PARTICULARITIES OF THE CARDIAC REMODELLING ECHOCARDIOGRAPHIC ESTIMATED AT CHILDREN WITH HEART FAILURE SECONDARY TO CONGENITAL HEART DISEASES AND PULMONARY HYPERTENSION

The aim of this study was the determination of the particularities of the cardiac remodeling with echo-cardio graphic methods at patients with chronic heart failure (CHF) secondary to congenital heart diseases and pulmonary arterial hypertension (PAH). Material and methods: In the study 204 children were included (average age of 37.1 +/- 3.7 months) with CHF secondary to congenital systemic-to-pulmonary shunts (simple, combined and complex) associated with PAH. Depending on the rang of PAH the children were divided into 2 subgroups: IA - 59 patients with CHF and moderate PAH and IB - 145 children with CHF and severe PAH. Using the echocardiography 2D the right and left dimensions of the heart, EF, SF of LV were determined; the Doppler exam - the global function of RV (Tei performance index), systolic and mean pressure in PA. Results and conclusions: The particularities of the cardiac remodeling estimated echocardiography with diagnostic value at patients with CHF secondary to congenital shunts complicated with PAH are the following: dilatation of the right cavities of the heart (RVDd and RAD) and of the PA with the tendency of reduction of the LV dimensions, hypertrophy of the anterior wall of the RV, the increasing of the diameter of the fibrosis ring at tricuspid valve, the global dysfunction of RV (Tei index), valvular insufficiency (TVI and PVI), the diminishing of the cardiac index. These parameters were more significant at patients with severe PAH (p<0.001), denoting the consequences of the pressure overload on the cardiac remodeling, estimating the level of hemodynamic severity and with certainty can have a special meaning in deciding the therapeutic tactics, prognosis and evolution.