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PubMed1998

[Acoustic quantification of right ventricular dimensions and systolic function].

In view of the important prognostic significance of right ventricular systolic function, there have been many non-invasive studies of this subject. The majority of these studies have been limited by difficulties in modelisation of this geometrically complex cardiac chamber. Automatic border detection by acoustic quantification based on the back scatter of ultrasound provides a "direct" method of analysing right ventricular dimensions and functions. The authors undertook a prospective study of 34 patients to evaluate the reliability of this technique in measuring the surfaces and fractional shortening of the right ventricle. The feasibility was 92%. The correlation coefficients between the manual two-dimensional technique and automatic border detection were 0.81 for the end diastolic surface areas, 0.85 for the end systolic surface areas and 0.74 for the fractional shortening. Compared with the isotopic ejection fraction, the correlation coefficient was 0.73. The authors conclude that acoustic quantification is a feasible and reliable technique of measuring right ventricular dimensions and its contractile function.

Adult↗
PubMedDate not supplied

Successful treatment of postoperative right ventricular heart failure with the HIA-Medos-assist system in a 2-year-old girl.

One year after total correction of tetralogy of Fallot, reoperation was performed in a 2-year-old infant because of an aneurysm of the right ventricular outflow tract. After removal of the aneurysm, massive right ventricular failure occurred. Maximal medical inotropic support could not reestablish sufficient right ventricular function. Therefore, it was decided to implant the new HIA-Medos system as a right ventricular assist. In the postoperative period, echocardiographic controls showed increasing contractility of the right ventricle. The assist system was removed after 3 days and the infant was discharged in good condition on the 22nd postoperative day.

Child, Preschool↗
PubMed1989

[Right ventricle support after lung resection].

It is very important to establish a method of determining the influence of lung resection on right ventricular function and to devise some therapeutic methods of supporting the right ventricle. However, there has been no systematic research on these issues. We found that echocardiographic demonstrated abnormal motion of the ventricular septum after right pneumonectomy and of the left ventricular wall after left pneumonectomy. We developed a triggered cuirass respirator and showed that it could support the right heart after a lung resection. We also found that the injection of SF6 Gas into the postpneumonectomy pleural space might be useful in supporting the right heart after a pneumonectomy.

Adult↗
PubMed1984

The effects of theophylline and salbutamol on right and left ventricular function in chronic bronchitis and emphysema.

We have compared the effects of oral theophylline and salbutamol on right and left ventricular function in twelve patients with chronic bronchitis and emphysema. Right and left ventricular ejection fraction (RVEF and LVEF) were measured using multiple gated radionuclide ventriculography. Theophylline 600 mg and salbutamol 4 mg both produced increases in RVEF and LVEF. There were no significant changes in blood gases after either drug. The clinical significance of the effects of oral bronchodilators on cardiac function in patients with chronic bronchitis and emphysema has yet to be determined.

Adult↗
PubMed2004

Long-term results of left ventricular reconditioning and anatomic correction for systemic right ventricular dysfunction after atrial switch procedures.

OBJECTIVES: Systemic right ventricular failure after atrial switch procedures for transposition of the great arteries has been addressed at Melbourne's Royal Children's Hospital (1981-1993) and the Cleveland Clinic Foundation (1993-2001) with reconditioning of the morphologically left ventricle by means of pulmonary artery banding followed by an arterial switch operation and an atrial reseptation. METHODS: Thirty-nine patients (Royal Children's Hospital, 19; Cleveland Clinic Foundation, 20) with a median age of 10.8 years (range, 13 months-24 years) entered this protocol a median of 10.3 years (range, 0.5-24 years) after an atrial switch procedure. RESULTS: The median duration of pulmonary artery banding was 13 months (range, 0.5-5.4 years). Ten (28%) patients responded unfavorably to morphologically left ventricular reconditioning (5 mortalities: 4 transplantations and 1 PAB still in place). Twenty-four (83%) of the 29 patients who underwent an atrial switch operation and atrial reseptation survived. During a median follow-up period of 8.2 years (range, 1-16 years), 3 patients had cardiac-related deaths. All 18 long-term survivors are asymptomatic. At last echocardiographic evaluation, the morphologically left ventricular function was normal or mildly decreased in 16 (89%) patients, and all had normal or mildly decreased systemic right ventricular function with no or mild tricuspid regurgitation. Age greater than 12 years was associated with a greater probability of morphologically left ventricular failure and not completing the protocol (P =.02) and a higher operative mortality at anatomic correction (P =.02). CONCLUSIONS: Morphologically left ventricular reconditioning and an anatomic correction protocol should be integrated into a cardiac transplantation program when treating patients with morphologically right ventricular failure after Mustard and Senning procedures. It is an alternative to cardiac transplantation in selected patients, with good long-term results. The response to morphologically left ventricular reconditioning past adolescence is inconsistent.

Adolescent↗
PubMed2002

Assessment of cardiac performance using Tei indices in patients undergoing pulmonary thromboendarterectomy.

BACKGROUND: This study was designed to evaluate left and right ventricular performance using Tei indices in patients with severe chronic thromboembolic pulmonary hypertension undergoing pulmonary thromboendarterectomy (PTE). The Doppler-derived indices are easily measurable indicators of ventricular function based on nongeometric assessment, which helps overcome some of the difficulties entailed in the geometric assessment of left ventricular (LV) and right ventricular (RV) function in pulmonary hypertension. METHODS: The indices were derived for 24 patients (aged 54+/-14 years) before and after PTE. Calculation of these indices was based on the duration of two time intervals using the formula (A - B)/B, where A is the interval between cessation and onset of mitral inflow (or tricuspid inflow) and B is LV or RV ejection time. In addition, LV and RV end-diastolic and end-systolic chamber areas were determined using two-dimensional echocardiography, and systolic function was calculated. Mean pulmonary artery pressure was determined invasively. RESULTS: PTE led to a significant reduction of mean pulmonary artery pressure (46+/-10 versus 25+/-6 mm Hg; p < 0.05). LV and RV indices were abnormally high before surgery, declined significantly afterwards, and then almost matched normal values (0.61+/-0.26 versus 0.37+/-0.18; p < 0.05 and 0.55+/-0.22 versus 0.37+/-0.13; p < 0.05). Geometric assessment of the left and right ventricle also showed impaired systolic function before PTE, with significant improvement after surgery. CONCLUSIONS: LV and RV Tei indices allow a quantitative assessment of ventricular function in patients undergoing PTE. Lower indices after surgery reflect an improvement of the previously impaired cardiac function. Our results emphasize the value of PTE in the treatment of chronic thromboembolic pulmonary hypertension.

Adult↗
PubMed1984

Right bundle branch block in complete transposition.

Two of 26 infants with complete transposition presented with complete right bundle branch block in the first year of life, and 10 showed incomplete right bundle branch block. In no instance was the right ventricular conduction anomaly related to surgery or cardiac catheterization and it was not present at birth. The two cases with complete right bundle branch block had prolonged and severe hypoxemia and markedly dilated right ventricles. One had depressed right ventricular function and died after a Mustard procedure from low output syndrome. Whereas incomplete right bundle branch block may reflect right ventricular hypertrophy, it is suggested that complete right bundle branch block in complete transposition may signify right ventricular dysfunction and possibly irreversible changes of the right ventricular myocardium. It may be a sequel of long-term hypoxemia and pressure overload. Once observed, it is perhaps an indication for an alternative surgical approach other than an intra-atrial repair procedure.

Bundle-Branch Block↗
PubMed1995

Arterial switch for pulmonary venous obstruction complicating Mustard procedure.

Two patients underwent an arterial switch procedure for the relief of severe pulmonary venous obstruction complicating a Mustard procedure. Without preparatory pulmonary banding, both patients had adequate left ventricular function due to secondary pulmonary hypertension. At 8 and 4 years after the procedure, both patients are in New York Heart Association functional class I, with echocardiographic evidence of good left and right ventricular function.

Heart Septal Defects, Atrial↗
PubMed1988

[Comparative angiographic evaluation of the functions of the left and right heart ventricles in dilated cardiomyopathy].

The paper is concerned with comparative analysis of disorder of left and right ventricular function (LV and RV, respectively) in 30 patients with dilatation cardiomyopathy after coronography, left and right ventriculography, myocardial biopsy. Disorder of LV and RV contractility was noted, however in most cases LV dysfunction was more noticeable. Direct correlation was revealed between the gravity of LV dysfunction and heart failure, whereas no significant differences were noted between RV parameters and heart failure, IIA-IIB stages.

Adult↗
PubMed1999

Phase-related changes in right ventricular cardiac output under volume-controlled mechanical ventilation with positive end-expiratory pressure.

OBJECTIVE: To examine determinants of right ventricular function throughout the ventilatory cycle under volume-controlled mechanical ventilation with various positive end-expiratory pressure (PEEP) stages. DESIGN: Prospective observational animal pilot study. SETTING: Animal research laboratory at a university hospital. SUBJECTS: Eight healthy swine under volume- controlled mechanical ventilation. INTERVENTIONS: Flow probes were implanted in eight swine in order to continuously measure blood flow in the pulmonary artery and inferior vena cava. After a recovery phase of 14 days, the swine were subjected to various PEEP stages (0, 5, 10 cm H2O) during volume-controlled positive pressure ventilation. MEASUREMENTS AND MAIN RESULTS: Continuous flow measurement took place in the pulmonary artery and inferior vena cava. Data on standard hemodynamic parameters were additionally acquired. Respiration-phase-specific analysis of right ventricular cardiac output and of additional hemodynamic function parameters followed, after calculation of mean values throughout five respiration cycles. PEEP at 5 cm H2O led to significant decreases in inferior vena cava flow (4.1%), and in right ventricular cardiac output (5.2%); the respective decreases at PEEP 10 cm H2O were 13.9% and 18.3%. In the inspiration phase at PEEP 10 cm H2O, results revealed an overproportionally pronounced decrease in comparison with the expiration phase in inferior vena cava flow (-24.6% vs. -10%) and right ventricular cardiac output (-35% vs. -13.5%). This phenomenon is presumably caused by a PEEP-related increase in mean airway pressure by the amount of 10.7 cm H2O in inspiration. CONCLUSIONS: Increases in PEEP during volume-controlled mechanical ventilation leads to respiration-phase-specific reduction of right ventricular cardiac output, with a significantly pronounced decrease during the inspiration phase. This decrease in cardiac output should be taken into particular consideration for patients with already critically reduced cardiac output.

Airway Resistance↗
PubMed1988

Pimobendane (UD-CG 115 BS) in the treatment of severe congestive heart failure. An acute haemodynamic cross-over and double-blind study with two different doses.

1. We compared the effects of two doses (5 and 10 mg) of oral pimobendane (UD-CG 115) on haemodynamics in eight patients suffering from chronic congestive heart failure. The two doses were given according to a randomized cross-over double-blind protocol; haemodynamics and plasma levels of pimobendane and its main metabolite UD-CG 212, were determined 1, 2, 3, 5, 7, 9, 11 and 12 h after each dose. 2. Both doses significantly improved the left and right ventricular functions of these patients, with a peak action 3 h after drug intake and long duration (more than 12 h). A significant dose-effect relationship was observed only for pulmonary wedge pressure and right atrial pressure. Significant correlations were found between UD-CG 212 plasma levels and cardiac index (r = 0.54, P less than 0.05), and pulmonary wedge pressure (r = 0.74, P less than 0.001); no correlation was found between these haemodynamic variables and pimobendane plasma levels. 3. One patient developed a transient drop in blood platelets together with a cutaneous rash, while three others had a transient and mild decrease of thrombocytes. 4. In conclusion, pimobendane improved right and left ventricular functions in severe heart failure. Both doses (5 and 10 mg) were effective. The higher dose induced marked improvement of the haemodynamic variables but the difference between doses was only significant for right atrial and pulmonary wedge pressures.

Aged↗
PubMed1992

[Radionuclide ventriculography as a method for assessing the functional status of the heart ventricles in patients with supraventricular tachycardia].

Left and right ventricular function was evaluated by means of radionuclide ventriculography in 44 patients with paroxysms of supraventricular tachycardia without sings of circulatory insufficiency of coronaro- and noncoronarogenic origin. Depending on the efficacy of antiarrhythmic treatment the patients were subdivided in two groups: patients amenable to treatment and patients with refractory arrhythmia. It was established that radionuclide ventriculography allows to objectively evaluate the functional state of both ventricles and to reveal early signs of deterioration of the hemodynamic productivity of the heart in patients with paroxysms of supraventricular tachycardia. Reduction of the pumping function of the right ventricle in patients with refractory tachycardia along with hyperkinesia of its separate segments, changes of left ventricular rate and an increase of the terminal diastolic and systolic volumes of both ventricles without changes of the stroke volume may be a criterion of refractoriness of arrhythmia in this category of patients.

Adolescent↗
PubMed2000

Modification of cardiac function in cirrhotic patients with and without ascites.

OBJECTIVES: Abnormalities in cardiac function have been reported in liver cirrhosis, suggesting a latent cardiomyopathy in these patients. In this study we investigated cardiac function in cirrhotic patients and in controls. METHODS: A total of 20 cirrhotic patients without previous or ongoing ascites, 20 cirrhotic patients with moderate-to-severe ascites, and 10 healthy controls were studied by two-dimensional Doppler echocardiography. Cardiac dimensions and left and right ventricular function were evaluated. The left ventricular geometric pattern was calculated according to Ganau's criteria. Diastolic function was evaluated by the peak filling velocity of E wave and A wave, E/A ratio, and deceleration time of E wave. The pulmonary systolic arterial pressure was also estimated in patients with tricuspid insufficiency. RESULTS: Right and left atrium and right ventricle diameters were significantly enlarged in cirrhotic patients versus controls. E/A ratio was decreased (p < 0.05) in patients with ascites (0.9 +/- 0.2) versus those without ascites (1.3 +/- 0.4) and controls (1.3 +/- 1). The estimated pulmonary systolic arterial pressure was slightly elevated in patients with ascites (35 +/- 5 mm Hg, six patients) versus those with no ascites (28 +/- 5, 10 patients) and controls (27 +/- 8, 6 controls, analysis of variance, p < 0.05). The pattern of left ventricular geometry was normal in the majority of patients. Nitrite and nitrate levels were increased in cirrhotics irrespective of the presence of ascites. CONCLUSIONS: Liver cirrhosis is associated with enlarged right cardiac chambers. Diastolic dysfunction and mild pulmonary hypertension are evident in cirrhotic patients with ascites. These changes do not depend on variations in the left ventricular geometry.

Ascites↗
PubMed2001

Doppler velocimetry in superior vena cava provides useful information on the right circulatory function in patients with congestive heart failure.

BACKGROUND: Although flow velocities curves recorded with pulsed-wave Doppler in systemic vein are known to provide functional data on the right circulatory function, little information is available on the relationship between right heart filling dynamics and right ventricular function. METHODS: Consecutive patients with chronic heart failure due to severe systolic left ventricular dysfunction and in sinus rhythm underwent echocardiography and right heart catheterization. In the initial part of the study, the hemodynamic correlates of different flow velocity patterns recorded into the superior vena cava were evaluated in 120 patients. The accuracy of the prediction of different right heart hemodynamic profiles by means of the different venous flow patterns was then prospectively tested in a subsequent series of 86 patients. RESULTS: The venous flow pattern was closely related to right heart hemodynamics. A normal Doppler pattern identified patients with normal right heart hemodynamics (sensitivity 86%, specificity 78%); a "predominant systolic wave" pattern identified patients with a reduced thermodilution-derived right ventricular ejection fraction (< 30%) and normal or slightly elevated right atrial pressure (< or = 8 mmHg) (sensitivity 69%, specificity 81%); a "predominant diastolic wave" pattern identified patients with a reduced right ventricular ejection fraction (< 3 0%) and elevated right atrial pressure (> 8 mmHg) (sensitivity 52%, specificity 95%). The observed and the predicted hemodynamic profiles turned out to be concordant in 80% of patients. CONCLUSIONS: The analysis of the flow velocity pattern into the superior vena cava is a useful tool to estimate the extent of the right circulatory impairment in patients with congestive heart failure.

Adult↗
PubMed2004

Diagnosis and differential assessment of pulmonary arterial hypertension.

Pulmonary arterial hypertension (PAH) is diagnosed by various investigations that are essential for making the diagnosis, and by additional tests to clarify the category of pulmonary hypertension (PH). A diagnostic algorithm can guide the evaluation of PH, but like all guidelines the algorithm can be modified according to specific clinical circumstances. Most patients are diagnosed as the result of an evaluation of symptoms, whereas others are diagnosed during screening of asymptomatic populations at risk. Right heart catheterization (RHC) must be performed in patients with suspected PH to establish the diagnosis and document pulmonary hemodynamics. Before initiation of medical therapy, assessment of acute vasoreactivity (during catheterization) is necessary to determine the appropriate therapy for an individual patient. An acute response is generally defined as a decrease in mean pulmonary arterial pressure of at least 10 mm Hg with the mean pulmonary arterial pressure decreasing to 40 mm Hg or below, accompanied by a normal or high cardiac output. After PAH is diagnosed, disease severity should be assessed in order to accurately determine risk:benefit profiles for various therapeutic options. Useful tools to predict outcome include functional class, exercise capacity, pulmonary hemodynamics, acute vasoreactivity, right ventricular function, as well as brain natriuretic peptide, endothelin-1, uric acid, and troponin levels. Repeating these tests serially on treatment is useful for monitoring the response to a given therapy. Close follow-up at a center specializing in management of PH is recommended, with careful periodic reassessment and adjustment of therapy.

Diagnosis, Differential↗
PubMed1984

Ventricular function following mitral valve surgery: assessment using radionuclide ventriculography.

The effects of mitral valve replacement or commissurotomy on cardiac function were studied using radionuclide ventriculography in 13 patients with chronic mitral stenosis and in 8 with chronic mitral regurgitation, before and after mitral valve surgery. The stenosis resulted from rheumatic heart disease in all instances while regurgitation was due to mitral valve prolapse in three patients and rheumatic heart disease in five. Fourteen patients had a Carpentier-Edwards valve inserted and 4 a Lillehei-Kaster disc valve. Three patients with mitral stenosis had an open commissurotomy. All patients underwent supine-rest and symptom-limited exercise radionuclide ventriculography shortly before and 6 to 12 months after operation. The data obtained showed that left ventricular function remained unchanged postoperatively in patients with mitral stenosis but deteriorated in those with mitral regurgitation. Right ventricular function improved postoperatively in those with mitral stenosis but remained unchanged in patients who had regurgitation.

Adult↗
PubMed1995

[Clinical usefulness of transesophageal echocardiography in heart surgery complications].

The role of monoplane transesophageal echocardiography (TEE) in rapid decision making process was investigated in 115 critically ill patients (pts) with early postoperative complications after cardio-thoracic surgery (hypotension, central venous pressure and/or wedge pressure elevation, electrocardiographic S-T segment elevation). Systolic and diastolic function of left ventricle, left ventricular wall motion abnormalities, right ventricular function, valves or prosthetic valves function, left ventricular outflow tract and morphologic changes were evaluated. Echocardiographic diagnoses were classified as: useful, incomplete, not diagnostic, misleading, unexpected. Echocardiographic diagnoses were confirmed by surgical or pathologic findings in all patients operated or dead. All but one patients, who needed surgical therapy, were operated on the basis of echo-diagnosis alone. Therapeutic changes induced by echo-diagnosis were evaluated and classified as major and minor. Diagnosis was fast (7 +/- 2 m) and sure (no complication). TEE was useful in 91% of cases (105/115 pts), incomplete in 2.3% (3/115 pts), not diagnostic in 2.3% (3/115 pts) and misleading in 3.4% of cases (4/115 pts). TEE findings made major therapeutic changes necessary in 66.9% (77/115 pts); there was a shift from medical to surgical therapy in 28% (41/115 pts); in 14.7% (17/115 pts) minor changes in drug therapy were made. TEE was also useful in quick and safe placement of devices (Swan-Ganz catheter, intra aortic balloon pump, endocardial pace maker, ventricular assist device) and in guiding urgent pericardiocentesis. The effects of medical therapy and evolution of ventricular dysfunction were well monitored by TEE. In our experience TEE was a very useful tool for management of early complications after cardio-thoracic surgery.

Cardiac Surgical Procedures↗