1114-204 Regression of left ventricular dilation in children with restrictive ventricular septal defects with initial large volume overload

The primary objective of this project is to design, fabricate, and test a small, integrated camera system for aiding in the visualization and surgical repair of certain types of ventricular septal defects (VSD), in pediatric patients. Currently, no purpose-designed commercial device to view VSDs from the left ventricle of the heart exists. The left ventricular perspective is ideal for obtaining an unobstructed view of the VSD. This VSD camera device would also provide a platform for passing a suture through the hole in the ventricular septum, with future work implementing additional tools capable of more advanced tasks. This camera device will help solve some of the major issues currently associated with cardiac imaging and surgical closure of VSDs in newborns and young children This paper examines the design development and preliminary evaluation of a proof of concept device. Included are preliminary results of image quality comparisons, design details of a pediatric-specific VSD camera device, and initial outcomes from in vitro testing.

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Co-morbidity (HFrEF and HFpEF): hypertension

ESC CardioMed ◽

10.1093/med/9780198784906.003.0415_update_002 ◽

2018 ◽

pp. 1808-1812

Author(s):

Francesco Paneni ◽

Massimo Volpe

Keyword(s):

Blood Pressure ◽

Ejection Fraction ◽

Left Ventricular ◽

Ventricular Dilation ◽

Hypertensive Patients ◽

Reduced Ejection Fraction ◽

Concentric Hypertrophy ◽

Drug Classes ◽

Left Ventricular Dilation ◽

Eccentric Hypertrophy

Hypertensive heart disease is a major cause of heart failure (HF) and mortality. Hypertension precedes HF occurrence in 75% of cases, and carries a sixfold increase in HF risk as compared to non-hypertensive individuals. Most importantly, a minority of patients survive 5 years after the onset of hypertensive HF. In hypertensive patients, the heart may present different patterns of adaptive remodelling: concentric remodelling, concentric hypertrophy, and eccentric hypertrophy. Although most hypertensive patients are at high risk of developing concentric hypertrophy, a growing proportion of subjects display a concentric-to-eccentric progression eventually leading to left ventricular dilation and systolic dysfunction. Several factors including myocardial ischaemia, ethnicity, genetic background, history of diabetes, and blood pressure pattern may significantly influence the pathway from hypertension to left ventricular dilation. Patients with a concentric hypertrophy usually develop HF with preserved ejection fraction (HFpEF), whereas those with an eccentric (dilated) phenotype develop HF with reduced ejection fraction (HFrEF). Lowering blood pressure has a striking effect in reducing the risk of HF. Although available antihypertensive drugs are all successful in lowering blood pressure, angiotensin-converting enzyme inhibitors, angiotensin receptor blocker (ARBs), and diuretics are more effective than other drug classes in preventing HF. The combination of the neprilysin inhibitor sacubitril with the ARB valsartan (LCZ696) has recently been shown to be highly effective in reducing HF-related outcomes in hypertensive subjects. An individualized treatment scheme taking into account blood pressure levels, type of HF (HFpEF or HFrEF), and relevant co-morbidities (i.e. renal disease, diabetes) is currently the best approach to improve morbidity and mortality in hypertensive patients with HF.

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