Pediatric Cardiology and Cardiac Surgery
Vol.27 No.2 2011 (76-87)
Hirofumi Saiki, Hideaki Senzaki
Department of Pediatric Cardiology, International Medical Center, Saitama Medical University, Saitama, Japan
Hemodynamic abnormalities of congenital heart disease (CHD) are caused by a complex interaction between heart and vessels, of which the structure and/or function are often fundamentally different from those in normal circulation. In addition, the structure and/or function of the heart and vessels could drastically be altered with disease progression and therapeutic interventions, including medications, catheter interventions, and surgery. Therefore, to better understand the pathophysiology of CHD hemodynamics and thereby to maximize the treatment effects, we have to overlook the hemodynamic status of CHD as the combined effects from the heart and vessels (i.e., systolic and diastolic function, pre- and after-load status, or heart rate), while evaluating each element separately. For this purpose, the pressure-volume relationship provides the best tool by allowing heart properties to be separately quantified from vessel properties and loading status. Heart properties and vessel properties can be coupled to predict net cardiac performance and hemodynamics.
In this article, we first summarize the basic concepts of the pressure-volume relationship to help all pediatric cardiologists and cardiovascular surgeons understand its usefulness. We then show how we should apply this theory to complex heart disease in children for the better management of patients in the clinical setting, including in the bedside setting. We hope that every physician engaged in pediatric cardiology will make the most of the pressure-volume relationship to maximize the patient’s quality of life throughout the treatment of congenital heart disease.