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PubMed1990

[Long-term follow-up (20 to 25 years) of tetralogy of Fallot after correction].

Eighty patients with tetralogy of Fallot who underwent corrective surgery between 1965 and 1970 were followed and evaluated. Late death was observed in 8 patients, and 3 of them were cardiac deaths. The survival rate at 10-year was 96.2%, at 20-year was 91.7%, and at 24-year was 89.0%. Of the surviving patients, 78% to 85% are spending normal social life. Twenty female patients experienced 31 deliveries, and no babies with cardiac anomaly were born. Most of the complaints come from late arrhythmias, and this is the main problem in the long-term period. Right ventricular function is considered to be moderately reduced by catheter analysis. The importance of preservation of right ventricular function during the surgery should be stressed.

Adolescent↗
PubMed2001

Right ventricular response to high-dose almitrine infusion in patients with severe hypoxemia related to acute respiratory distress syndrome.

OBJECTIVE: To evaluate the effects of high-dose almitrine infusion on gas exchange and right ventricular function in patients with severe hypoxemia related to acute respiratory distress syndrome (ARDS). DESIGN: Prospective study. SETTING: Medicosurgical intensive care department (ten beds). PATIENTS: Nine patients with ARDS and severe hypoxemia (PaO2/FIO2 ratio, <150 torr [20 kPa]). INTERVENTION: High-dose almitrine infusion (16 microg/kg/min for 30 mins). MEASUREMENTS AND MAIN RESULTS: Gas exchange and hemodynamic parameters were recorded before and after almitrine infusion. Right ventricular function was evaluated by using a fast response thermistor pulmonary artery catheter that allowed measurement of right ventricular ejection fraction and calculation of right ventricular end-diastolic and end-systolic volumes. Almitrine did not significantly alter arterial oxygenation and intrapulmonary shunt. Almitrine increased mean pulmonary arterial pressure (MPAP) from 31 +/- 4 to 33 +/- 4 mm Hg (p < .05), pulmonary vascular resistance index from 353 +/- 63 to 397 +/- 100 dyne x sec/ cm5 x m2 (p < .05), and right ventricular end-systolic volume index from 71 +/- 22 to 77 +/- 21 mL/m2 (p < .05); almitrine decreased right ventricular ejection fraction from 36% +/- 7% to 34% +/- 8% (p < .05). Stroke volume index and cardiac index did not change. The almitrine-induced changes in right ventricular ejection fraction were closely correlated with the baseline MPAP (r2 = .71, p < .01). CONCLUSION: In patients with severe hypoxemia related to ARDS, high-dose almitrine infusion did not improve arterial oxygenation and impaired the loading conditions of the right ventricle. The decrease in right ventricular ejection fraction induced by almitrine was correlated with the baseline MPAP. Thus, high-dose almitrine infusion may be harmful in ARDS patients with severe hypoxemia and pulmonary hypertension.

Adult↗
PubMed1978

Assessment of cardiac performance with quantitative radionuclide angiocardiography: right ventricular ejection fraction with reference to findings in chronic obstructive pulmonary disease.

A reproducible noninvasive technique for measuring righ ventricular ejection fraction was developed using first pass quantitative radionuclide angiocardiography. Studies were obtained in the anterior position with a computerized multicrystal scintillation camera with high count rate capabilities. Right ventricular ejection fraction was calculated on a beat to beat basis from the high frequency components of the background-corrected right ventricular time-activity curve. In 50 normal adults, right ventricular ejection fraction averaged 55 percent (range of 45 to 65 percent). This radionuclide measure of right ventricular function was reproducible, with minimal inter- and intraobserver variability, and was sensitive to changes in inotropic state induced with isoproterenol. In 36 patients with chronic obstructive pulmonary disease, right ventricular ejection fraction ranged from 19 to 71 percent. All 10 patients with corpulmonale, as well as 9 additional patients, had an abnormal right ventricular ejection fraction. Arterial oxygen tension and forced expiratory volume were depressed significantly more in patients with abnormal right ventricular ejection fraction than in subjects with normal right ventricular function. There was no relation between abnormalities in right and left ventricular ejection fraction.

Adult↗
PubMed1985

Biventricular function after myocardial revascularization in humans: deterioration and recovery patterns during the first 24 hours.

Critical changes in left and right ventricular function immediately after myocardial revascularization may affect the success of the procedure, morbidity, and mortality. To delineate these changes and identify vulnerable patient populations and times of highest risk, ventricular function was studied for 24 h in 22 patients undergoing myocardial revascularization. Preoperative ejection fractions ranged from 0.26 to 0.81. For each patient, eight left and eight right ventricular function curves (LVFC and RVFC) were generated by altering preload during the 24-h perioperative period. Central venous pressure ranged from 0 to 19 mmHg and pulmonary capillary wedge pressure from 0 to 31 mmHg. In all patients, significant (P less than 0.05) left and right ventricular dysfunction occurred at 15 min following bypass, LVFCs and RVFCs being depressed 35-75% of control. The degree of depression and the pattern of recovery could be predicted best (stepwise logistic regression) by two preoperative indices: the ejection fraction and degree of dyssynergy. Patients with ejection fractions greater than 0.55 and no significant dyssynergy (n = 11) had postbypass LVFCs and RVFCs that were 75% and 60% of control, respectively. However, these depressions were transient, and recovery to 90% of control occurred within 4 h of revascularization. In contrast, patients having preoperative ejection fractions less than 0.45 or dyssynergy (n = 11) had more severely depressed ventricular function (LVFC = 40% and RVFC = 30% of control) that persisted for 24 h after revascularization, resulting in only 60% recovery of ventricular function. In conclusion, the preoperative indices--ejection fraction and degree of dyssynergy--best identified patients most likely to have significant and prolonged biventricular dysfunction after revascularization.

Adult↗
PubMed1999

Dobutamine stress echocardiography for the preoperative evaluation of patients undergoing lung volume reduction surgery.

BACKGROUND: Lung volume reduction surgery has been proposed as a bridge to lung transplantation and as definitive therapy for advanced chronic obstructive lung disease. However, patient selection criteria and optimal preoperative assessment have not been clearly defined. OBJECTIVE: We investigated the feasibility, safety, and value of dobutamine stress echocardiography as a predictor of major early cardiac events in patients who underwent lung volume reduction surgery. METHODS: The study population consisted of 46 patients (21 men and 25 women, mean age 59 +/- 9 years) who underwent dobutamine stress echocardiography (maximum dose 40 microg. kg(-1). min(-1) plus atropine if needed) 180 days or less before lung volume reduction surgery. Adverse cardiac events were prospectively defined and tabulated during hospitalization after the operation and at subsequent outpatient visits. RESULTS: Dobutamine stress echocardiography was interpretable in 45 of 46 (98%) patients. There were no adverse events during testing. The studies revealed normal left ventricular systolic function at rest in all patients and normal right ventricular function in all patients but one. Thirteen patients had right ventricular enlargement. Estimated right ventricular systolic pressure was mildly elevated (>40 mm Hg) in 5 patients. Four patients (9%) had stress tests positive for ischemia. There were no perioperative deaths. Follow-up was available for 44 of 45 patients at a duration of 20.0 +/- 7.0 months. Two major adverse cardiac events occurred in the same patient in whom the results of dobutamine stress echocardiography were positive for ischemia (positive predictive value 25%, 95% confidence interval 0% to 83%; negative predictive value 100%, 95% confidence interval 90 to 100%). CONCLUSION: Despite end-stage chronic obstructive lung disease and poor ultrasound windows, dobutamine stress echocardiography is feasible and safe in patients undergoing evaluation for lung volume reduction surgery. It yields important information on right and left ventricular function and has an excellent negative predictive value for early and late adverse cardiac events.

Adult↗
PubMed2006

[Quantification of right and left ventricular function with magnetic resonance imaging after Senning operation for complete transposition of the great arteries].

INTRODUCTION: The different non-invasive examinations do not result in unambigous results about the long-term determination of right ventricular function providing systemic circulation in children with transposition of the great arteries operated with Senning procedure. AIM: The goal of study was to determine the application of MRI for the observation of right and left ventricular morphology and function, for the recognition of the progression of the disease, and for the necessity of reoperation. METHODS: The authors have observed the morphology and function of the right and left ventricule by ECG triggered short axis MR pictures. For the analysis of MR pictures MASS 5.0 software was used. Authors have determined the end systolic and end diastolic volume, the ejection fraction, the mass, and the stroke volume of the right ventricule, the end systolic and end diastolic volume, ejection fraction, the mass, and the stroke volume of the left ventricle, and the shunt volume. The values of these data corrected to body mass have been calculated. PATIENTS: 176 Senning operations took place between 1980 and 1996. MRI exploration at 21 of the 118 analyzed patients were carried out. RESULTS: The right ventricular ejection fraction value at Senning operated patients is significantly different (49 +/- 9% vs. 70 +/- 4%) from those of healthy children (P < 0.01). Right ventricular stroke volume/m2 and right ventricular end systolic volume/m2 were significantly different compared to normal (43 +/- 10 ml/m2 vs. 48 +/- 7 ml/mn and 46 +/- 16 ml/m2 vs. 21 +/- 5 ml/m2, p < 0.05). Authors found also significant differences in left ventricular ejection fraction in Senning patients as compared to normal (60 +/- 9% vs. 70 +/- 6%, p < 0.01). CONCLUSION: MRI, which is a reliable method of objective determination of right ventricular function, became an available method in Hungary. According to the results, authors might presume that the development of right ventricular dysfunction is expected even among Senning operated children without clinical symptoms, so more frequent control is required. The pathological left ventricular parameters may be explained by ventricular interactions. Authors find MRI an important part of the complex follow-up protocol of Senning operations. MRI data extended by results of other non-invasive explorations are appropriate for the follow-up of right ventricular dysfunction.

Cardiac Surgical Procedures↗
PubMed2006

Dysautonomia and ventricular dysfunction in the indeterminate form of Chagas disease.

BACKGROUND: The associations between autonomic function and biventricular function in patients with the indeterminate form of Chagas disease remains to be elucidated. METHODS: In 42 asymptomatic patients and 19 healthy volunteers, the autonomic function was assessed by time domain indices of heart rate variability (HRV), analyzed for 24 h; the right ventricular function was assessed by fraction area change, right ventricle shortening, and systolic excursion of the tricuspid valve; and the left ventricular function was assessed by ejection fraction and transmitral flow velocities. Data were expressed as mean+/-SD or medians (including the lower quartile and upper quartile). Groups were compared by Student's t or Mann-Whitney U test. Autonomic and ventricular function were correlated by Pearson's or Spearman's correlation coefficient. The level of significance was 5%. RESULTS: Right and left ventricular systolic function indexes were comparable between groups. Transmitral flow velocities were decreased in the Chagas disease group (p<0.05). The patients presented impaired HRV as indicated by the values of SDNN-day (80 (64-99) ms vs. 98 (78-127) ms; p=0.045), SDNNI-24 h (54 (43-71) vs. 65 (54-105) ms; p=0.027), SDNNI-day (49 (42-64) vs. 67 (48-76) ms; p=0.045), pNN50-day (2.2 (0.7-5)% vs. 10 (3-11)%; p=0.033); and pNN50-24 h (3 (1-7)% vs. 12 (8-19)%; p=0.013). There were no correlations between the left ventricular diastolic indices and autonomic dysfunctional indices (p>0.05). CONCLUSION: Patients with the indeterminate form of Chagas disease have both dysautonomia and left ventricular diastolic dysfunction. However, the right ventricular function is preserved. Importantly, ventricular diastolic dysfunction and dysautonomia are independent phenomena.

Adult↗
PubMed1991

Right and left ventricular function after cardiac transplantation. Changes during and after rejection.

BACKGROUND: Attempts to identify noninvasive markers of ventricular dysfunction accompanying acute rejection have been hampered by a lack of detailed simultaneous hemodynamic data. Therefore, we prospectively performed serial monitoring of detailed left and right heart hemodynamic parameters in cardiac transplant recipients at the time of routine endomyocardial biopsy to better define the physiology of the allograft heart during and after acute rejection. METHODS AND RESULTS: To better assess the pathophysiology of the rejection process, 18 cardiac transplant patients were prospectively studied by serial right heart micromanometer catheterization and digital image processing at the time of routine endomyocardial biopsy. Eleven patients had 18 episodes of rejection. Studies of baseline (negative biopsy preceding rejection), rejection (acute moderate rejection), and resolved (first negative biopsy after rejection) states were compared. Seven patients who did not experience an episode of rejection served as the control group. Right ventricular minimum and end-diastolic pressures increased from baseline values of 0.9 +/- 3.2 and 6.9 +/- 3.7 mm Hg, respectively, to 3.2 +/- 5.5 and 9.9 +/- 6.6 mm Hg, respectively, with rejection (both variables, p less than 0.05) and remained elevated despite histological resolution of rejection (4.3 +/- 5.5 and 10.0 +/- 7.1 mm Hg, respectively; p less than 0.05 for both variables compared with baseline values). Concurrently, right ventricular end-diastolic volumes (133 +/- 29, 119 +/- 27, and 114 +/- 30 ml; baseline, rejection, and resolved, respectively) and left ventricular end-diastolic volumes (133 +/- 24, 117 +/- 20, and 113 +/- 30 ml; baseline, rejection, and resolved, respectively) significantly decreased during rejection and remained decreased after resolution of rejection (rejection and resolved compared with baseline values, p less than 0.05). Right ventricular chamber stiffness (0.055 +/- 0.035, 0.085 +/- 0.057, and 0.092 +/- 0.076 mm Hg/ml; baseline, rejection, and resolution, respectively; rejection and resolved compared with baseline values, p less than 0.05) increased with rejection and remained elevated after resolution of rejection. Right ventricular peak filling rate also increased from a baseline value of 2.48 +/- 0.45 to 2.76 +/- 0.63 ml end-diastolic volumes per second with rejection (p less than 0.05). Elevation of right ventricular filling pressures, peak filling rate, and chamber stiffness with a concomitant decrease in end-diastolic volume is consistent with a restrictive/constrictive physiology. Mean arterial blood pressure and systemic vascular resistance were elevated after the resolution of rejection (compared with either rejection or baseline values, p less than 0.05) associated with a higher mean daily dose of prednisone (resolved compared with either baseline or rejection values, p less than 0.05). The control group experienced a time-dependent increase in mean and diastolic systemic arterial pressures (both comparisons, p less than 0.05) without detectable diastolic dysfunction. CONCLUSIONS: Persistence of biventricular diastolic dysfunction may be due to an irreversible effect of rejection, although multifactorial changes in left ventricular afterload occur that may complicate serial assessment of ventricular function.

Adult↗
PubMed1990

Early thrombolytic therapy does not enhance the recovery of the right ventricle in patients with acute inferior myocardial infarction and predominant right ventricular involvement.

In this study we report the effects of early thrombolytic therapy on the recovery of the right ventricle after an acute myocardial infarction. Sixty-five patients presenting with their first inferior myocardial infarction and predominant right ventricular involvement were consecutively treated as follows: group A (20 patients) conservatively (without thrombolytic therapy), group B (19 patients) with streptokinase and group C (26 patients) with recombinant tissue type plasminogen activator. Coronary angiography was performed within 72 h after admission in 52 patients (10 of group A, 18 of group B and in 24 patients of group C) followed by transluminal coronary angioplasty in 26. All groups had similar characteristics except for a higher mean age in group A. Within 3 months, a remarkable improvement in right ventricular function and a major increase in ejection fraction was observed for all three patient groups. Improvement of right ventricular function was more prominent in patients with residual flow through the infarct-related artery. The beneficial course was comparable in all the groups, unaffected by the type of medical treatment applied, or by the performance of coronary angioplasty. No further significant change occurred beyond this period. Thus, early thrombolytic therapy does not augment the generally favorable course of recovery of the right ventricle from acute infarction.

Adult↗
PubMedDate not supplied

Tissue Doppler echocardiography and myocardial performance index in patients with scleroderma.

In this study, left and right ventricular functions were examined echocardiographically in 22 patients with scleroderma and 22 healthy volunteers. Conventional and tissue Doppler echocardiography and myocardial performance indexes were used as measures of right and left ventricular global functions. Mitral early diastolic E wave deceleration time, isovolumetric contraction time and left ventricular myocardial performance index and peak tricuspid A wave velocity were significantly higher in the scleroderma group compared with the control group. Mitral and tricuspid E/A ratios were significantly lower in patients with scleroderma. In addition, mitral annular and tricuspid annular isovolumetric relaxation times and the tricuspid E/E' ratio were significantly increased in scleroderma patients compared with the control group. In conclusion, in scleroderma patients the global left ventricular functions were depressed and diastolic function abnormalities were seen in both right and left ventricles. In addition, longitudinal muscle functions of the ventricles were depressed in scleroderma patients, as shown by tissue Doppler imaging parameters.

Adult↗
PubMed2006

[A study on atrioventricular annular movement in healthy children by tissue Doppler imaging].

OBJECTIVE: Detecting the atrioventricular annular velocity along the long axis of ventricle by tissue Doppler imaging (TDI) is a useful modality to quantitatively assess global myocardial function. The present study was designed to quantitatively assess ventricular function in healthy children by TDI and to evaluate the clinical effect of growth and echocardiographic parameters on TDI velocities during childhood. METHODS: The study enrolled 242 healthy children aged 3 days to 17 years and they were divided into 8 groups: < 1 month of age group (37 cases), 1 month-of age group (28 cases), 7 months-of age group (21 cases), 1 year-of age group (36 cases), 4 years-of age group (40 cases), 7 years-of age group (26 cases), 10 years-of age group (28 cases) and > or = 13 years of age group (26 cases). Pulsed wave TDI velocities were obtained at the lateral mitral annulus (MA-L), basal septum (MA-S) and lateral tricuspid annulus (TA) during ventricular systole (Sa), early diastole (Ea) and late diastole (Aa), and Ea/Aa and E/Ea were obtained. Conventional echocardiography performed done and the parameters of left ventricular end-diastolic dimension (LVEDD), left ventricular ejection fraction (LVEF), the transmitral and transtricuspid flow E wave and A wave velocities and E/A ratio were obtained. TDI parameters were compared with demographic and echocardiographic variables. RESULTS: Sa, Ea and Ea/Aa were the lowest in children < 1 month of age [MA-L: Sa (4.8 +/- 0.7) cm/s, Ea (6.6 +/- 1.1) cm/s; MA-S: Sa (4.1 +/- 0.6) cm/s, Ea (5.0 +/- 0.8) cm/s; TA: Sa (6.2 +/- 1.2) cm/s, Ea (6.4 +/- 1.0) cm/s], and increased with age. The increase was significant from 1 month- to 1 year-of age group 1 year-of age group: MA-L: Sa (8.5 +/- 2.0) cm/s, Ea (16.3 +/- 2.6) cm/s; MA-S: Sa (7.2 +/- 0.8) cm/s, Ea (12.2 +/- 1.6) cm/s; TA: Sa (12.6 +/- 2.3) cm/s, Ea (14.7 +/- 2.6) cm/s. Ea and Sa of TA reached the older children's value earlier than those of the mitral annulus did. Aa increased in the 1 month-of age group compared to < 1 month of age group and remained stable beyond 1 year-of age group. Mitral annulus E/Ea ratio was high among neonates to 7-months-old children (MA-L: 9.2 +/- 2.1, MA-S: 12.1 +/- 2.9), and decreased with age, and there was a significant decrease in 1 year-of age group (MA-L: 5.9 +/- 1.2, MA-S: 7.8 +/- 1.3). In these healthy children, all the above TDI parameters except Aa were influenced by age, body surface area (BSA), LVEDD and heart rate. The influence of age and BSA showed a logarithm model. LVEDD was the main factor that influenced Sa and Ea of MA-L and MA-S, and it was the only single factor that influenced E/Ea ratio at mitral annulus. CONCLUSIONS: This study demonstrated that the left and right ventricular function developed with age in childhood, and it developed most rapidly during infancy and toddler period. The right ventricular function matured earlier than that of the left ventricle. Cardiac growth, age, and heart rate had important clinical effects on TDI velocities during childhood, and LVEDD had the most important influence on left ventricular systolic and diastolic function.

Adolescent↗
PubMed2005

Multislice computed tomography for preoperative evaluation of right ventricular volumes and function: comparison with magnetic resonance imaging.

BACKGROUND: This study was performed to validate preoperative right ventricular measurements obtained from multislice spiral computed tomography data sets in comparison with magnetic resonance imaging. METHODS: Before cardiac surgery, 25 patients (among them 12 patients with compromised right ventricular function) underwent contrast-enhanced retrospectively electrocardiogram-gated multislice spiral computed tomography and cine magnetic resonance imaging in a standardized fashion. Right ventricular end-diastolic, end-systolic and stroke volume, ejection fraction, and myocardial mass were calculated according to the slice summation method. Measurements obtained with both modalities were compared using Pearson's correlation coefficient (r), Student's t test for paired samples, and Bland-Altman analysis. RESULTS: The right ventricle was completely visualized with invariably adequate image quality on all multislice spiral computed tomography and magnetic resonance images. For all measurements a close correlation between multislice spiral computed tomography and magnetic resonance imaging was found (end-diastolic volume, r = 0.93; end-systolic volume, r = 0.95; stroke volume, r = 0.91; ejection fraction, r = 0.96; mass, r = 0.94). Mean values of all measurements did not differ significantly between both modalities, and limits of agreement were in an acceptable range. CONCLUSIONS: When compared with magnetic resonance imaging as a reference method, multislice spiral computed tomography seems to be an accurate and reliable noninvasive technique for evaluating right ventricular measurements.

Adult↗
PubMed1991

Single-lung transplantation for pulmonary vascular disease.

Six patients with end-stage pulmonary vascular disease received right SLTs. Though patients generally had difficult early postoperative courses, four of the six have survived from 3 to 23 months and have achieved good recovery of right ventricular function and good functional results. SLT is a viable option in selected patients with severe pulmonary hypertension even when right ventricular function is severely impaired.

Female↗
PubMedDate not supplied

Assessment of the right ventricle with radionuclide techniques.

The right ventricle has a prominent role in determining overall cardiac function. Thus an accurate measurement of right ventricular (RV) function is important. Radionuclide angiography has advanced our ability to measure RV function. In this way, it has furthered our understanding of the pathophysiology of disease states involving the right ventricle. This article reviews the current methods of measuring RV function by radionuclide angiography. The physiology of normal RV function is discussed. Then several common disease states in which RV dysfunction is prominent are addressed.

Animals↗
PubMed1992

Right and left ventricular functional impairment and sleep apnea.

Obstructive sleep apnea may contribute to the development of pulmonary hypertension and RVF primarily through pulmonary vasoconstriction secondary to hypoxia. Several recent studies indicate, however, that intermittent apnea-related hypoxia is not sufficient to cause sustained pulmonary hypertension. These studies have been consistent in showing that pulmonary hypertension and RVF are almost invariably seen in the presence of diurnal hypoxia. Sustained pulmonary hypertension, therefore, appears to be associated with sustained hypoxia as is the case in COPD. Patients with OSA who have hypoxia while awake are, as a rule, obese and have mild-to-moderate diffuse obstructive airways disease. Thus, most cases of pulmonary hypertension in association with OSA result from a combination of OSA, obesity, and diffuse obstructive airways disease, a so-called overlap syndrome. However, from the therapeutic viewpoint, it is apparent that treatment of OSA by NCPAP or tracheostomy, in such cases, is usually sufficient to reverse pulmonary hypertension and RVF. More recent work has provided strong evidence that OSA can play a role in the pathogenesis of LV heart failure in patients with CHF of otherwise unknown etiology. It is likely that this occurs through a combination of increased LV afterload related to exaggerated negative Pit swings during obstructive apneas, to intermittent hypoxia, and to chronically elevated sympathoadrenal activity. Reversal of OSA by NCPAP in these patients may relieve LV heart failure. These findings add a new dimension to our understanding of the pathophysiologic effects of OSA on the cardiovascular system by demonstrating that the LV is a structure that may suffer functional impairment secondary to the stresses imposed by OSA. Finally, it has now become apparent that CSR in patients with CHF can cause symptoms of a sleep apnea syndrome when associated with intermittent hypoxia and arousals from sleep. Reversal of CSR during sleep by NCPAP can lead to alleviation of these symptoms and possibly to reduced cardiac dyspnea and LV systolic function as well. Taken together, this suggests that much more extensive use of polysomnography may be warranted in the investigation of cardiovascular disease. The reasons are compelling: sleep apnea disorders are common and eminently treatable conditions whose reversal can result in improved right and left heart function and symptomatic improvement in patients with impaired myocardial function.

Cheyne-Stokes Respiration↗
PubMed1987

Positive end-expiratory pressure and the damaged right ventricle. An experimental open versus closed chest study.

Hemodynamic changes after isolated impairment of right ventricular function (produced by increasing afterload by temporary banding of the pulmonary artery) were studied in 22 ventilated pigs during increased levels of positive end-expiratory pressure (4, 8, 12, and 16 cm H2O). In the open chest group, application of positive end-expiratory pressure produced only a slight decrease of cardiac index. After right ventricular damage a decrease of cardiac index of more than 25% occurred only when higher levels of positive end-expiratory pressure were applied. In contrast to the open chest group, the closed chest group showed more distinct cardiovascular responses after positive end-expiratory pressure. In the damaged right ventricle with a positive end-expiratory pressure of 16 cm H2O, right ventricular end-diastolic pressure increased more than 100%. With positive end-expiratory pressure, cardiac index decreased 34% before and 47% after right ventricular damage. We conclude that positive end-expiratory pressure induces a more pronounced decrease in cardiac index if right ventricular function is impaired. During open chest conditions with lower levels of positive end-expiratory pressure, these changes are only small, however, and probably irrelevant. During closed chest conditions, the hemodynamic changes are much more pronounced. High right ventricular end-diastolic pressures resulting from impaired right ventricular contractility as well as from high levels of positive end-expiratory pressure may have an impact on biventricular function and right ventricular coronary driving pressure.

Animals↗
PubMed1998

Pulmonary and cardiac function in advanced fibrodysplasia ossificans progressiva.

Fibrodysplasia ossificans progressiva is a rare genetic disease characterized by heterotopic ossification in soft tissues. Severe disability results from progressive immobilization of the limbs, jaw, and chest wall. To determine whether cardiac function is altered in this disease, 25 patients ranging in age from 5 to 55 years (disease duration 1-51 years) were studied. History, physical examination, pulmonary functions, electrocardiography, and echocardiography were performed on each patient. Physical examination of the lungs and heart was unrevealing; no right sided ventricular gallops were heard, and no patient was found to have neck vein distention or peripheral edema. The patients had extremely limited chest expansion (1.9 +/- 0.8 inches), suggesting dependence on diaphragmatic breathing. Lung volumes were severely reduced (mean forced vital capacity 44% +/- 14% of predicted), but flow rates were relatively normal. All patients had normal capillary oxygen saturation. Echocardiography was technically difficult, but no abnormalities of left or right ventricular function were seen. Ten (40%) patients had electrocardiographic evidence of right ventricular dysfunction. Compared with patients without such evidence, these patients were older, had significantly longer disease duration, higher hemoglobin, and more impaired pulmonary function. The results of this study suggest that the presence of severely restrictive chest wall disease is associated with a high incidence of right ventricular abnormalities on electrocardiogram. Whether cor pulmonale will eventually occur remains to be determined.

Adolescent↗
PubMed1987

Inspiratory impairment in right ventricular performance during acute asthma.

Right ventricular function was investigated in seven asthmatic patients during an acute attack, using simultaneous bedside right heart catheterization and two-dimensional echocardiography (2DE). Hemodynamic and echocardiographic data were compared during four successive periods of the respiratory cycle: inspiration, early expiration, mid-expiration, and late expiration. During inspiration, 2DE showed a significant increase in right ventricular area at both end-systole and end-diastole. This inspiratory right ventricular enlargement coexisted with a significant reduction in 2DE stroke area and pulmonary artery pulse pressure suggesting an inspiratory reduction in right ventricular stroke output. A transient depression of right ventricular function during deep inspiratory effort in asthma was thus strongly suggested. The negative pressure surrounding the right ventricle at inspiration is advocated as the causative factor enabling reduction in the hydraulic force effecting right ventricular ejection. The highly negative pleural pressure probably holds the right ventricular free wall and restrains its systolic inward motion, as suggested by the finding of a concomitant inspiratory reduction in right ventricular developed pressure and 2DE fractional area contraction.

Acute Disease↗