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PubMedDate not supplied

Evaluation of left ventricular functions in chronic renal failure before and after acute hemodialysis.

Left ventricular functions were evaluated in 25 adult patients of chronic renal failure by 2-D echocardiography before and after four hours of standard hemodialysis session. Eighteen patients showed clinical evidence of fluid overload. Predialysis left ventricular end-diastolic diameter, left ventricular end-diastolic volume, left ventricular end-systolic diameter and left ventricular end-systolic volume were comparable in patients with or without fluid overload. Similarly, predialysis stroke volume and left ventricular ejection fraction were not significantly different in the two subsets. However, following hemodialysis there was a significant decrease in the left ventricular systolic and diastolic volumes and diameters in patients with fluid overload. The improvement in the left ventricular ejection fraction was of the same magnitude in the two subsets. The significant improvement in the left ventricular functions both in patients with and without fluid overload indicates that fluid overload may not be the only determinant of left ventricular functions in patients of chronic renal failure, but other factors, such as various uraemia toxins and metabolic changes might also be inhibiting the myocardial functions.

Adult↗
PubMed1991

[Hemodynamic changes and ventricular function before and after Fontan procedure for univentricular heart].

Ventricular function and hemodynamic parameters before and after Fontan operation were studied in patients with univentricular heart (UVH) of left ventricular (LV) type (9 cases, ages: 6-66, mean 13 years) and right ventricular (RV) type (13 cases, ages: 6-17, mean 9 years) without atrioventricular valve regurgitation. The preoperative ejection fraction (EF) was poor and only 44% of LV type and 23% of RV type met the Choussat's criterion (EF greater than or equal to 60%). There were 2 hospital deaths each in LV type and in RV type, but their causes could not be attributed to preoperative parameters of ventricular function. In survivors, the EF reduced from 62.9 +/- 7.0% before Fontan procedure to 43.4 +/- 12.6% after the procedure in LV type (p less than .05) and from 54.5 +/- 7.0% to 47.0 +/- 9.0% in RV type (p less than .01), although the ventricular end-diastolic pressure (EDP) also reduced from 12.7 +/- 2.7 mmHg before to 6.6 +/- 1.9 mmHg after the operation in LV type (p less than .05) and 10.4 +/- 2.6 mmHg to 5.5 +/- 2.4 mmHg in RV type (p less than .05). the ventricular end-diastolic volume (EDV) also reduced from 185 +/- 35% to 126 +/- 58% of expected normal volume in LV type (p less than .05) and 173 +/- 28% to 99 +/- 18% of expected normal volume in RV type (p less than .01).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2006

Comparison of right ventricular functions by tissue Doppler imaging in patients with obstructive sleep apnea syndrome with or without hypertension.

OBJECTIVE: To evaluate the right ventricular function in patients with obstructive sleep apnea syndrome (OSAS) independent from systemic hypertension (HT) and to determine the association between OSAS severity and right ventricular dysfunction. METHODS: The study population included 77 consecutive subjects; 20 of these patients had OSAS, 20 of them had HT, but did not have OSAS, 16 patients, who constituted the study group, had both disorders, and 21 subjects without any of these two disorders represented the control group. Right ventricular function was assessed by echocardiography: standard two-dimensional, M-Mode, and conventional Doppler as well as tissue Doppler imaging. None of the patients had a previous history of cardiac disease. The diagnosis of OSAS was based on an apnea- hipopnea index of 5 or higher in polysomnography. RESULTS: Tricuspid inflow velocities and tissue Doppler derived tricuspid annular diastolic velocities were significantly different in the patient groups (OSAS, HT, OSAS + HT) compared to the control group. Tricuspid annular plane systolic excursion (TAPSE) (18.3 +/- 3.2, 18.4 +/- 2.5, 20.1 +/- 2.1, and 20.7 +/- 2.5 mm, respectively, P = 0.024) and peak systolic myocardial velocity at tricuspid lateral annulus (S-vel) (12.2 +/- 1.5, 10.9 +/- 0.9, 11.2 +/- 1.1, and 13.1 +/- 2.1 cm/s, respectively, P < 0.001) were significantly lower in patient groups compared to those of the study group. Tissue Doppler derived myocardial performance index (MPI) of the right ventricle was significantly impaired in the patient groups compared to the control group (0.34 +/- 0.06, 0.44 +/- 0.06, 0.45 +/- 0.07, and 0.41 +/- 0.06, respectively, P < 0.001). With regard to these right ventricular functional parameters, there was no significant difference between OSAS and the other patient groups (HT and OSAS + HT). There were significant correlations both between OSAS severity and the right ventricular functions, and between diastolic and systolic parameters of the right ventricle (r = -0.45, P < 0.05). CONCLUSION: Both right ventricular systolic and diastolic functions are impaired in patients having OSAS with or without HT. Right ventricular MPI was found to be the parameter most closely related with OSAS severity and the right ventricular subclinical dysfunction.

Adult↗
PubMedDate not supplied

[Simultaneous analysis of myocardial perfusion and ventricular function. Normal values in the Mexican population].

UNLABELLED: Myocardial perfusion imaging is an useful procedure in the evaluation of patients with coronary artery disease, Gated SPECT technique evaluates simultaneously perfusion and ventricular function, left ventricular ejection fraction (LVEF), ventricular volumes and the transient ischemic dilatation of the left ventricle. OBJECTIVE: To evaluate the normal ventricle volumes and the ejection fraction of the LV obtained automatically with the Gated SPECT in Mexican population. METHODS: 100 patients were studied with low likelihood for CAD. All of them were studied with Tc-99m Sestamibi Gated SPECT. We obtained automatically the LVEF, and the end diastolic and systolic left ventricular volumes. RESULTS: Myocardial perfusion, regional motion and systolic thickening were normal in all patients. We obtained the mean values of EF and end diastolic and systolic volumes. These values were lower in female. CONCLUSION: Tc-99m Sestamibi myocardial perfusion SPECT is an useful procedure, with high accuracy for the simultaneous evaluation of myocardial perfusion and ventricular function.

Coronary Circulation↗
PubMed1999

Influence of high-intensity exercise training on the ventilatory response to exercise in patients with reduced ventricular function.

BACKGROUND: Exercise training increases exercise capacity in patients with reduced ventricular function in part through improved skeletal muscle metabolism, but the effect training might have on abnormal ventilatory and gas exchange responses to exercise has not been clearly defined. METHODS: Twenty-five male patients with reduced ventricular function after a myocardial infarction were randomized to either a 2-month high-intensity residential exercise training program or to a control group. Before and after the study period, upright exercise testing was performed with measurements of ventilatory gas exchange, lactate, arterial blood gases, cardiac output, and pulmonary artery and wedge pressures. RESULTS: In the exercise group, peak VO2 and VO2 at the lactate threshold increased 29 and 39%, respectively, whereas no increases were observed among controls. Maximal cardiac output increased only in the exercise group (1.7 L x min(-1), P < 0.05), and no changes in rest or peak exercise pulmonary pressures were observed in either group. At baseline, modest inverse relationships were observed between pulmonary wedge pressure and peak VO2 both at rest (r = -0.56, P < 0.05) and peak exercise (r = -0.43, P < 0.05). Maximal VE/VCO2 was inversely related to maximal cardiac output (r = -0.72, P < 0.001). Training did not have a significant effect on these relationships. Training lowered VE/VO2, heart rate, and blood lactate levels at matched work rates throughout exercise and tended to lower maximal Vd/Vt. The slope of the relationship between VE and VCO2 was reduced after training in the exercise group (0.33 pre vs 0.27 post, P < 0.01), whereas control patients did not differ. CONCLUSIONS: Exercise training among patients with reduced left ventricular function results in a systematic improvement in the ventilatory response to exercise. Training increased maximal cardiac output, tended to lower Vd/Vt, and markedly improved the efficiency of ventilation. Peak VO2 and ventilatory responses to exercise were only modestly related to pulmonary vascular pressures, and training had no effect on the relationships between exercise capacity, ventilatory responses, and pulmonary pressures.

Anaerobic Threshold↗
PubMed1996

Importance of infarct-related artery patency for recovery of left ventricular function and late survival after primary angioplasty for acute myocardial infarction.

OBJECTIVES: The purpose of this study was to evaluate the importance of late infarct-related artery patency for recovery of left ventricular function and late survival after primary angio-plasty for acute myocardial infarction. BACKGROUND: Infarct-related artery patency is thought to improve late survival by its effect on preservation of left ventricular function. Patency may also enhance late survival by preventing left ventricular dilation and reducing arrhythmias, independent of myocardial salvage. However, most studies have not shown patency to be an independent predictor of survival when late left ventricular function is taken into account. METHODS: We followed up 576 hospital survivors of acute myocardial infarction treated with primary angioplasty for 5.3 years. Ejection fraction and infarct-related artery patency were determined at follow-up catheterization at 6 months. Predictors of late cardiac survival were determined using Cox regression models. RESULTS: Patients with patent arteries had more improvement and a better late ejection fraction than patients with occluded arteries (56.3% vs. 47.9%, p = 0.001). In patients with acute ejection fraction < 45%, late survival was better in those with patent versus occluded arteries (89% vs. 44%, p = 0.003), but patency was not a significant predictor after improvement in ejection fraction was taken into account. In patients with a large anterior infarction, patency was a significant independent predictor of late survival. CONCLUSIONS: Infarct-related artery patency is important for recovery of left ventricular function, and in patients with acute ejection fraction < 45%, patency is important for late survival. Our data are consistent with the hypothesis that the survival benefit is due primarily to the effect of patency on recovery of left ventricular function. In patients with a large anterior infarction, patency appears to provide an additional late survival benefit independent of myocardial salvage. These observations support the need for additional clinical trials of late reperfusion in patients with a large anterior infarction.

Angioplasty, Balloon, Coronary↗
PubMed1994

Experimental assessment of right ventricular function in normal pigs with a left ventricular assist device.

Right ventricular (RV) failure during the use of a left ventricular assist device (LVAD) is the leading cause of death in circulatory support patients. Previous work, both experimentally and clinically, has shown the difficulties in predicting the behavior of the right ventricle at the start of LVAD. An experimental study has been designed to evaluate RV functional changes during LVAD and its relation to preload changes. The model used adult mongrel pigs (n = 10). Right ventricular functional parameters were measured with a thermodilution RV ejection fraction catheter. The left ventricle was supported by a Nippon Zeon blood pump. Two groups were studied, the first one was the LVAD-off group (n = 5) and the other was the LVAD-on group (n = 5) which was supported by LVAD at maximum flow. Change of cardiac output, mean pulmonary artery pressure (PAP), RV stroke work, and RV ejection fraction in both groups were not significantly different. However, the relationship between right ventricular end-diastolic pressure (RV-EDP) and right ventricular stroke volume (RVSV) was significantly changed at a high level of RV-EDP. When RV-EDP was over 6.5 mm Hg in the LVAD-off group, RVSV decreased to 52.3 +/- 11.5 ml while in the LVAD-on group, RVSV increased to 97.2 +/- 22.0 ml. The change in PAP in the LVAD-on group was lower than in the LVAD-off group. We conclude that, at the volume overload state, LVAD can reduce the afterload of the right ventricle and maintain Frank-Starling's effect, thus having a beneficial effect on right ventricular performance.

Animals↗
PubMed2002

Prediction of improvement in regional left ventricular function after coronary artery bypass grafting: quantitative stress-redistribution 201Tl imaging in detection of myocardial viability.

BACKGROUND: This study investigated the usefulness of quantitative assessment of Thallium-201 stress redistribution myocardial scintigraphy combined with quantitative assessment of regional left ventricular function using the centerline method for predicting of recovery regional left ventricular function following myocardial revascularization. METHODS: Twenty patients with chronic total obstruction of the proximal portion of left anterior descending artery and/or right coronary artery were studied. Percent Tl-uptake method was used to evaluate myocardial viability before CABG. Regional LV function was evaluated before and after CABG with the centerline method. The territory of LAD was defined by chords 10 to 58 and that of RCA was defined by chords 59 to 80 in the centerline method. The parameter of regional left ventricular function was the mean (SF-Av.)/SD of each LAD and RCA territory. RESULTS: In cases showing a % uptake value under 50%, the preoperative value of (SF-Av.)/SD was -3.18+/-0.74 and postoperative value was -2.63+/-0.8 1. The difference between these values was not significant. When the %uptake value over 50%, the preoperative value of (SF-Av.)/SD was -2.80+/-0.49 and the postoperative value was -2.27+/-0.28. The postoperative value was significantly higher than the preoperative value(p=0.007). CONCLUSIONS: Even in cases of severe left ventricular dysfunction, regional left ventricular function improved if the value of % uptake in the redistribution Thallium imaging was 50% or over. Quantitative analysis of myocardial scintigraphy combined with quantitative analysis of left ventriculography is a useful method for predicting recovery of regional left ventricular function following myocardial revascularization.

Aged↗
PubMed1976

Normalized first derivative ofthe left apex cardiogram in assessment of left ventricular function.

The relation between the left displacement apex cardiogram and the left ventricular pressure during isovolumic contraction was studied in 30 patients with cardiac disease. Using the instantaneous relation between the first time derivative and the magnitude of both the left apex cardiogram and the left ventricular pressure, normalized derivatives were obtained. These noramized velocities were correlated with each other and with several indexes of left ventricular function. The normalized derivatives of the left apex cardiogram (dD/dt/D) and the left ventricular pressure (dP/dt/P) were similar in magnitude, standard deviation and variation coefficient. No such similarity was present when the first time derivatives of each tracing (dD/dt and dP/dt) were compared. A highly significant relation was found between normalized displacement velocity and normalized pressure velocity using both total (r = 0.76, P less than 0.001) and developed (r = 0.75, P less than 0.001) displacement and pressure. Significant correlations with several other indexes of left ventricular function (end-diastolic pressure, peak dP/dt, maximal velocity of the contractile elements at zero load[Vmax]) were also observed. It is concluded that the index dD/dt/D of the left apex cardiogram is an important noninvasive tool for assessing left ventricular function in man.

Adult↗
PubMed1995

Non-invasive assessment of reperfusion of the infarct-related artery during coronary thrombolysis and its relation with left ventricular function.

We monitored ST segment continuously for at least 3 h after the beginning of lytic treatment in 103 patients undergoing early coronary thrombolysis for acute myocardial infarction in order to ascertain whether this technique, which has been shown to be useful to assess recanalization of the infarct-related artery, is also able to identify the improvement in left ventricular function associated with successful reperfusion. Global left ventricular function (assessed in the 30 degrees right anterior oblique projection with the area/length method) and infarct zone wall motion (studied with the centerline method) were evaluated at least 4 weeks after the event. Reperfusion was thought to be achieved when ST segment elevation dropped > 50% relative to the most abnormal peak documented at any time in the study. Eighty patients (78%) met the criterium for successful reperfusion (group 1), and 23 (22%) did not (group 2). Both groups had similar clinical and angiographic characteristics. All indexes of global left ventricular function were significantly better in group 1 than in group 2 patients (end-diastolic volume: 176 +/- 51 vs. 209 +/- 76 ml, end-systolic volume: 66 +/- 40 vs. 97 +/- 55 ml, ejection fraction: 65 +/- 13 vs. 57 +/- 11%, respectively, all P < 0.02). Also the severity (-1.6 +/- 1.3 vs. -2.6 +/- 1.01 S.D./chord, respectively, P < 0.001) and the extension of hypokinesia in the infarct zone (number of chords with > 2 S.D.: 13 +/- 16 vs. 28 +/- 17, respectively, P < 0.0001) were less in group 1 than in group 2 patients. Furthermore, in reperfused patients, both global left ventricular function and regional wall motion were better in those admitted < 60 min from onset of pain. In conclusion, patients with rapid ( > 50%) decrease of ST segment elevation have smaller infarct size and better global left ventricular function than patients without electrocardiographic signs of reperfusion as assessed by continuous ST segment monitoring. This suggests that this non-invasive technique is a powerful tool able to identify patients most benefiting from thrombolytic therapy.

Cardiac Catheterization↗
PubMed1985

[Regional left ventricular function in dilated cardiomyopathy: observation of regional left ventricular wall motion before and during dobutamine administration].

To investigate left ventricular function and the prognosis of patients with dilated cardiomyopathy (DCM), regional wall motion of the left ventricle of 38 patients with DCM was observed before and during dobutamine infusion (8 micrograms/kg X min) by two-dimensional echocardiography (2DE). The left ventricle was divided into 11 segments and the severity of wall motion abnormality (WMA) was classified into 4 grades, i.e. akinesis or dyskinesis (A), severe hypokinesis (SH), hypokinesis (H) and normokinesis (N), and numerical scores were assigned to each grade of WMA as follow; A: 3, SH: 2, H: 1, and N: 0. In the 38 patients with DCM, the number of segments with WMA was 8.3 +/- 2.9 (mean +/- SD). Among 418 segments in the 38 patients, we observed A in 71 segments, SH in 104 segments, H in 140 segments, and N in 103 segments. The WMA was not uniform in the left ventricle, and severe WMA was observed in the apex (WMA score: 2.0 +/- 1.0), while the grades of WMA in the lateral and posterior walls were mild (WMA score: 0.8 +/- 1.1) compared with those of other segments. The total sums of the WMA scores in 11 segments for each patient (TWMAS) were significantly greater in patients with severe heart failure (New York Heart Association [NYHA] functional class III or IV) than in patients with mild heart failure (NYHA class I or II) (22.0 +/- 5.2 and 9.9 +/- 4.9, p less than 0.001). TWMAS correlated with the cardiac index (CI) (r = -0.58, p less than 0.005) and pulmonary capillary pressure (PCP) (r = 0.68, p less than 0.001). In 242 segments of 22 patients, whose regional wall motion was observed before and during dobutamine administration, wall motion was improved by one grade in 82 of 170 segments with WMA before dobutamine infusion; i.e. regional wall motion changed from A to SH in six segments, from SH to H in 31 segments, and from H to N in 45 segments with dobutamine administration. According to the change in grade of TWMAS induced by dobutamine administration, 22 patients with DCM were classified into two groups: a good response group (% change of TWMAS greater than or equal to 40%), and a poor response group (% change of TWMAS less than 40%). The poor response group had ventricular tachycardia more frequently, more severe heart failure, lower CI and higher PCP than the good response group.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMedDate not supplied

[Left ventricular function in pure mitral stenosis. Hemodynamic echocardiographic study].

We studied the left ventricular performance in 40 patients with pure mitral stenosis, using a M Mode Echocardiographic study. In 19% of the group the left ventricular function was abnormal, however, we were able to distinguish three subsets: small left ventricular dimension, normaland dilated. In the first two subsets, the cardiac performance was normal in almost all the patients (85%). In 15%, the left ventricular function was depressed, probably due to a restricting flow into the cavity, segmental atrophy and fibrosis caused by chronic mitral obstruction. In the last group (dilated left ventricle), the end-systolic dimension was abnormal in 71,4% of the patients. Our study suggests that the increased dimension of the left ventricle is accompanied by poor ventricular performance and represents an intrinsic trace of damage of the myocardium by the previous rheumatic carditis. The importance of detecting this last subset is emphasized due to the high incidence of impairment in left ventricular function. This detection could in some cases prevent the surgical treatment when this function is severely depressed.

Adolescent↗
PubMed1989

Pulmonary artery counterpulsation to improve right ventricular function after heart transplantation.

The effectiveness of pulmonary artery counterpulsation in improving right ventricular function after heart transplantation was evaluated in a pig model. The balloon catheter was introduced through the anterior wall of the pulmonary artery distal to the pulmonary valve. A Millar catheter with a distal high-fidelity pressure transducer was placed in the right ventricle, where the peak rate of pressure rise, dP/dT, was measured. Pulmonary artery counterpulsation significantly improved right ventricular function, increasing both dP/dT and systolic pressure. A diastolic dip in pulmonary artery pressure and a fall in the early portion of the right ventricular pressure curve were seen. Inflation of the balloon caused a second (suprasystolic) wave in that curve. Improved right ventricular function was also seen when normal pig hearts were counterpulsated after occlusion of the right coronary artery and following increased afterload due to occlusion of a main pulmonary artery. There were no changes in central venous or systemic pressure. The results indicate that pulmonary artery counterpulsation may be valuable when the transplanted heart has a poorly functioning right ventricle.

Animals↗
PubMed1991

Left ventricular function during transient coronary occlusion: digital subtraction left ventriculograms during coronary angioplasty.

The impact of transient myocardial ischemia on left ventricular function was examined by digital subtraction left ventricular angiography. Contrast medium was injected into the right pulmonary artery before, at 60 seconds of balloon inflation, and 10 minutes after balloon deflation. A total of 69 patients completed the study. In 52 patients, the left anterior descending artery (LAD) was involved, and in 17, the right coronary artery (RCA) was the focus. Ejection fraction (EF) declined by balloon inflation and returned to baseline value after deflation of the balloon. There was tendency toward a lower EF and wider akinetic area for LAD dilatation. The linear correlation between resting EF and EF during balloon inflation suggested that the effect of momentary coronary occlusion on left ventricular function appears to be additive to pre-existing left ventricular dysfunction, and resting ejection fraction is an important parameter for estimating the degree of diminished left ventricular function during myocardial ischemia.

Angiography, Digital Subtraction↗
PubMed1988

[Study of the correlation between severity of hypertension and the left ventricular mass and left ventricular functions].

The correlation between the severity of hypertension and the left ventricular mass and left ventricular functions were studied in normal controls (n = 6) and essential hypertensives (n = 37). And we studied the factors that influence on the severity of hypertension by discriminant analysis. Thirty-seven hypertensives were divided into three groups (WHO I 16, WHO II 16, WHO III 5). The left ventricular mass (LVM) was calculated by X-ray computed tomography. The %fractional shortening (%FS), mean Vcf (mVcf) and ejection fraction (EF) were obtained as left ventricular systolic function by echocardiogram. The left ventricular diastolic posterior wall velocity (PWVd) and left ventricular rapid filling volume/stroke volume (RFV/SV) were obtained as left ventricular diastolic function by echocardiogram. The LVMs (g/m2) of controls, WHO I, WHO II and WHO III were 92 +/- 14, 113 +/- 23, 155 +/- 56 and 237 +/- 38. The LVM were great as the stage of hypertension was deteriorated. The left ventricular diastolic function was impaired as hypertension exacerbated. The left ventricular systolic function was not changed in four groups including controls. The LVM was significantly well correlated with systolic blood pressure (r = 0.48, p less than 0.01), diastolic blood pressure (r = 0.30, p less than 0.05), cardiothoracic ratio (r = 0.36, p less than 0.05), SV1 + RV5 on ECG (r = 0.66, p less than 0.001) and left ventricular diastolic function (PWVd; r = 0.49, p less than 0.01, RFV/SV; r = 0.52, p less than 0.001). But, the LVM was poor correlated with left ventricular systolic function. Depending on the discriminant analysis, the LVM and left ventricular diastolic function had significantly well influence on the severity of hypertension and ECG abnormality. As using the LVM calculated by computed tomography, we have exactly and useful informations of essential hypertension.

Adult↗
PubMed1997

Left ventricular function during exercise testing and training.

Left ventricular function (LVEF) deteriorates during incremental exercise (GXT) in patients with ischemia (+ISCH). Left ventricular (LV) functional response during steady-state exercise, typical of that used in exercise training, are unknown. We compared LVEF in patients with documented coronary heart disease (CHD) who either had (+) or did not have (-) ISCH, and in healthy volunteers (CONTROL) during GXT and steady state. First pass RNA was performed during upright cycle GXT at rest (R), at the ventilatory threshold (VT), and at maximal exercise (Max); and during steady state at the workload associated with VT after 10, 20, and 30 min of exercise. RNA allowed measurement of ejection fraction (EF) and wall motion (WM); ISCH was mild, angina being relieved by momentary reductions in workload during steady state. Although +ISCH demonstrated the expected deterioration in LV function during GXT (decreased EF, abnormal WM)(EF = 58 to 56 to 54%), there was no evidence for progressive deterioration of LV function during steady state despite the presence of mild ISCH (56 to 56 to 54 to 54%). In -ISCH and CONTROL there were normal responses of EF during GXT (43 to 51 to 51% and 59 to 65 to 61%) and steady state (43 to 51 to 53 to 51% and 59 to 65 to 68 to 69%). We conclude that mild ischemia may be tolerated during steady-state exercise at levels consistent with exercise training without progressive deterioration of LV function.

Adult↗
PubMed1993

Effect of cardiac stabbing on ventricular function: evaluation by radionuclide angiography.

OBJECTIVE: To determine whether cardiac stab wounds cause early ventricular dysfunction. DESIGN: Retrospective case series over 7 years. SETTING: University-affiliated teaching hospital. PATIENTS: Nine consecutive survivors of cardiac stab wounds. INTERVENTIONS: Postoperative radionuclide angiography performed in all patients between 1 and 13 days after injury. MAIN OUTCOME MEASURES: Information on the patient's clinical presentation and hospital course was obtained from the patient's charts and correlated with ventricular function as measured by the right and left ventricular ejection fractions (RVEF and LVEF). RESULTS: Cardiac injuries consisted of isolated right (five) and left (three) ventricular lacerations, and one biventricular laceration. Three patients had perioperative dysrhythmias (two ventricular, one atrial), and nonspecific electrocardiographic changes occurred in seven patients. Six patients had postoperative complications: pericarditis in three and pneumonia, pulmonary thromboembolism and abdominal wound dehiscence in one each. The LVEF was normal in all patients. Although none had clinically apparent cardiac dysfunction at the time of radionuclide angiography, six patients had a reduced RVEF (less than 0.45). All patients remained asymptomatic at the time of discharge from hospital (median 12 days postoperatively). In two of the six patients who had a reduced RVEF, one had a normal RVEF 2 months later; the other had a near-normal RVEF (0.43) but had persistent right ventricular enlargement 7 months later. Both were asymptomatic. CONCLUSIONS: Although a reduced RVEF is common in survivors of cardiac stab wounds, the reduction is small and is not associated with clinically apparent cardiac dysfunction.

Adult↗
PubMed2000

Quantitative assessment of ventricular function in children with single ventricles using the Doppler myocardial performance index.

Assessment of ventricular function in patients with functionally single ventricles and unusual ventricular geometry is difficult. The Doppler myocardial performance index (MPI) may provide a method of assessing function in these patients. The purposes of this study were to compare the MPI in normal children and in children with a functionally single ventricle, and to compare the MPI in patients with single ventricles before and after bidirectional cavopulmonary anastamosis (BCPA). Echocardiograms of all patients who underwent BCPA between January 1994 and December 1998 were reviewed before and after surgical palliation. Age-matched normal subjects (n = 30) served as controls. The MPI was calculated from Doppler tracings of ventricular inflow and outflow. Of the 60 patients with single ventricles who underwent BCPA, 41 had adequate preoperative Doppler studies to allow calculation of the MPI, and 21 of 41 had adequate studies before and after BCPA. The MPI was higher in patients with single ventricles than in normal controls (0.67 +/- 0.14 vs 0.32 +/- 0.10, p < 0.001). There was no significant difference in the MPI in patients with single ventricles before and after surgery (0.70 +/- 0.16 vs 0.66 +/- 0.15). However, patients who had a BCPA at < 1 year of age had a significant decrease in the MPI after surgery (0.71 +/- 0.10 vs 0.61 +/- 0.11, p = 0.01). Compared with controls, the MPI was significantly higher in patients with single ventricles suggesting an altered hemodynamic state consistent with decreased ventricular function. The MPI decreased in patients who underwent BCPA at < 1 year of age, suggesting an improvement in ventricular function. The MPI provides an objective method of assessing and following ventricular function in patients with single ventricles that is independent of ventricular geometry.

Age Factors↗