Growth related changes of cardiovascular dimensions : basic structure - function relation : physiological basis - application to the quantitative assessment of cardiovascular dimensions and ventricular function
(1997)
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- Observations of the developing cardiovascular system date from antiquity with Aristotle description of the beating heart in a chicken egg. However, quantitative description of the cardiovascular system, an essential part of William Harvey’s method, was provably the initial step on the path of modern cardiology. The development of measurement techniques, beginning in the 19th century, combined with the ability to treat heart lesions, beginning in the mid 20th, spurred interest in accurate diagnosis and in methods correlating physiology with clinical outcome. <BRW> This thesis concentrated on the evaluation of the normal growth of cardiovascular pathways and on the evaluation of cardiac function. The evaluation of the child growth is a cornerstone of the practice of pediatrics. Body height and weight are easy to measure. The exploration of changes in the heart with growth is more difficult. With the advent of Doppler-echocardiographic techniques, anatomy and physiology of the infant heart are together in images, obtained non invasively through the skin. Cardiac anatomy, cardiac physiology and cardiac function ca now be analyzed freed from the constraints of more invasive techniques. This thesis analyzed the statistical relationship and the physiologic nature of the relation of body size and cardiovascular dimensions, in 435 normal children, aged 2 weeks to 20 years of age. The normal dimensions of cardiac and vascular pathways have to accommodate the normal blood flow eat rest and during exercise with little or no pressure drop across the pathway. In some patients, these dimensions are to small. Predictions of the outcome on the basis of dimensions are therefore an essential aspect of the therapeutic decision. A precise “normalization” of the dimension measured for the size of the subject is necessary, because the population considered goes from infancy adulthood, and because of the normal difference between individuals of the same age or size. Because of the potential of myocardial injury as a result of the hemodynamic abnormalities associated with congenital heart diseases, the evaluation of cardiac performance is crucial but challenging. Echocardiography combined with ingenious application of physiological concepts, derived from studies performed using an isolated strip of cardiac muscle, allowed for non invasive assessment of the left ventricular systolic function from birth to adulthood. The method was used in this thesis to evaluate the impact of therapeutic measures in some clinical entities. <BR> A cardiologist dedicated to the care of children with congenital heart disease has to recognize, aside the need of adequate anatomic description, the need of accurate quantitative evaluation of cardiac dimensions and cardiac function. Such evaluation requires the comprehensive approach and the knowledge of cardiovascular functioning. Only with that kind of perspective, a physician can appropriately help infants and children affected by acquired or congenital heart diseases
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Sluysmans, T. (1997). Growth related changes of cardiovascular dimensions : basic structure - function relation : physiological basis - application to the quantitative assessment of cardiovascular dimensions and ventricular function. https://hdl.handle.net/2078.5/111391