Two-dimensional echocardiographic recognition of papillary muscle fibrosis in pediatric patients.

Two-dimensional echocardiographic examinations were performed in seven infants with anomalous origin of the left coronary artery from the pulmonary artery (ALCA), in one infant with myocardial infarction and left main coronary obstruction, and in eight with critical valvar aortic stenosis (AS). Comparative qualitative echo density assessment demonstrated that each infant had a marked increase in the echo density of one or both left ventricular papillary muscles. The increased echo density was considered to represent fibrosis and scar formation as a result of ischemia and infarction. Pathologic proof of excessive fibrosis of the papillary muscles was obtained in three cases. In an additional case, calcification of the papillary muscle was noted on fluoroscopic examination. The echocardiographic appearance of papillary muscle fibrosis provides a useful indicator of severe subendocardial ischemia in patients with either critical AS or ALCA.