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PubMed1991

Cardiac function and maximal exercise capacity early after acute myocardial infarction.

The purpose of the study was to assess the relationship between left and right ventricular function measured at rest and maximal exercise capacity in patients with recent acute myocardial infarction (AMI). Forty-three male patients (Killip Class I, n = 36; Killip Class II, n = 7) with a wide range of left ventricular (LV) function and size underwent graded bicycle exercise testing less than 4 weeks after AMI (mean 21 days, 17-27). None of the patients had exercise limiting factors other than dyspnoea and fatigue. Left and right ventricular ejection fractions were determined by a radionuclide ventriculographic method which also allowed determination of absolute LV volumes and actual LV peak filling rate. LV ejection fraction had a weak association to estimated maximal oxygen uptake (VO2 max) (r = 0.37). No association was found between LV size, LV stroke volume, or LV peak filling rate and estimated VO2 max. Similarly, right ventricular ejection fraction showed no correlation to estimated VO2 max. Patients with well preserved LV function had a higher exercise induced increase in systolic blood pressure than patients with reduced LV function, but the increase in systolic blood pressure could not be used to estimate LV function with any reasonable accuracy. We conclude that the maximal exercise capacity of patients with recent AMI is virtually independent of their left and right ventricular function determined at rest, and that exercise testing and radionuclide ventriculography should be regarded as complementary procedures in the evaluation of patients with AMI.

Exercise↗
PubMed1979

Morphological variations in pulmonary atresia with intact ventricular septum.

The morphological features of a series of 37 specimens of pulmonary atresia with intact ventricular septum were reviewed with particular emphasis on features which might influence the results of pulmonary valvotomy. The degree of right heart hypoplasia was quantified by measuring right and left heart dimensions and comparing them with 20 normal infant hearts. Right ventricular cavity size was usually smaller than normal but constituted a spectrum ranging from tiny to a dilated ventricle larger than normal. There was a positive correlation between triscuspid annular size and right ventricular size but no correlation between the size of the pulmonary artery and the right ventricle. Successful pulmonary valvotomy with subsequent adequate right ventricular function would have been precluded by a tiny right ventricular cavity or infundibular atresia in 14 specimens and by severe tricuspid stenosis or regurgitation in an additional 4. Severe right or left ventricular endocardial fibroelastosis may have adversely affected ventricular function in several others. Ten specimens displayed convex bulging of the left ventricular septal surface. If these these anatomical findings are representative for the condition as a whole, they provide a good explanation for its disastrous prognosis.

Ebstein Anomaly↗
PubMed1990

Wavefront myocyte injury and relationship to function in right ventricular ischemia.

Past studies of acute canine right ventricular (RV) ischemia have failed to demonstrate early irreversible injury or decreased function. However, the dog frequently has an extensive collateral circulation not found in all humans. The aim of this study was to measure RV global and regional function after right coronary occlusion in 32 closed-chest pigs. RV function was assessed by biplane ventriculography, and myocardial injury was examined by immunohistochemical localization of creatine kinase (CK) and by electron microscopy. Global RV ejection fraction and apical and midventricular regional function declined significantly after 10 min of occlusion. Injury to the myocardium progressed from the endocardium to the epicardium. Significant injury was observed in myocytes of the endocardium, midmyocardium, and epicardium at 10, 30, and 60 min of occlusion, respectively. Regional RV function and the extent of myocardial injury showed a high correlation (r = 0.96, P less than 0.01). The strong CK immunostaining seen in control hearts was diminished in myocytes along the endocardium at 15 min of occlusion. Depletion of immunoreactive CK in myocytes progressed toward the epicardium with longer ischemic times. These findings demonstrate that RV ischemic injury progresses in a wavefront fashion in the pig, which has similar coronary anatomy to humans, and irreversible myocardial injury occurred after 15-30 min of ischemia.

Animals↗
PubMed1993

Magnetic resonance imaging for quantitation of right ventricular volume in patients with pulmonary hypertension.

Evaluation of right ventricular function in patients with right-sided heart failure is difficult because of the complex anatomy of the right ventricle; the distinct geometry of the dilating, failing right ventricle; its variance from the typical oblate spheroid shape used to model the left ventricle; associated cardiac lesions in patients with right ventricular failure (including tricuspid and pulmonary regurgitation); and the inherent risk of conventional contrast ventriculography. With magnetic resonance techniques, tomographic images of the heart may be obtained at multiple points in the cardiac cycle without the use of intravascular contrast agents. From the end-diastolic and end-systolic images, chamber volume may then be determined directly without any modeling assumptions as to the geometry of the ventricular chamber.

Cardiac Volume↗
PubMed1998

Nongeometric quantitative assessment of right and left ventricular function: myocardial performance index in normal children and patients with Ebstein anomaly.

Assessment of ventricular systolic function has been based on the geometric models of ventricular shape. This study was designed to define normal values for a nongeometric myocardial performance index (MPI) in children and to evaluate the utility of MPI in congenital heart disease. The MPI measures the ratio of total time spent in isovolumic activity (isovolumic contraction time and isovolumic relaxation time) to the ejection time. The right ventricular (RV) and left ventricular (LV) MPI were measured in 152 normal children (ages 3 to 18 years) and 45 preoperative patients with Ebstein anomaly (age 1 week to 52 years). In normal children, the RV MPI was 0.32+/-0.03 and the LV MPI was 0.35+/-0.03. In the Ebstein group, both RV and LV MPI were abnormally increased compared with age-matched normal subjects (Ebstein group: RV MPI=0.49+/-0.12, LV MPI=0.42+/-0.09, P < .001). Increasing RV dysfunction was associated with progressively increasing (abnormal) values of RV MPI (P < .001). The myocardial performance index quantitatively reflects ventricular performance in patients with complex ventricular geometry (ie, Ebstein anomaly). In the absence of a geometric solution, this nongeometric index is particularly appealing for the assessment of RV or LV performance.

Adolescent↗
PubMed2004

Tricuspid valve repair in hypoplastic left heart syndrome.

OBJECTIVES: Currently, the survival for the Norwood procedure for hypoplastic left heart syndrome is approximately 90% in selected centers. However, the development of tricuspid regurgitation remains a significant obstacle to successful staged repair in a subset of these patients. The results of tricuspid valve repair in this challenging patient population remain largely unknown. METHODS: Twenty-eight patients with significant (3-4+) tricuspid regurgitation after the Norwood procedure required tricuspid valve repair from August 1995 through December 2002. The clinical and Doppler-echocardiographic data were reviewed to determine the efficacy of repair and patient outcome. RESULTS: Follow-up was 96% complete (27/28). Patients were divided into 2 groups on the basis of tricuspid regurgitation at late follow-up: those with a successful late outcome (0-2+) and those with a poor outcome (3-4+). There were 17 (63%) patients with a successful result and 10 (37%) with an adverse outcome. Age, weight, follow-up duration, valve anatomy, and stage of palliation were not significantly different between groups. Early postoperative 0 to 2+ regurgitation was associated with a durable result (P =.012) and preserved ventricular function (P =.04). Need for repair other than a partial annuloplasty was predictive of a poor outcome (P =.04). Overall survival was 67% (18/27). Survival was 94% (16/17) for patients with a successful late result versus 20% (2/10) for those with a poor outcome (P =.0002). CONCLUSIONS: Tricuspid valve repair can be accomplished in this challenging patient population with excellent results. Successful tricuspid valve repair is predictive of continued good valve function and preserved right ventricular function. Successful valve repair at late follow-up predicts excellent late survival.

Child↗
PubMed2002

Fan-shaped expanded polytetrafluoroethylene valve in the pulmonary position.

BACKGROUND: Residual pulmonary insufficiency remains a problem after transannular repair in pediatric patients. We have developed fan-shaped monocuspid and bicuspid valves made of expanded polytetrafluoroethylene (ePTFE) membrane for repair of right ventricular outflow tract obstruction in patients with tetralogy of Fallot. METHODS: We studied 20 patients (mean age, 39.6 months) with tetralogy of Fallot. The right ventricular outflow tract was reconstructed with use of a short, wide transannular patch and a fan-shaped valve made of 0.1-mm-thick expanded ePTFE membrane (PRECLUDE Pericardial Membrane, W.L. Gore & Associates, Inc, Flagstaff, AZ). The width of the valve and the outflow patch were constructed so that the neopulmonary annulus was approximately 130% the normal size. RESULTS: A monocuspid valve was used in 17 patients and a bicuspid valve in 3. The mean follow-up time was 32.3 months (range, 14.7 to 56.7 months). Right ventricular function was well maintained in all patients. Valvular motion remained competent in 13 patients (65%). In the remaining 7 (35%), the valve became fixed in the open position. Trivial and mild pulmonary insufficiency was detected in 10 patients with a competent valve and 7 with an incompetent valve. No pressure gradient across the neopulmonary annulus or calcification of the expanded ePTFE membrane was detected in any patient. CONCLUSIONS: The fan-shaped expanded ePTFE valve is a useful substitute with adequate function in transannular right ventricular outflow reconstruction.

Bioprosthesis↗
PubMedDate not supplied

Determination of right ventricular ejection fraction by two-dimensional echocardiographic single plane subtraction method.

Right ventricular ejection fraction is a useful measurement for evaluating right ventricular function in various states, including coronary artery disease, chronic obstructive pulmonary disease, and both congenital and valvular heart diseases. The right ventricular geometry has made it difficult to evaluate right ventricular ejection fraction by simple echocardiographic methods. In this study 36 consecutive patients were examined by two-dimensional echocardiography within 4 hours of radionuclide-determined right ventricular ejection fraction to test a simplified method for calculating right ventricular ejection fraction by two-dimensional echocardiography. Echocardiographic measurements were independently determined in the subcostal and apical four-chamber views. Correlation with first pass radionuclide right ventricular ejection fraction was r = 0.89 and 0.84. Right ventricular ejection fraction could be calculated from one of two views in 92% of patients studied. This technique for determination of right ventricular ejection fraction offers a simple noninvasive method of evaluating right ventricular function.

Adolescent↗
PubMed2004

Doppler tissue imaging analysis of ventricular function after surgical and transcatheter closure of atrial septal defect.

The long-term ventricular function of children after surgical and transcatheter closure of secundum atrial septal defects was assessed by Doppler tissue imaging and compared with that of age-matched controls. Long-term right ventricular function was impaired in patients after surgical repair, as reflected by decreased systolic and diastolic tricuspid annular velocities and an increased Tei index. In contrast, right ventricular function was preserved after transcatheter device closure.

Adolescent↗
PubMed1991

[Right ventricular hypertrophy in rats: effect of ACE inhibitors].

Models of right ventricular hypertrophy in rats have been created and characterized: Daily injections of triiodothyronine, irradiation of the lung in Brown-Norway rats, chronic myocardial infarction, and pulmonary artery stenosis. A new Millar ultraminature catheter pressure transducer designed for right heart catheterization allowed the measurement of right ventricular function. All models were characterized by an increase in right ventricular systolic pressure, by an elevation in the RNA/DNA ratio in the right ventricle, and by an increase in the right ventricular weight/body weight ratio. Myocytes isolated from the right ventricle 4 weeks after coronary artery ligation had a greater volume and cross sectional area. Similar results were obtained 14 days after pulmonary artery stenosis. In this model, the effect of angiotensin converting enzyme inhibition with ramipril (1 mg/kg, daily) was examined. The increase in right ventricular systolic pressure from 35 +/- 2 mm Hg to 61 +/- 4 mm Hg (without ramipril) was not influenced by ramipril (63 +/- 4 mm Hg), neither was the elevation of right ventricular weight. However, the increase in cell volume and cross-sectional area of myocytes isolated from the right ventricle was less pronounced in the ramipril-treated group (+27% compared to +58% in untreated animals). Thus, angiotensin converting enzyme inhibition with ramipril altered the hypertrophic response at the cellular level.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1992

[Long-term results of Mustard operation in transposition of the great arteries. Angiographic and nuclear medicine study of ventricular function].

The fate of the right ventricle as systemic ventricle after atrial repair of complete transposition of the great arteries has not been clearly elucidated. In order to assess the long-term results of the Mustard operation in patients with complete transposition of the great arteries we present the clinical data of 23 patients who had been operated in the years 1974 and 1975. Twenty of these patients had simple complete transposition of the great arteries with intact ventricular septum, two had an additional small ventricular septal defect and one an additional left ventricular outflow tract obstruction with a 40 mm Hg systolic pressure gradient. The Mustard operation had been performed at a mean age of 2.2 (1 to 3.7) years. Seventeen of the 23 patients underwent a postoperative hemodynamic study with angiocardiography 1.1 (1 to 1.8) years following surgery. At that time the right ventricular ejection fraction, which had been calculated from biplane angiographic right ventricular volume measurements in twelve patients was 62 (52 to 68) %. However the right ventricle was dilated and the mean enddiastolic volume was 132 (108 to 192) % of normal. In twelve of the 23 patients right ventricular function was reassessed 12.6 (11 to 15.3) years after surgery by Technetium-99m-scintigraphy at rest and in ten of those after exercise with a workload of 2 watt/kg. The mean ejection fraction was 51 (38 to 66) % at rest and 52 (40 to 80) % during exercise. Only three patients had a normal response to exercise, which was defined as an increase of ejection fraction with exercise of more than 5%.(ABSTRACT TRUNCATED AT 250 WORDS)

Angiocardiography↗
PubMed2003

[Left ventricular function in adult patients after the atrial switch operation for transposition of the great arteries].

OBJECTIVES: Right ventricular function may deteriorate after the atrial switch operation in patients with transposition of the great arteries, but the effect on left ventricular function is unknown. Chronic left ventricular function was evaluated in adult patients after the atrial switch operation for transposition of the great arteries. METHODS: Right and left ventricular functions were evaluated using data from cardiac catheterization performed in nine patients older than 17 years who had undergone the atrial switch operation for transposition of the great arteries. The mean age at operation was 19 +/- 16 months and the age at catheterization ranged from 17 to 32 years (mean age 23 +/- 5 years). Echocardiography was performed in all patients to evaluate tricuspid regurgitation. Myocardial perfusion studies using technetium-99 m-tetrofosmin were assessed in five patients. RESULTS: Mean right ventricular end-diastolic volume was slightly increased to 122 +/- 27% of the normal value and mean right ventricular ejection fraction was depressed to 44 +/- 5% of the normal value. Left ventricular ejection fraction ranged from 37% to 63% (mean 50 +/- 7%) and was under 50% in four of the nine (44%) patients. Right ventricular ejection fraction was positively correlated with left ventricular ejection fraction(r = 0.72, p < 0.05). All patients had tricuspid regurgitation, mild in four, moderate in four, and severe in one patient. Left ventricular ejection fraction was lower in patients with moderate or severe tricuspid regurgitation(54 +/- 4%) than in patients with mild tricuspid regurgitation(47 +/- 6%, p < 0.05). Mild or moderate perfusion abnormalities were observed in all patients (five of five) who underwent myocardial perfusion studies. Mean right and left ventricular ejection fractions were 43 +/- 3% and 50 +/- 3%, respectively, in patients who underwent myocardial perfusion study, which were under the normal levels. CONCLUSIONS: Left ventricular dysfunction is common in adult patients after the atrial switch operation for transposition of the great arteries. Some right ventricular abnormalities may correlate with the left ventricular dysfunction.

Adolescent↗
PubMed2005

Color Doppler tissue imaging for evaluation of right ventricular systolic function in patients with congenital heart disease.

OBJECTIVE: We sought to explore the relationship of color Doppler tissue imaging-derived systolic indices of tricuspid valve annular motion and magnetic resonance imaging-derived right ventricular (RV) ejection fraction in patients with congenital heart disease. METHODS: Patients with congenital heart disease who underwent echocardiography and magnetic resonance imaging on the same day were included. The tricuspid valve annular color Doppler tissue imaging-derived parameters of peak velocity during isovolumic contraction, myocardial acceleration during isovolumic contraction, peak systolic velocity, and Tei index were compared with magnetic resonance imaging-derived RV ejection fraction. RESULTS: Peak systolic velocity and myocardial acceleration during isovolumic contraction correlated well with RV ejection fraction after adjusting for age, RV dilation, and pressure overload (r = 0.65 and 0.73, respectively). Interobserver and intraobserver reliability were excellent for peak systolic velocity (r = 0.95 and 0.97, respectively) and very good for myocardial acceleration during isovolumic contraction (r = 0.93 and 0.85, respectively). CONCLUSIONS: Color Doppler tissue imaging indices of tricuspid valve annular motion are reproducible and provide a potentially useful complementary tool for assessment of RV systolic function in patients with congenital heart disease.

Adolescent↗
PubMed2000

Role of the etiology of cardiomyopathies on exercise capacity and oxygen consumption in patients with severe congestive heart failure.

Peak oxygen consumption is of great importance for the decision of heart transplantation in congestive heart failure. Moreover, the level of exercise capacity seems to depend on the etiology of congestive heart failure. This study compared 14 heart failure patients with idiopathic dilated cardiomyopathy (group 1) to 14 heart failure patients with cardiomyopathy due to ischemic heart disease (group 2), matched for sex (13 male, one female in each group), age +/-10 years, left ventricular ejection fraction +/-5% and pulmonary artery mean pressure +/-5 mm Hg, to assess exercise capacity and oxygen consumption independently of the age, sex and the level of left ventricular dysfunction. Right ventricular function was also assessed. No difference existed in terms of right ventricular parameters. Maximal exercise parameters were significantly higher in group 1 than in group 2. Peak oxygen consumption was statistically higher in group 1 than in group 2. In the whole population, a significant correlation was found between peak oxygen consumption and right ventricular ejection fraction (r=0. 44, P<0.02) but not between peak oxygen consumption and left ventricular ejection fraction. For similar levels of left ventricular dysfunction, exercise capacity and oxygen consumption appear to be better in idiopathic dilated cardiomyopathy than in ischemic cardiomyopathy, thereby suggesting that functional tolerance of left ventricular dysfunction might depend on the etiology of severe congestive heart failure.

Cardiomyopathies↗
PubMed1999

Late results of Senning operation.

OBJECTIVES: Few data exist for long-term results after the Senning operation for transposition of the great arteries. Sinus node dysfunction and systemic ventricular dysfunction have been the main problems. We evaluated risk factors for late death and the incidence of late death, sinus node dysfunction, and right ventricular dysfunction in 100 patients. METHODS: The study was a retrospective analysis with a mean follow-up time of 12.8 +/- 3.1 years. No patients were lost to follow-up. Patients were divided in 2 groups according to ventricular septal defect (73 simple, 27 complex). The electrocardiogram, ambulatory electrocardiogram, echocardiogram, and chest radiograph were reviewed for each patient. RESULTS: The overall mortality rate was 10%. The actuarial survival was 90% (simple) and 78% (complex); the probability of staying in sinus rhythm was 34% and 7%, and the probability of normal right ventricular function was 52% and 39%, respectively, 15 years after operation. The incidence of sinus node dysfunction increased gradually over time, although the incidence of right ventricular dysfunction increased rapidly after 10 years of follow-up. Late deaths, arrhythmias, and right ventricular dysfunction were significantly more frequent in the complex group. Right ventricular dysfunction and active arrhythmias were risk factors for late death. CONCLUSION: Long-term follow-up after the Senning operation shows increasing incidence of sinus node dysfunction and right ventricular dysfunction over time. Deteriorating right ventricular function is a major concern. Its early recognition and initiation of appropriate management to preserve cardiac function is an important follow-up goal.

Actuarial Analysis↗
PubMed2005

Spontaneous improvement of severe right ventricular dysfunction in the setting of hypoplasia of the left heart.

Right ventricular dysfunction is known to occur after the first stage of the Norwood sequence for treatment of patients with hypoplasia of the left heart. In a subset of patients, such ventricular dysfunction occurs without a specific anatomical cause. We describe two such cases with severe right ventricular dysfunction. In both cases, magnetic resonance imaging was used accurately to measure ventricular function and assess the arterial trunks. In both cases, cardiac transplantation was considered, but right ventricular function improved without invasive management. Transient right ventricular dysfunction in these cases may be due to the reduced ability of the right ventricle to adapt to the systemic vasculature. The improvement in ventricular function in these two cases may be due to delayed adaptation.

Female↗
PubMed1987

[Videodensitometric assessment of right and left ventricular functions by digital subtraction angiography].

Right and left ventricular volumes and systolic indices were determined by intravenous digital subtraction ventriculography in 50 patients with various heart diseases. Using a constant injection speed of 35 ml Renografin-76 contrast medium, serial right and left ventriculograms were obtained in the 30 degree right anterior oblique projection. Right ventriculograms were also obtained in the 60 degree left anterior oblique projection. The videotape recordings of subtracted images were continuously digitized into 128 X 128 eight bit (256 gray scales) pixel matrices using an image-processing computer. The endocardial outlines of the right and left ventricles were drawn manually using a joystick, frame by frame, for each cardiac cycle. By integrating overall the pixel densitometric counts within this outline for each frame, the computer generated a time-density curve with maxima and minima represented in the end-diastolic and end-systolic frames, respectively. Systolic indices including ejection fraction (EF), one-third ejection fraction (1/3 EF) and the peak ejection rate (PER) were derived from the time-density curve. Right ventricular volume was determined by the single-plane or biplane mathematical formulae of Ferlinz et al., and left ventricular volume was calculated by the area-length method in the 30 degree right anterior oblique projection. Results by the two geometric methods correlated well for right ventricular volume (r = 0.84) and for EF (r = 0.80). Right ventricular densitometric counts correlated closely with single-plane volume (r = 0.91). Right ventricular ejection fraction (RVEF) determined by videodensitometry also correlated satisfactorily with that by single-plane angiography (r = 0.74).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗