Myocardial factor revisited: The importance of myocardial fibrosis in adults with congenital heart disease

Craig S. Broberg, Luke J. Burchill

    Research output: Contribution to journalReview articlepeer-review

    24 Scopus citations


    Pioneers in congenital heart surgery observed that exercise capacity did not return to normal levels despite successful surgical repair, leading some to cite a "myocardial factor" playing a role. They conjectured that residual alterations in myocardial function would be significant for patients' long-term outlook. In fulfillment of their early observations, today's adult congenital heart disease (ACHD) population shows well-recognized features of heart failure, even among patients without clear residual anatomic or hemodynamic abnormalities, demonstrating the vital role of the myocardium in their morbidity and mortality. Whereas the 'myocardial factor' was an elusive concept in the early history of congenital heart care, we now have imaging techniques to detect and quantify one such factor - myocardial fibrosis. Understanding the importance of myocardial fibrosis as a final common pathway in a variety of congenital lesions provides a framework for both the study and treatment of clinical heart failure in this context. While typical heart failure pharmacology should reduce or attenuate fibrogenesis, efforts to show meaningful improvements with standard pharmacotherapy in ACHD repeatedly fall short. This paper considers the importance of myocardial fibrosis and function, the current body of evidence for myocardial fibrosis in ACHD, and its implications for research and treatment.

    Original languageEnglish (US)
    Pages (from-to)204-210
    Number of pages7
    JournalInternational Journal of Cardiology
    Issue number1
    StatePublished - Jun 15 2015


    • Cardiac magnetic resonance
    • Congenital
    • Heart defects
    • Heart failure
    • Myocardial fibrosis

    ASJC Scopus subject areas

    • Cardiology and Cardiovascular Medicine


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