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At least 1,315 records · Page 73Linked to original sources
PubMed2006

The effect of open lung ventilation on right ventricular and left ventricular function in lung-lavaged pigs.

INTRODUCTION: Ventilation according to the open lung concept (OLC) consists of recruitment maneuvers, followed by low tidal volume and high positive end-expiratory pressure, aiming at minimizing atelectasis. The minimization of atelectasis reduces the right ventricular (RV) afterload, but the increased intrathoracic pressures used by OLC ventilation could increase the RV afterload. We hypothesize that when atelectasis is minimized by OLC ventilation, cardiac function is not affected despite the higher mean airway pressure. METHODS: After repeated lung lavage, each pig (n = 10) was conventionally ventilated and was ventilated according to OLC in a randomized cross-over setting. Conventional mechanical ventilation (CMV) consisted of volume-controlled ventilation with 5 cmH2O positive end-expiratory pressure and a tidal volume of 8-10 ml/kg. No recruitment maneuvers were performed. During OLC ventilation, recruitment maneuvers were applied until PaO2/FiO2 > 60 kPa. The peak inspiratory pressure was set to obtain a tidal volume of 6-8 ml/kg. The cardiac output (CO), the RV preload, the contractility and the afterload were measured with a volumetric pulmonary artery catheter. A high-resolution computed tomography scan measured the whole lung density and left ventricular (LV) volumes. RESULTS: The RV end-systolic pressure-volume relationship, representing RV afterload, during steady-state OLC ventilation (2.7 +/- 1.2 mmHg/ml) was not significantly different compared with CMV (3.6 +/- 2.5 mmHg/ml). Pulmonary vascular resistance (OLC, 137 +/- 49 dynes/s/cm5 versus CMV, 130 +/- 34 dynes/s/cm5) was comparable between groups. OLC led to a significantly lower amount of atelectasis (13 +/- 2% of the lung area) compared with CMV (52 +/- 3% of the lung area). Atelectasis was not correlated with pulmonary vascular resistance or end-systolic pressure-volume relationship. The LV contractility and afterload during OLC was not significantly different compared with CMV. Compared with baseline, the LV end-diastolic volume (66 +/- 4 ml) decreased significantly during OLC (56 +/- 5 ml) ventilation and not during CMV (61 +/- 3 ml). Also, CO was significantly lower during OLC ventilation (OLC, 4.1 +/- 0.3 l/minute versus CMV, 4.9 +/- 0.3 l/minute). CONCLUSION: In this experimental study, OLC resulted in significantly improved lung aeration. Despite the use of elevated airway pressures, no evidence was found for a negative effect of OLC on RV afterload or LV afterload, which might be associated with a loss of hypoxic pulmonary vasoconstriction due to alveolar recruitment. The reductions in the CO and in the mean pulmonary artery pressure were consequences of a reduced preload.

Animals↗
PubMed2005

Transcatheter closure of atrial septal defects improves right ventricular volume, mass, function, pulmonary pressure, and functional class: a magnetic resonance imaging study.

OBJECTIVE: To characterise prospectively by magnetic resonance imaging (MRI) changes in right ventricular (RV) volume, function, and mass after transcatheter closure of atrial septal defects (ASDs) and to evaluate the course of pulmonary pressure and functional class criteria. METHODS: In 20 patients with secundum-type ASD and dilated RV diameter, MRI was performed to quantify RV end diastolic (RVEDV) and end systolic volumes (RVESV), RV mass, tricuspid annular diameter, and RV ejection fraction before and 6 and 12 months after transcatheter closure of the ASD. RV systolic pressure was measured during follow up by transthoracic echocardiography. RESULTS: Functional class improved in the majority of patients after ASD closure. RVESV (from 81 (18) ml/m2 to 53 (15) ml/m2, p < 0.001), RVEDV (from 127 (17) ml/m2 to 99 (18) ml/m2, p < 0.001), and RV mass (from 79 (10) g to 63 (8) g, p < 0.01) decreased significantly during follow up, although tricuspid annular diameter did not. RV ejection fraction improved (by 9% compared with baseline, p < 0.05) and RV systolic pressure decreased significantly (from 33 (8) mm Hg to 24 (6) mm Hg, p < 0.001) after closure. CONCLUSION: MRI studies showed significant improvement of RV volumes, mass, and function after transcatheter closure of ASDs. Restoration of the RV leads to decreased pulmonary pressure resulting in a better functional class in the majority of patients.

Adult↗
PubMed1977

Clinical and electrocardiographic correlations in pulmonary heart disease (cor pulmonale).

It is now possible to diagnose early cor pulmonale by utilizing electrocardiographic fluctuations which are the result of moderate pulmonary hypertension and the accompanying effect upon right ventricular function. This holds whether the ECG alterations are produced by chronic obstructive pulmonary disease or by the rarer forms of obliterative lung disease. The late stage of cor pulmonale, in which right ventricular hypertrophy is manifest, should now be rarely encountered in view of our improved understanding of cor pulmonale and more rational therapeutic approaches to the underlying disorders.

Coronary Circulation↗
PubMed2000

Pericardial disease is often not recognised as a cause of chronic severe ascites.

BACKGROUND/AIMS: Severe chronic ascites remains a difficult diagnostic and therapeutic problem. Even in the current era, constrictive pericarditis is an underestimated and sometimes unrecognised cause. Moreover, missing the diagnosis deprives patients of remedial therapy. METHODS: Two cases of calcified constrictive pericarditis, complicated with cirrhosis and diagnosed in a late stage, are described. Due to insufficient clinical appreciation and lack of trust in echocardiography results, performed by cardiologists who were insufficiently familiar with the echocardiographic features of constrictive pericarditis, diagnosis was delayed in the two patients RESULTS: The diagnosis of constrictive pericarditis as a cause of ascites is based upon the clinical signs of right heart failure in a patient with normal systolic left and right ventricular function and a high, serumascitic albumin-content difference. Complementary workup with complete Doppler echocardiography study, right and left heart catheterisation and MRI or cine CT of the heart is necessary to confirm the diagnosis. CONCLUSION: Careful history taking and clinical examination remain the cornerstone of any diagnostic work-up, even in this era of technological refinement.

Adolescent↗
PubMedDate not supplied

Septal/free wall curvature ratio: a noninvasive index of pulmonary arterial pressure.

The leftward septal shift, a well-recognized feature of pulmonary hypertension, was used to quantify right ventricular pressure in 16 patients with pulmonary hypertension and 11 control patients, all with normal left ventricular function. Pulmonary pressure was calculated from the tricuspid regurgitation jet and left ventricular pressure was taken by arm cuff measurements. Short-axis echocardiographic images were obtained and the midwall curvatures of the septum and the left ventricular free wall were measured for each frame from end diastole to end systole and averaged. The septal/free-wall curvature ratio (CR) was 0.37 +/- 0.19 in the study group compared with 0.79 +/- 0.06 in the control group (p < 0.0001). A tight relationship between the CR and the transseptal/transmural pressure ratio (CR = 0.057 + 0.89 x transseptal/transmural pressure ratio; r = 0.98; p < 0.001) was obtained by linear regression. Given the systolic arterial pressure, the pulmonary systolic pressure is given by: systolic arterial pressure x (1.064-1.12 x CR). Therefore the CR can be used as a noninvasive index that reflects the level of pulmonary pressure in relationship to the systolic arterial pressure.

Blood Pressure↗
PubMed1987

Evaluation of diastolic function with Doppler echocardiography: the PDF formalism.

A new parametrized diastolic filling (PDF) formalism for evaluation of holodiastolic (left and right) ventricular function via Doppler echocardiography is presented. It is motivated by the empiric observation that during diastole the heart behaves as a suction pump whose dynamics, in certain respects, are those of a damped harmonic oscillator. An expression for elastic recoil (suction) initiated ventricular diastolic fluid inflow velocity v(t) is obtained by differentiation from the solution x(t) of the linear differential equation that describes the motion of a forced, damped harmonic oscillator. It is solved for "over-damped" motion, for zero initial velocity and initial displacement = xo cm. An explicit forcing term F(t) = Fosin(omega t) is included to account for late diastolic (atrial) filling. The quantitative parameters of the model include inertia (mass; m), viscosity (damping constant; c), source of stored energy for suction (spring constant; k), and its initial displacement xo, the amplitude and frequency of the (atrial) forcing term Fo, omega. The mathematical behavior of the solution v(t) and its dependence on the parameters xo, c, and k, which characterize the contour of the Doppler velocity profile (DVP), is discussed. When clinical examples of normal and abnormal transmitral DVPs are compared with v(t) calculated using the harmonic oscillator model, excellent agreement [DVP-v(t)]/v(t) approximately 0.05 is obtained throughout diastole. Thus the model allows accurate qualitative and quantitative characterization of global ventricular diastolic behavior by noninvasive means in a variety of normal and abnormal stiffness-compliance states. In addition, it may serve as a prototype for a class of mathematical models that can encompass the essential dynamic elements of ventricular diastolic function that couple to flow and further enhance the role of the heart as a suction pump.

Animals↗
PubMed1987

Increased right ventricular afterload alters left ventricular function in newborn lambs.

The effects of acutely increased right ventricular afterload induced by mechanical constriction of the main pulmonary artery or with alveolar hypoxia on function of the left ventricle were assessed in six and nine lambs, respectively (aged 1 to 3 days). Mechanical constriction of the main pulmonary artery in newborn lambs compromised left ventricular function with significant decreases in systemic blood flow and the peak first derivative of left ventricular pressure when considered simultaneously and as single variables. In contrast, alveolar hypoxia augmented left ventricular function with significant increases in systemic blood flow and the peak first derivative of left ventricular pressure when considered simultaneously or as single variables. Interaction appears to exist between the right and left ventricles during the newborn period. The mechanically increased afterload may have compromised left ventricular function by altering its end-diastolic size, inotropic state, or both. On the other hand, the augmented left ventricular function in the presence of hypoxia may have been due to an increase in inotropic background. The clinical implications in some infants with pulmonary hypertension and left ventricular dysfunction are raised.

Animals↗
PubMed1981

Response of normal and abnormal sinus node to right ventricular stimulation.

Right ventricular pacing at progressively increasing rates was performed in 25 patients with complete ventriculoatrial block, before and after autonomic blockade with intravenous propranolol and atropine. At the end of each ventricular pacing stage a right intraatrial electrogram and electrocardiographic leads were simultaneously recorded. The relation between right ventricular pacing and atrial rates was studied from the recordings obtained at each pacing stage in both group I, 8 patients with sick sinus syndrome, and group II, 17 patients with normal sinus function. Right ventricular pacing was associated with an increment in atrial rate that ws significantly smaller (probability [p] less than 0.001) in patients in group I (mean +/- standard error of the mean 8 +/- 6 beats/min) than in group II (mean 25 +/- 10 beats/min). The maximal atrial rate reached during right ventricular pacing exceeded 80 beats/min in all patients in group II but remained less than 74 beats/min in patients in group I. Because autonomic blockade did not significantly influence the preceding results, it is concluded that a mechanical effect on the sinus node may explain this phenomenon.

Adult↗
PubMed1989

[Right ventricular regional wall motion and function after tetralogy repair].

The right ventricular (RV) function is very important after correction of tetralogy of Fallot (TOF) similarly to left ventricular (LV) function. The influence to RV contraction caused by RV outflow tract patch after repair of TOF is serious. There are a few literatures about contraction mode of RV but we can't see any reports about regional RV wall motion before and after surgery of TOF. This paper is the first report about RV regional wall motion and function after 20 cases of tetralogy repair. We would emphasize the following points. 1) Regional wall motion of RV at antero-basal and anterolateral is getting worse but is improved at anteroapical of RV. 2) Appropriate rate of RV systolic pressure to LV systolic pressure just after weaning from cardiopulmonary bypass and rate of patch length to RV length is below 0.5 and 0.4 respectively. 3) There is positive correlation between RV ejection fraction and wall motion at anteroapical of RV.

Child↗
PubMed2004

[Dynamics of parameters of diastole and subendocardial right ventricular blood flow in adult patients after correction of atrial septal defect].

The study of intracardiac hemodynamics and subendocardial blood flow in 55 adults with atrial septal defect confirmed practical value of assessment of myocardial contractility by long term catheterization of right cardiac chambers, construction of right ventricular function curves and "pressure-volume" diagrams. Simultaneous graphical registration with the help of computer diagnostic system represented character and direction of changes of controlled parameters during the period of observation as well as peculiarities of interventricular interaction after removal of isotonic right ventricular overload. Compared with traditional hemodynamic monitoring this approach to analysis of intracardiac hemodynamics provided real time assessment of cardiac function, facilitated elucidation of causes of cardiac output lowering and optimization of myocardial contractility regulation.

Adult↗
PubMed1997

Extending the concept of the autograft for complete repair of transposition of the great arteries with ventricular septal defect and left ventricular outflow tract obstruction: a report of ten cases of a modified procedure.

BACKGROUND: In most cases of transposition of the great arteries with ventricular septal defect and left ventricular outflow tract obstruction, a Lecompte procedure (réparation à l'étage ventriculaire) is possible without interposition of a conduit between the right ventricle and pulmonary artery. However, the anterior location of the pulmonary arteries after the Lecompte maneuver may be a potential cause for right ventricular outflow obstruction, which continues to be reported in 5% to 25% of cases. We have used a tubular segment of aortic autograft to connect the pulmonary artery, left in the orthotopic posterior position (without the Lecompte maneuver), to the right ventricle in 10 consecutive patients with transposition, ventricular septal defect, and left ventricular outflow tract obstruction. METHODS: Ten consecutive patients aged 2 months to 11 years (mean 32 months) have undergone a modified Lecompte operation. Eight had severe pulmonary stenosis, two had pulmonary atresia, and four had a restrictive ventricular septal defect at the time of the operation. Two had multiple ventricular septal defects. Seven had undergone one (n = 5) or two (n = 2) previous modified Blalock-Taussig shunts. All patients underwent a total correction with left ventricular-aortic intraventricular connection (four needed a ventricular septal defect enlargement), connection between the right ventricle and pulmonary arteries with a tubular segment of autograft aorta, without the Lecompte maneuver (anterior location of the bifurcation of the pulmonary arteries) on the right (n = 6) or the left (n = 4) of the aorta. No valvular device was used for the right ventricular outflow repair. RESULTS: No early or late deaths occurred. One patient with multiple ventricular septal defects needed an early (2 weeks) reoperation for a residual muscular ventricular septal defect. All patients are currently in New York Heart. Association class I, without medications, in sinus rhythm, at a mean follow-up of 30 months. Late results up to 3.6 years show no calcification on the chest roentgenogram, and at the most recent echocardiogram, right ventricular pressures were low (25 to 40 mm Hg, mean 33 mm Hg) and no significant gradient (over 10 mm Hg) was found between the right ventricle and pulmonary arteries. Left and right ventricular function was satisfactory. CONCLUSION: This modification of the Lecompte operation using a segment of autograft allows an excellent early and late result, with no danger of compression of anteriorly placed pulmonary arteries, no significant right ventricular outflow obstruction, and normal appearance of the tubular autograft. In view of laboratory and clinical evidence, normal growth of the autograft can be anticipated. It allows an elective correction of transposition, ventricular septal defect, and left ventricular outflow tract obstruction without a previous Blalock-Taussig shunt (three patients) and correction at a young age (three patients younger than 1 year).

Aorta↗
PubMed1980

[Shock secondary to right ventricular infarction (author's transl)].

The diagnosis of right ventricular infarction was made in a patient with acute inferior myocardial infarction on the basis of: right atrial pressure higher than pulmonary capillary pressure, increase of echocardiographic diameter, and abnormal technetium pyrophosphate deposit on the right ventricle. The patient developed a severe shock syndrome of 30 hours duration, which was successfully corrected with massive fluid volume replacement. Study of ventricular functions suggested right ventricular infarction as the cause of shock, since this ventricle showed a greater degree of functional impairment.

Aged↗
PubMed1990

Acute myocardial dysfunction and recovery: a common occurrence after coronary bypass surgery.

To evaluate whether acute myocardial dysfunction was common in the early postoperative period, serial hemodynamic measurements and radionuclide evaluation of ventricular function were performed before and after operation in 24 patients undergoing elective coronary bypass surgery. All patients had uncomplicated surgery, and no patient sustained an intraoperative infarction. In 96% of patients, significant depression in right and left ventricular ejection fraction was seen postoperatively, reaching a nadir at 262 +/- 116 min after coronary bypass. Left ventricular ejection fraction was 58 +/- 12% preoperatively and 37 +/- 10% at trough. Right ventricular function displayed a similar pattern. These findings were also associated with depressed cardiac and left ventricular stroke work index despite maintenance of adequate ventricular filling pressures and mean arterial pressure. The depression in ventricular function was partially reversible within 8 to 10 h after surgery. Left ventricular ejection fraction had increased to 55 +/- 13% at 426 +/- 77 min after coronary bypass and showed complete recovery within 48 h. Left ventricular end-systolic and end-diastolic volume index increased significantly postoperatively, but recovery in left ventricular ejection fraction was mostly due to decreases in end-systolic volume index (50 +/- 22 ml at trough and 32 +/- 16 ml at recovery). Depressed myocardial function was independent of bypass time, number of grafts placed, preoperative medications or core temperatures postoperatively. Postoperative therapy with pressors or inotropic agents delayed but did not prevent the occurrence of postoperative ventricular dysfunction. Despite improvements in operative techniques and methods of myocardial protection, postoperative left ventricular dysfunction continues to be common in patients undergoing cardiopulmonary bypass surgery.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMedDate not supplied

Role of radionuclide ventriculography in evaluating cardiac function.

The role of nuclear cardiology techniques for evaluating cardiac function has become increasingly important among other diagnostic techniques. The current status of radionuclide imaging of left and right ventricular function allows accurate diagnosis of cardiac patients with both coronary and noncoronary disease. The combination of gated first-pass and equilibrium radionuclide ventriculography makes it possible to assess more completely cardiac function than by either technique alone. Of particular interest to most imaging physicians is the current position of exercise ventriculography in the diagnostic setting, especially since this test has undergone new scrutiny in its application to broader patient segments. This technique and issues related to its place in the diagnostic environment are discussed in this review article, with emphasis on relevance to the clinical laboratory.

Cardiomyopathies↗
PubMed1991

Radionuclide evaluation of cardiac function during sleep in children with bronchopulmonary dysplasia.

The influence of sleep on cardiac function in severe bronchopulmonary dysplasia was assessed in five children 1.5 to 5 years of age. Left and right ventricular ejection fractions (LVEF and RVEF) were investigated by equilibrium radionuclide ventriculography in five children undergoing polygraphic monitoring during the different states of alertness: wakefulness, nonrapid eye movement sleep, and rapid eye movement sleep. Intraobserver and interobserver LVEF and RVEF measurement reproducibility was high. During quiet, supine wakefulness, LVEF was normal, but RVEF was low. During sleep, a decrease in both LVEF and RVEF, expressed as a percentage of the awake value, was marked in the two children with the most nocturnal desaturation and longest duration of paradoxic rib cage motion during inspiration. It is concluded that radionuclide ventriculography can be easily performed during sleep in children and can provide useful information regarding right ventricular function during sleep in children with severe bronchopulmonary dysplasia.

Bronchopulmonary Dysplasia↗
PubMed1982

The effects of oral hydralazine on right ventricular end-diastolic pressure in patients with right ventricular failure.

Hydralazine reduces pulmonary vascular resistance in patients with primary and secondary pulmonary hypertension, but the effects on right ventricular function of a change in resistance without a reduction in pulmonary arterial pressure are not known. We evaluated the hemodynamic effects of hydralazine, 50 mg, administered orally every 6 hours for 48 hours in 14 patients with right ventricular failure and pulmonary hypertension resulting from various causes. Hydralazine reduced mean right ventricular end-diastolic pressure from 17.4 +/- 5.6 to 11.6 +/- 5.3 mm Hg (p less than 0.001) and increased cardiac output and stroke volume by more than 40%. In nine patients who had no change in mean pulmonary arterial pressure after hydralazine, total pulmonary resistance decreased from 15.9 +/- 6.0 to 10.6 +/- 4.3 (p less than 0.001) and cardiac index increased from 2.07 +/- 0.51 to 2.97 +/- 0.91 (p less than 0.005). There was a close correlation between the reductions in total pulmonary resistance and right ventricular end-diastolic pressure (r = 0.73)). These data suggest that hydralazine can increase cardiac output and reduce right ventricular end-diastolic pressure even when pulmonary arterial pressure remains unchanged.

Adult↗