989, left ventricular function was echocardiographically assessed preoperatively (within 6 months) and postoperatively (within 1 year). RESULTS: After correction of mitral regurgitation, left ventricular ejection fraction decreased significantly ([mean +/- SD] 50% +/- 14% vs. 58% +/- 13%, p < 0.0001). Postoperative left ventricular dysfunction (ejection fraction < 50%) was frequent (41% of patients) and carried a poor prognosis (at 8 years survival, 38% +/- 9% vs. 69% +/- 8%, p < 0.0001). Four preoperative echocardiographic variables showed good correlation with postoperative ejection fraction: preoperative ejection fraction (r = -0.70), systolic diameter (r = -0.63), diameter/thickness ratio (r = -0.64) and end-systolic wall stress (r = -0.62) (all p < 0.0001). With multivariate analysis, ejection fraction (p = 0.0001) and systolic diameter (p = 0.0005) were independent predictors of postoperative ejection fraction, and angiographic variables provided no incremental predictive power. In addition to echocardiographic variables, recent regurgitation, functional class and coronary artery disease were also independent predictors of postoperative ejection fraction. CONCLUSIONS: After surgical correction of mitral regurgitation, left ventricular dysfunction is frequent and carries a poor prognosis. Postoperative ejection fraction can be predicted by echocardiographic preoperative ejection fraction and systolic diameter. Recent onset of regurgitation, mild or no symptoms, and absence of coronary artery disease are independent and favorable predictors of postoperative ejection fraction. These results should lead to consideration of surgical correction at an earlier stage.

Aged↗

PubMed1993

Within-breath modulation of left ventricular function during normal breathing and positive-pressure ventilation in man.

1. To investigate how intrathoracic pressure affects left ventricular function during normal breathing and positive-pressure ventilation, beat-by-beat measurements of left ventricular stroke volume (LVSV; pulsed Doppler ultrasound), heart rate and blood pressure were made in five normal subjects breathing actively and then undergoing passive positive-pressure ventilation. 2. To assess the within-breath effects of positive-pressure ventilation on left ventricular function in the clinical setting, further measurements were made in six patients sedated, paralysed and ventilated because of brain injuries, who had no disease of the heart or lungs. 3. In the normal subjects, there were minimal phasic variation in LVSV during positive-pressure ventilation with the subject passive. Heart rate and blood pressure also stayed relatively constant throughout the ventilator cycle. During active breathing at the same depth and rate, there were large phasic respiratory variations in LVSV, with the lowest values occurring during inspiration. 4. In the paralysed and unconscious patients, an increase in LVSV was associated with the increase in airway pressure which occurred during lung inflation; however, the phase lag between the rise in airway pressure and the rise in LVSV varied widely between patients. These changes occurred whether or not sinus arrhythmia was present. 5. Addition of 4.6 +/- 1 cmH2O of positive end-expiratory pressure (PEEP) did not increase the within-breath LVSV variations, but resulted in a mean depression of LVSV of 5.4% (paired t test, P = 0.035). 6. The smaller variations in LVSV during positive-pressure ventilation compared to normal breathing in the conscious subjects may reflect (a) the smaller magnitude of positive, compared to negative, pleural pressure excursions which accompany a given tidal volume, and (b) an asymmetry between the effects of positive and negative pleural pressure on the heart. 7. The prominent effects of positive-pressure ventilation on LVSV in unconscious patients, compared to the minimal effects seen in ventilated normal subjects, may result from reduced lung compliance and a degree of pulmonary vascular congestion in the patients which was undetectable clinically or radiologically.

Adolescent↗

PubMed2005

[Segmental left ventricular function in patients with syndrome X].

Impulse tissue Doppler study of the left ventricle was carried out in 44 patients with cardiac syndrome X (age 47.15+/-6.27 years) and 46 healthy volunteers aged 35-55 years. Maximal peak velocities "s", "e", "a", "e/a" ratio and segmental isovolumic relaxation time "ivrt" were evaluated for each of 18 selected left ventricular segments. Criteria of disturbed segmental diastolic left ventricular function were e/a ratio <1.0 and ivrt >85 ms. Left ventricular filling was abnormal (E/A (min) <1.0) in 18 (40.9%) patients all of whom had segments with e/a <1.0. According to e/a values 18 of 26 patients (69,23%) with E/A (min) >1.0 had segmental dysfunction while 8 patients (30,77%) had intact segmental diastolic function. Patients with and without segmental diastolic dysfunction had different exercise tolerance, nocturnal blood pressure fall, blood levels of glucose and low density lipoprotein cholesterol. Patients with abnormal (IVRT >90 ms) and normal (IVRT 40-80 ms) left ventricular relaxation had similar numbers of dysfunctional segments. Patients with IVRT 80-40 ms and with (n=21) or without (n=4) disturbances of segmental relaxation had different age, left ventricular myocardial mass index and magnitude of myocardial hypoperfusion.

Adult↗

PubMed1983

Resting and exercise left ventricular function in patients with hypertrophic cardiomyopathy.

Left ventricular ejection fraction (EF) at rest and during exercise was measured in 19 patients with hypertrophic cardiomyopathy (HCM) by means of radionuclide angiography. The results were compared to those in 20 normal subjects. Based on hemodynamic data, patients with HCM were divided into three groups. In group I, no demonstrable left ventricular outflow obstruction, there were five patients; their mean EF increased from 68% +/- 8.9 (+/- SD) at rest to 74% +/- 9.2 during exercise (p less than 0.05). In group II, latent obstruction, there were six patients; their mean EF at rest (75.2% +/- 8.2) and at peak exercise (78.7% +/- 6.7) was not statistically different (p greater than 0.05). Group III, obstruction present at rest, consisted of eight patients; EF at rest (82.6% +/- 8.5) decreased significantly during exercise (75.6% +/- 7.7, p less than 0.01). In normal subjects resting EF was 66.3% +/- 7.6; it increased to 76.4% +/- 7 (p less than 0.001). Exercise duration and heart rate-blood pressure product were lower in groups II and III. Thus there are significant differences in left ventricular systolic function both at rest and during exercise between these three major hemodynamic subgroups. These findings emphasize the importance of such a hemodynamic classification of HCM.

Adult↗

PubMed1988

[Quantitative echocardiographic study of the left ventricular function in acute aortic infective endocarditis].

Left ventricular (LV) function in 45 patients with native aortic valve infective endocarditis was studied in order to identify high surgical risk patients and the pattern of irreversible myocardial damage. LV function was studied by M-mode and 2D-echocardiography (LV volumes; ejection fraction, EF; peak systolic pressure to end-systolic volume ratio (PAP/ESV) as an index of myocardial contractility; LV mean systolic wall stress as an index of LV afterload and the radius to thickness ratio (R/Th). Thirteen patients underwent aortic valve replacement with an overall operative mortality of 15%. The cause of death was intractable heart failure. Different EF vs stress relationships could be described for different level of myocardial contractility: patients with intractable heart failure had a severely depressed myocardial contractility so that for a given level of LV stress, EF was significantly lower. High operative risk patients were identified by the PAP/ESV vs R/Th relation. All surgical deaths occurred in patients with a severely depressed myocardial contractility (PAP/ESV less than 2) and inadequate hypertrophy (R/Th greater than 4). Reversal of LV dysfunction in patients with moderately depressed myocardial contractility depended on the pattern of LV hypertrophy; a normal post-operative EF was achieved only in patients with adequate hypertrophy (R/Th less than 4).

Acute Disease↗

PubMed1986

Relation between coronary anatomy and serial changes in left ventricular function on exercise: a study using first pass radionuclide angiography with gold-195m.

Serial changes in left ventricular function on exercise were assessed by first pass radionuclide angiography with gold-195m (half life 30.5 s) in 25 men with known coronary anatomy. In the seven patients with three vessel disease, abnormalities of global left ventricular function and regional wall motion occurred earlier during exercise, were of greater extent at peak exercise, and persisted longer after exercise than in the 11 patients with one and two vessel disease or the seven with normal coronary arteries. Although there were significant differences between the groups in absolute change in ejection fraction and the rate of change in ejection fraction related to exercise duration and heart rate, a considerable overlap of values between groups precluded the accurate prediction of coronary anatomy in individuals. These data suggest that the amount of myocardium at risk from ischaemia in some patients with one and two vessel disease may resemble that in patients with three vessel disease. This study shows that an anatomical classification based solely on the number of diseased vessels will not predict the extent of the impairment of left ventricular function on exercise.

Blood Pressure↗

PubMed1990

[Correlation between late potentials, left ventricular function and coronary heart disease].

By signal averaging it is possible to registrate late, fragmented low amplitude signals (late potentials, LP's) from the bodysurface 26 patients (21 males, 5 females) with a mean age of 57 years were investigated by signal averaging, Holter-monitoring and cardiac catheterization. 11 patients had a dilative cardiomyopathy (group A), 10 patients a coronary heart disease (group B), 5 of them with an ejection fraction greater than 50%, 5 of them with a reduced ejection fraction, whereas the control-group with 5 patients (group C) showed no coronary stenosis or reduced ventricular function, 6 out of 11 patients with dilative cardiomyopathy showed LP's; all of these with Lown IVb had LP's. In 2 patients with coronary heart disease and good left ventricular function late potentials were found, and in all 5 patients with disturbed left ventricular function. The control-group revealed no late potentials although 4 patients had Lown IVa or more in Holter-ECG. In conclusion, late potentials show a good correlation to malignant ventricular ectopic beats in patients with dilative cardiomyopathy and coronary heart disease, especially when the left ventricular function is reduced.

Adult↗

PubMed1984

Assessment of left ventricular function in coronary artery disease with the nuclear probe during intervention studies.

The nuclear probe was used for measuring left ventricular function in 11 normal subjects and the results compared with those using a digital gammacamera. The probe was then used to measure left ventricular function in patients with coronary artery disease during dynamic exercise and stress atrial pacing. The ability of the probe to detect changes induced by glyceryl trinitrate was also evaluated in separate parallel studies. In the 11 normal subjects there was a good correlation between the left ventricular ejection fraction measured by the gammacamera and the nuclear probe both at rest and during exercise. Exercise increased this value by at least 5% in all normal subjects during measurements with both the gammacamera and the nuclear probe. The mean (SD) difference was -0.3% (2.60) at rest and 2.3% (5.02) at peak exercise. Both exercise and pacing produced angina in the patient group and the mean (SEM) value fell from 52% (3.5) to 28% (2.6) and from 46% (5.1) to 34% (3.2) respectively. Glyceryl trinitrate prolonged the exercise and pacing times, and the corresponding falls in ejection fraction were significantly reduced. The non-imaging nuclear probe is a cheap and portable instrument capable of assessing left ventricular function in patients with cardiac disease. It is designed for high count rate acquisition over a short period of time and can thus provide both beat to beat and summated left ventricular time activity curves suitable for quantitative analysis. It therefore has important advantages in the clinical setting and during controlled interventions compared with the gammacameras.

Adult↗

PubMed2004

Echocardiographic AV-interval optimization in patients with reduced left ventricular function.

BACKGROUND: Ritter's method is a tool used to optimize AV delay in DDD pacemaker patients with normal left ventricular function only. The goal of our study was to evaluate Ritter's method in AV delay-interval optimization in patients with reduced left ventricular function. METHODS: Patients with implanted DDD pacemakers and AVB III degrees were assigned to one of two groups according to ejection fraction (EF): Group 1 (EF > 35%) and Group 2 (EF < 35%). AV delay optimization was performed by means of radionuclide ventriculography (RNV) and application of Ritter's method. RESULTS: For each of the patients examined, we succeeded in defining an optimal AV interval by means of both RNV and Ritter's method. The optimal AV delay determined by RNV correlated well with the delay found by Ritter's method, especially among those patients with reduced EF. The intra-class correlation coefficient was 0.8965 in Group 1 and 0.9228 in Group 2. The optimal AV interval in Group 1 was 190 +/- 28.5 ms, and 180 +/- 35 ms in Group 2. CONCLUSION: Ritter's method is also effective for optimization of AV intervals among patients with reduced left ventricular function (EF < 35%). The results obtained by RNV correlate well with those from Ritter's method. Individual programming of the AV interval is fundamentally essential in all cases.

Aged↗

PubMed1991

[Improved left ventricular function and perfusion at rest following transluminal coronary angioplasty].

The purpose of this study was to evaluate left ventricular function and perfusion at rest before and after percutaneous transluminal coronary angioplasty. In consecutive 69 patients in whom coronary stenoses were dilated, the radionuclide left ventricular ejection fraction at rest increased significantly. In 26 of these patients, the ejection fraction increased by at least 4%. In these patients, exercise-induced ischemic ST depression had been more pronounced than in the others. 36 other patients underwent 201TI myocardial scintigraphy before and after angioplasty. Twelve patients in whom pre-PTCA images had revealed regions with irreversible 201TI uptake defects, showed normal 201TI distribution patterns on post-PTCA scintigrams. Post-exercise 201TI uptake (representing myocardial perfusion and metabolic activity) during pre-PTCA exercise stress tests was significantly lower in these cases. It is concluded that PTCA can improve left ventricular function and perfusion at rest. This improvement is most obvious in patients with pronounced exercise-induced myocardial ischemia as diagnosed by typical ST segment depression and reduced thallium uptake.

Adult↗

PubMedDate not supplied

A comparison of the effects of beta-blockers with and without intrinsic sympathomimetic activity on hemodynamics and left ventricular function at rest and during exercise in patients with coronary artery disease.

The effects on hemodynamics and left ventricular function of propranolol and pindolol, beta-blockers without and with intrinsic sympathomimetic activity (ISA), respectively, were compared in six men with stable exertional angina at rest and during symptom-limited bicycle exercise. The study was controlled and double blinded, and the order of drug administration was randomized. The dosage of each drug (propranolol 0.15 mg/kg i.v., pindolol 0.02 mg/kg i.v.) was chosen to reduce exercise tachycardia by approximately 18%. Exercise capacity and duration were similar after each drug, and both drugs similarly reduced ST depression during exercise. At rest, propranolol significantly reduced heart rate, systolic arterial pressure, rate-pressure product, stroke volume index, cardiac index, and left ventricular ejection fraction, and increased systemic vascular resistance. In contrast, pindolol significantly reduced only the rate-pressure product and cardiac index, and to a lesser extent than propranolol. During exercise on the other hand, both drugs reduced the heart rate, arterial pressure, rate-pressure product, and cardiac index to a similar degree. Neither drug altered pulmonary artery wedge pressure, systemic vascular resistance, stroke volume index, left ventricular ejection fraction, or left ventricular end-diastolic and end-systolic volume indices. At equipotent beta-blocking dosages, ISA in pindolol reduced the effects of beta-blockade on resting hemodynamics and left ventricular function compared to propranolol, but during exercise the influence of ISA was reduced; and both pindolol and propranolol exert similar effects on hemodynamics and left ventricular function.

Adult↗

PubMed2001

Importance of rate control or rate regulation for improving exercise capacity and quality of life in patients with permanent atrial fibrillation and normal left ventricular function: a randomised controlled study.

OBJECTIVE: To determine the importance of rhythm regulation or rate control in patients with permanent atrial fibrillation (AF) and normal left ventricular function. PATIENTS AND INTERVENTIONS: Thirty six patients with a mixed fast and slow ventricular response rate to their AF were randomised to either His bundle ablation (HBA) and VVIR pacemaker (HBA group) or VVI pacemaker and atrioventricular modifying drugs (Med group). Outcomes assessed at one, three, six, and 12 months included exercise duration and quality of life. RESULTS: Exercise duration significantly improved from baseline in both groups. There was no difference in outcome between the groups (Med +40% v HBA +20%, p = NS). The heart rate profile on exercise was similarly slowed in both groups compared to baseline. Quality of life significantly improved in both treatment arms for the modified Karolinska questionnaire (KQ) (Med +50% v HBA +50%, p = NS) and the Nottingham health profile (NHP) (Med +40% v HBA +20%, p = NS). However, for the individual symptom scores of each questionnaire more were improved in the Med group (KQ-Med 6 improved v HBA 4, NHP-Med 3 v HBA 1). Left ventricular function was equally preserved by both treatments during follow up. CONCLUSION: In these patients control of ventricular response rate with either HBA + VVIR pacemaker or atrioventricular modifying drugs + VVI pacemaker will lead to a significant improvement in exercise duration and quality of life. Rhythm regulation by HBA did not confer additional benefit, suggesting rate control alone is necessary for the successful symptomatic treatment of these patients in permanent AF.

Aged↗

PubMed1980

[Study of dynamics and left ventricular function using radioisotopic technics in the heart cavities].

The imaging of the cardiac cavities with appropriate tracer materials (99 m Technetium or 113 m Indium), the recording of intracardiac dilution curves by radionuclide angiography and dynamic studies by gamma cinecardiography give global and regional parameters of left ventricular function which are reliable and reproducible: an index of cardiac output, intracardiac circulation times and ventricular volumes. The assessment of left ventricular contraction and global and regional ejection fractions is facilitated by coupling the gamma camera and the electrocardiogramme and computer analysis of the results. "First passage" recordings may be used to differentiate the right from the left heart chambers. "Equilibrium" studies give detailed information at rest, under stress (or leg-raising) and under pacing and/or trinitrin. Average and maximal rates of contraction derived from the ejection fraction and left ventricular contraction times are indices comparable to the rate of fibre shortening. The calculation or regional parameters point by point such as the ejection fraction, contraction time and ejection volume gives a more accurate and sensitive estimation of left ventricular function than the global left ventricular indices. They are many practical applications in cardiology especially in coronary artery disease: monitoring the changes in the acute phase of myocardial infarction, the selection of patients for aorto-coronary bypass surgery and their pre- and post-operative controls. These non-invasive, easy and reliable cardiac studies justify the development of laboratories of nuclear cardiology within departments of cardiac physiological investigation.

Animals↗

PubMed1997

Anomalous origin of left coronary artery from pulmonary artery: recovery of left ventricular function after dual coronary repair.

OBJECTIVES: We reviewed our institutional experience with anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) after dual coronary repair to assess preoperative variables predictive of outcome, the time course for postoperative recovery of cardiac function, the short- and long-term complications and our experience with left ventricular assist devices (LVAD) in these patients. BACKGROUND: Outcome after surgical repair of ALCAPA remains incompletely defined. METHODS: The surgical records and echocardiograms of 42 patients were reviewed. Left ventricular function was assessed by fractional shortening z-score (FSz) and stress-velocity index. RESULTS: The overall survival rate was 86%. All six patients who died were < 1 year old and died within 3 days of the operation. More severe preoperative mitral regurgitation (MR) was associated with increased mortality, but age, body surface area, preoperative FSz and end-diastolic dimension were not. We used an LVAD for 7 of 28 patients who underwent repair for ALCAPA since its introduction at our institution, with a survival of 5 of 7 patients. The degree of MR improved in 62% of patients and remained unchanged in 38%. Complications included supravalvar pulmonary stenosis (16 of 21 patients) and baffle leaks (11 of 21 patients) with the intrapulmonary baffling technique. Supravalvar pulmonary stenosis developed in 1 of 11 patients after direct coronary reimplantation. Left ventricular function became normalized in all 28 patients with follow-up past 1 year, regardless of preoperative FSz. Of 13 patients who underwent serial postoperative echocardiography, the average time to normalization of function was 2 to 7 months. CONCLUSIONS: The degree of preoperative MR was predictive of outcome, whereas the severity of preoperative cardiac dysfunction and ventricular dilation were not. Mild and moderate MR tended to improve without mitral valvuloplasty. Complete recovery from myocardial dysfunction is expected after dual coronary repair of ALCAPA.

Adolescent↗