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PubMed1995

[Heart transplantation, cardiomyoplasty or artificial heart?].

This is a difficult question and the answer is uncertain. The authors review the state of the art of the three methods in 1993. Cardiac transplantation seems to have attained its maturity. The annual number of transplant operations is stagnant and the results progress little. Functional rehabilitation is excellent, the essential immunosuppression which has not changed in principle over the last 12 years, remains prejudicial. Cardiomyoplasty is an attractive concept with difficult surgical indications (Stage III, moderately dilated cardiomyopathy with good right ventricular function without arrhythmias, pulmonary hypertension or mitral regurgitation), a delayed efficacy, a hospital mortality comparable with that of transplantation and a similar survival rate. The objective results are not as good as the more subjective functional improvement. This limited experience (about 500 patients in 50 centers throughout the world, 70% of whom are European) should be continued and evaluated in the centers which initiated it. The artificial heart is only a temporary though essential therapeutic option in certain extremely urgent situations. It is a form of circulatory assistance, ranging from the simple univentricular accessory pump to the univentricular (Novacor) or biventricular (Jarvik) heart, in a rapidly evolving technology with problems of energy sources, marketing, cost and also clinical management which is often difficult especially with respect to coagulation. What do the next ten years hold in store for us? A nex immunosuppressor or the xenograft? A more efficient cardiomyoplasty with more precise medications? A totally implantable autonomous artificial heart? Can economic considerations accompany this development? This is undoubtedly the deepest source of concern for the future.

Adolescent↗
PubMed1997

Right ventricular performance and left ventricular assist device filling.

BACKGROUND: Right ventricular (RV) function is believed to be an important determinant of left ventricular assist device (LVAD) filling. This study was designed to demonstrate this relation in patients. METHODS: To demonstrate the interaction between RV ejection and LVAD filling, 10 patients (mean age, 49 +/- 13 years) supported with an LVAD were studied. Right ventricular pressure-area loops from cross-sectional area using transesophageal echocardiographic automated border detection and high-fidelity RV pressure were recorded simultaneously with LVAD volume during intraoperative inferior vena cava occlusion. Beat-by-beat RV ejection phase indices were calculated: stroke area, peak ejection rate, and stroke work. The LVAD filling rate was calculated as the first derivative of the volume, and the peak filling rate and the mean filling rate during RV systole were determined for each cardiac cycle. RESULTS: Right ventricular stroke area, peak ejection rate, and stroke work were closely correlated with LVAD peak filling rate (r = 0.87 +/- 0.09, r = 0.83 +/- 0.09, and r = 0.85 +/- 0.10, respectively). Also, baseline LVAD mean filling rate correlated with RV stroke work (r = 0.77) and LVAD peak filling rate with RV peak ejection rate for the group (r = 0.75). CONCLUSIONS: These correlations demonstrate predictable associations of RV ejection with LVAD filling.

Heart Failure↗
PubMed1986

The interventricular septum in health and disease.

The interventricular septum constitutes a major part of the heart and contributes to both left and right ventricular function. It is directly affected in certain disease states which can be diagnosed by echocardiographic examination of the septum. The septum also demonstrates characteristic patterns in cardiac conditions that do not directly affect it. These abnormal patterns have physiologic and diagnostic value. As a general rule, no matter what the diastolic configuration of the interventricular septum, it tries to assume its characteristic concave shape in systole. The significant exception is the presence of right ventricular pressure overload. The introduction of echocardiography has greatly increased our understanding of the interventricular septum in both health and disease.

Cardiomyopathies↗
PubMed1986

[Left and right ventricular dimensions and functions measured by ECG-gated NMR cardiac imaging].

Experimental studies using static and dynamic phantoms have shown that nuclear magnetic resonance cardiac imaging (MRI) can provide accurate measurements of left ventricular wax cast volumes, wax cavity volumes and pumping volumes. Ventricular dimensions and functions of 15 normal volunteers were quantitatively studied. A multislice spin echo (SE) sequence with ECG-gating identified end-diastole and end-systole. Ventricular volumes were calculated by summing the areas of the cavities in multiple contiguous transverse sections. Stroke volume, cardiac output, and ejection fraction were consequently calculated. The right and left ventricular dimensions and functions were compared using these method. The stroke volumes of the right (71.3 +/- 13.5 ml) and left ventricles (72.5 +/- 12.1 ml) were identical. Accordingly, the cardiac outputs of the right (4.8 +/- 0.9 l/min) and left ventricles (4.9 +/- 0.8 l/min) were identical. Right ventricular end-diastolic volumes (133.6 +/- 18.6 ml) and end-systolic volumes (62.3 +/- 10.0 ml) were significantly larger than the corresponding left ventricular volumes (120.2 +/- 15.9 ml and 47.7 +/- 9.7 ml, respectively) (p less than 0.001). Right ventricular ejection fraction (53.1 +/- 5.4%) was significantly less than left ventricular ejection fraction (60.8 +/- 6.2%) (p less than 0.001). Using MRI, measurements of right and left ventricular dimensions and functions were simultaneously obtained, accurately and non-invasively.

Adult↗
PubMed1995

Adequate distribution of warm cardioplegic solution.

Seventy-five patients undergoing coronary artery bypass grafting were randomized to receive warm antegrade (N = 25), warm retrograde (N = 25), or a combination of warm antegrade and retrograde (N = 25) delivery of blood cardioplegic solution. Myocardial oxygen utilization, lactate and acid metabolism, and adenine nucleotides and their degradation products were measured during the operation and cardiac function was assessed postoperatively. Warm retrograde delivery of cardioplegic solution increased lactate and acid release during cardioplegia and reperfusion, decreased left ventricular adenosine triphosphate concentrations, and reduced the washout of adenine nucleotide degradation products from both left and right ventricles. Warm antegrade delivery of cardioplegic solution resulted in less lactate and acid release during cardioplegia but more lactate accumulated in the territory of the left anterior descending artery during the crossclamp period. Intermittent antegrade delivery of the cardioplegic solution during combination cardioplegia washed out lactate and acid, which suggested inhomogeneous delivery of the cardioplegic solution during continuous retrograde cardioplegia. Combination cardioplegia best preserved adenosine triphosphate in the left ventricle and resulted in the best postoperative left and right ventricular function. A combination of intermittent antegrade and continuous retrograde delivery of cardioplegic solution provided better myocardial protection than either antegrade or retrograde delivery of cardioplegic solution alone.

Adenine Nucleotides↗
PubMed2006

Tricuspid annular displacement predicts survival in pulmonary hypertension.

RATIONALE: Right ventricular (RV) function is an important determinant of prognosis in pulmonary hypertension. However, noninvasive assessment of the RV function is often limited by complex geometry and poor endocardial definition. OBJECTIVES: To test whether the degree of tricuspid annular displacement (tricuspid annular plane systolic excursion [TAPSE]) is a useful echo-derived measure of RV function with prognostic significance in pulmonary hypertension. METHODS: We prospectively studied 63 consecutive patients with pulmonary hypertension who were referred for a clinically indicated right heart catheterization. Patients underwent right heart catheterization immediately followed by transthoracic echocardiogram and TAPSE measurement. RESULTS: In the overall cohort, a TAPSE of less than 1.8 cm was associated with greater RV systolic dysfunction (cardiac index, 1.9 vs. 2.7 L/min/m2; RV % area change, 24 vs. 33%), right heart remodeling (right atrial area index, 17.0 vs. 12.1 cm(2)/m), and RV-left ventricular (LV) disproportion (RV/LV diastolic area, 1.7 vs. 1.2; all p < 0.001), versus a TAPSE of 1.8 cm or greater. In patients with pulmonary arterial hypertension (PAH; n = 47), survival estimates at 1 and 2 yr were 94 and 88%, respectively, in those with a TAPSE of 1.8 cm or greater versus 60 and 50%, respectively, in subjects with a TAPSE less than 1.8 cm. The unadjusted risk of death (hazard ratio) in patients with a TAPSE less than 1.8 versus 1.8 cm or greater was 5.7 (95% confidence interval, 1.3-24.9; p = 0.02) for the PAH cohort. For every 1-mm decrease in TAPSE, the unadjusted risk of death increased by 17% (hazard ratio, 1.17; 95% confidence interval, 1.05-1.30; p = 0.006), which persisted after adjusting for other echocardiographic and hemodynamic variables and baseline treatment status. CONCLUSIONS: TAPSE powerfully reflects RV function and prognosis in PAH.

Adult↗
PubMed2002

Clinical significance of tricuspid valve dysfunction after orthotopic heart transplantation.

OBJECTIVES: Tricuspid regurgitation (TR) is common after heart transplantation (OHT), but its clinical relevance is undetermined. This study documents the clinical progress of patients with TR after OHT in relation to the severity of TR. METHODS: We studied 238 transplant recipients who had survived for at least 12 months after OHT. Tricuspid regurgitation was graded clinically and by assessing regurgitant jet area. Recipients were divided into those with no TR Group 1 (n = 64), those with sub-clinical TR (TR absent clinically and regurgitant jet area <25%, Group 2 (n = 89), and those with clinical TR (with clinical TR or regurgitant jet area > or =25%, Group 3 (n = 85). RESULTS: We found no significant difference among the groups in terms of age, or pre-operative events. At 12 months after OHT, mean right atrial and pulmonary artery pressures were higher in Group 3 than in Group 1 or Group 2 (p = 0.005 and 0.03, respectively). Right ventricular end-diastolic and end-systolic volumes were smaller for recipients in Groups 1 and 2 compared with those in Group 3 (p = 0.01 and 0.02). The annual development of renal impairment was 0.019 (95% confidence interval [CI], 0.014-0.029), 0.026 (95% CI, 0.022-0.62), and 0.613 (95% CI, 0.346-0.756) in Groups 1, 2, and 3, respectively (p = 0.02). At the most recent follow-up, mean New York Heart Association class for Group 1 was 1.4, for Group 2 was 1.7, and for Group 3 was 2.7 (p = 0.04). CONCLUSIONS: The integrity of the tricuspid valve has a significant impact on long-term clinical progress of OHT recipients. Recipients with significant TR are more symptomatic and have poorer right-sided heart function compared with those with mild or no TR.

Adult↗
PubMed1987

Postoperative functional assessment of a modified surgical approach to repair of tetralogy of Fallot.

Since February 1982, we have used a modified technique to repair tetralogy of Fallot with transatrial closure of the ventricular septal defect, a short infundibular incision with avoidance of muscle resection, and anterior expansion of the right ventricular outflow tract using a patch in every case. The pulmonary anulus is approached in the usual manner. Twenty-six patients have had repair with this technique without mortality, and 20 patients (Group 1) have been evaluated 1 to 3 years postoperatively. Their results are compared with those of all patients followed up in our division who had had repair by the traditional technique in the 5 years before February 1982, with the same evaluation within 4 years of operation (Group 2, n = 22). Ten of 20 patients in Group 1 and 14 of 22 in Group 2 required a transannular patch. At cardiac catheterization, right ventricular outflow tract obstruction was effectively relieved in both groups (right ventricular systolic pressure [mean +/- standard error], Group 1 versus Group 2, 45 +/- 5 versus 49 +/- 4 mm Hg). No patient with the modified technique had a residual ventricular septal defect. By M-mode echocardiography, right ventricular-left ventricular end-diastolic dimension ratio was significantly lower for Group 1 patients (0.58 +/- 0.03 versus 0.78 +/- 0.04; normal less than 0.45; p less than 0.001). With radionuclide ventriculography, right ventricular ejection fractions were significantly higher for Group 1 patients with the modified repair (38% +/- 2.2% versus 33% +/- 1.8%; normal greater than or equal to 45%; p less than 0.05). Because the incidence of obligatory pulmonary insufficiency caused by transannular patch is similar in both groups, these results cannot be directly attributed to the presence of pulmonary insufficiency alone. With ambulatory electrocardiographic monitoring, no patient in Group 1 had any ventricular premature contractions whatsoever, whereas six of 22 patients in Group 2 had demonstrable ventricular premature contractions. These results suggest that in children with tetralogy of Fallot, right ventricular outflow tract obstruction can be effectively relieved with this modified approach with improved early preservation of right ventricular function.

Ambulatory Care↗
PubMed1989

Coronary sinus versus aortic root perfusion with blood cardioplegia in elective myocardial revascularization.

The role of retrograde coronary sinus cardioplegia in patients undergoing elective coronary artery bypass grafting has not been fully defined. Forty patients undergoing coronary artery bypass grafting received either aortic root (20 patients) or coronary sinus (20 patients) cold potassium blood cardioplegia. The patients were similar with respect to age, ventricular function, severity of coronary artery disease, cross-clamp time, completeness of revascularization, frequency of internal mammary artery grafting, and mean infusate volume and temperature. The time required to deliver the initial dose of cardioplegic solution and the time to achieve arrest were prolonged in the coronary sinus group (p less than 0.001 and p less than 0.02, respectively). There were no differences between the two groups postoperatively with regard to enzymatic indices, hemodynamic measurement, or clinical outcome. Right ventricular function was preserved equally in both groups. We conclude that coronary sinus cardioplegia is a safe alternative to aortic root perfusion, but offers no advantage in elective myocardial revascularization.

Aged↗
PubMed2005

Is there a role for mechanical valved conduits in the pulmonary position?

BACKGROUND: The use of allografts or xenografts is the treatment of choice for pulmonary valve replacement. However, the limited durability is responsible for multiple reoperations associated with increased morbidity. In search of a definitive solution, the implantation of a mechanical valved conduit might be an option in highly selected patients. This study evaluated short-term results after pulmonary valve replacement with a mechanical valved conduit. METHODS: Fourteen patients underwent pulmonary valve replacement with a mechanical valved conduit. All patients had a mean of 3.0 +/- 1.2 previous operations. Seven patients were previously operated on for tetralogy of Fallot, 3 patients for pulmonary atresia, 3 patients for common arterial trunk, and 1 patient for subaortic stenosis. RESULTS: All patients survived the operation and are currently well. At follow-up (11 to 63 months), all but 2 patients showed normal right ventricular function, with a mean gradient of 14 +/- 9 mm Hg (range, 4 to 30 mm Hg) across the pulmonary valve. At follow-up, there was no evidence of valve failure or tissue growth within the valve annulus. All patients are receiving anticoagulants to maintain an international normalized ratio of 3.0 to 4.5. CONCLUSIONS: In highly selected patients, the use of a mechanical valved conduit in the pulmonary position leads to satisfactory results. To avoid a predictable reoperation after multiple right ventricular outflow tract reconstruction, and therefore reoperation-related morbidity, the implantation of a mechanical prosthesis as a lifelong solution requires consideration. Selection criteria for this permanent solution should include older age, multiple previous operations, and patient compliance with anticoagulant therapy.

Adolescent↗
PubMed2002

[Doppler tissue imaging of the myocardium and right ventricle].

Doppler tissue imaging is a technique of analysis of myocardial wall motion. It may easily be used for the right ventricular walls, especially in the apical 4-chamber view, from which the velocities of the RV free wall can be measured from the tricuspid annulus to the apex. The regional velocities of the right ventricle in its long axis and the excursion of the tricuspid annulus are higher than those of the left ventricle but the velocities of circumferential fibre shortening are lower. Moreover, the time interval between the end of the Sm wave and the onset of the Em wave (equivalent to the isovolumic relaxation time) is almost virtual in the right ventricle. The parameters of deformation (strain rate, strain) are also higher in the right than in the left ventricle and are variably distributed. Several studies have examined the clinical value of Doppler tissue imaging of the right ventricle. In cardiac failure, a significant correlation between the systolic velocity of the tricuspid annulus displacement and right ventricular ejection fraction has been reported. The ratio of tricuspid E wave velocity to the tricuspid annulus B wave allow assessment of right ventricular filling pressures. The measurement of tricuspid annulus velocities could be diagnostic of right ventricular extension of an inferior wall infarct. The recording of a "rebound" positive wave just after the E wave in the RV and LV free walls (and in the interventricular septum) is a diagnostic sign of constrictive pericarditis. Doppler tissue imaging is therefore a promising technique for evaluating right ventricular function.

Diagnosis, Differential↗
PubMed1998

Haemodynamic patterns in patients with scorpion envenomation.

OBJECTIVE: To study cardiovascular haemodynamics following scorpion envenomation. SETTING: Intensive care unit of a university hospital. PATIENTS: Eight patients with Indian red scorpion (Mesobuthus tamulus) stings. INTERVENTION: Captopril (6.25 to 12.5 mg orally) every 30 minutes until pulmonary oedema resolved. MAIN OUTCOME MEASURES: Haemodynamic data obtained by pulmonary artery catheterisation. RESULTS: Two haemodynamic patterns were seen. There was a predominant vascular effect in one patient, with severe hypertension, tachycardia, increased systemic vascular resistance index (SVRI = 5893 dyn.s.cm-5), and normal cardiac index (2.73 l/m2). A predominant myocardial effect with left ventricular dysfunction and normal right ventricular function was seen in the other seven patients, with tachycardia, pulmonary oedema, mild hypotension, reduced stroke volume (mean (SD), 25.9 (8.3) ml/m2), normal SVRI (1812 (831) dyn.s.cm-5), and increased pulmonary artery wedge pressure (PAWP = 25 (4.4) mm Hg). Following mild dehydration pulmonary oedema subsided (PAWP = 14 (8.5) mm Hg) in three of these patients, but hypovolaemic shock developed (right atrial pressure (RAP) = 1.3 (2.1) mm Hg); pulmonary oedema recurred with rehydration. One patient developed fatal cardiogenic shock with raised PAWP (27 mm Hg) and RAP (11 mm Hg), and vasodilatation (SVRI = 1129 dyn.s.cm-5). Stroke volume (30.5 (8.7) ml/m2) and cardiac output (4.3 (1.5) 1/m2) improved with resolution of pulmonary oedema (PAWP = 14.4 (4.2) mm Hg) following afterload reduction with captopril. CONCLUSIONS: Mild envenomation causes severe vasoconstriction and hypertension. Severe envenomation produces predominant left ventricular dysfunction with normal systemic vascular resistance manifesting as pulmonary oedema or severe hypotension depending on the fluid balance. Shock due to biventricular dysfunction and vasodilatation occurs terminally.

Adolescent↗
PubMed2004

Impact of pregnancy on the systemic right ventricle after a Mustard operation for transposition of the great arteries.

OBJECTIVES: We sought to determine the impact of pregnancy on the systemic right ventricle (RV) after a Mustard operation for transposition of the great arteries. BACKGROUND: Dysfunction of the RV remains a continuing problem after a Mustard operation. Concerns exist about the potentially deleterious effects of pregnancy on this ventricle. METHODS: The records of 16 women who completed 28 pregnancies were reviewed for clinical status, echocardiographic evaluation of RV dimensions, RV function, and tricuspid regurgitation (TR) before, during, and after pregnancy. RESULTS: Women were in New York Heart Association functional class I (n = 21) and II (n = 7) before pregnancy. The functional class deteriorated in six women, with no return to the pre-pregnancy level after delivery in two. Data on RV dimensions were available in 18 pregnancies, on RV function in 21, and on TR in 20. Before pregnancy, RV dilation was absent (n = 4), mild/moderate (n = 12), or severe (n = 2) and progressed in five women (31%), with no recovery in all patients at the last follow-up. Right ventricular systolic dysfunction was absent (n = 16), mild/moderate (n = 4), or severe (n = 1) before pregnancy and progressed in four women (25%), with no recovery in three cases. Tricuspid regurgitation was absent (n = 8), mild (n = 9), or moderate (n = 3) before pregnancy and deteriorated in eight women (50%), with no recovery in three patients. CONCLUSIONS: Pregnancy after a Mustard operation is clinically well tolerated but carries a risk of RV dysfunction, which is sometimes irreversible.

Adult↗
PubMed2001

Right ventricular diastolic dysfunction in patients with anticardiolipin antibodies and antiphospholipid syndrome.

OBJECTIVE: To evaluate the prevalence of diastolic dysfunction in patients with anticardiolipin antibodies (aCL) and to examine whether the antiphospholipid syndrome (APS) is associated with diastolic dysfunction independently of valvular abnormalities and systolic dysfunction. METHODS: Pulsed, continuous, colour Doppler echocardiography was performed in 179 subjects, of whom 15 were excluded from the analysis because of systolic dysfunction or severe valvular disease. The remaining 164 subjects included 29 patients with primary APS, 26 patients with secondary APS (APS in the presence of systemic lupus erythematosus (SLE)), and 30 patients with SLE and aCL but without APS; 43 patients with SLE without aCL and 36 normal volunteers served as control groups. RESULTS: The groups compared differed significantly in all measures of right ventricular function. There was a gradation of increasing diastolic function impairment as manifested by prolonged deceleration time (DT) and isovolumic relaxation time (IVRT) across the groups of patients with SLE without aCL, SLE with aCL, secondary APS, and primary APS. Differences in left ventricular diastolic function measures were less prominent. In regression analysis, DT increased by 19.6 ms (p=0.002) in the presence of primary APS and by 20.1 ms (p=0.038) in the presence of pulmonary hypertension. The titre of IgG aCL was the strongest predictor of a prolonged IVRT. CONCLUSION: Diastolic dysfunction, in particular of the right ventricle-that is, independent of valvular disease and systolic dysfunction, is a prominent feature of APS and may be related to the pathogenesis of the syndrome.

Adult↗
PubMed1989

[The significance of heart rate for stress hemodynamics following heart transplantation].

Since 1985, orthotopic heart transplantation had been carried out in 20 patients. Seventeen patients are still alive. 341 +/- 156 days after cardiac transplantation hemodynamics at rest were normalized. Left ventricular ejection fraction at rest and during exercise was within normal ranges for all patients except one. During symptom-limited bicycle exercise (121 +/- 35 Watt), pulmonary capillary wedge pressure (PCP) and right atrial pressure (RAP) increased to unphysiological high levels (PCP: 8.2 +/- 2.7 mmHg at rest, 19.1 +/- 4.9 mmHg at exercise; RAP: 4.1 +/- 2.3 mmHg at rest, 12.1 +/- 3.9 mmHg at exercise), whereas cardiac index was elevated to a normal level (3.6 l/min.m2 at rest; 6.9 l/min.m2 at exercise). Increase in heart rate, however, was subnormal (from 90 +/- 13/min at rest to 122 +/- 15/min at exercise). To examine the influence of heart rate on hemodynamics, in 8 patients with normal tricuspid valve function, heart rate was gradually increased by atrial stimulation during continuous exercise; PCP maximally could be reduced from 19.1 +/- 4 mmHg to 10.8 +/- 2.7 mmHg (p less than 0.01) at an optimum heart rate of 139 +/- 9/min. Reduction of RAP was by far less pronounced and normalization could not be achieved (from 12.2 +/- 3.7 mmHg to 9.5 +/- 3.4 mmHg, p less than 0.01), suggesting an impaired right ventricular function. By atrial stimulation stroke volume was reduced from 109.8 +/- 17.7 ml to 91.8 +/- 14.2 ml (p less than 0.01). These results indicate that, at exercise, the denervated transplanted heart, to a large extent, increases cardiac output by means of the Frank-Starling mechanism.(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiac Output↗
PubMed1999

[Influence of the equality of ventricular pressure in the echocardiographic determination of the ejection fraction of the left ventricle].

OBJECTIVES: Limited data have been reported concerning the influence of right ventricular systolic overload on the accuracy of the 2D echocardiographic (echo) determination of left ventricular (LV) ejection fraction (EF). The normal newborn at birth (high pulmonary peak systolic pressure) and just after the fall of pulmonary pressure, represent an in vivo model to study this influence. This study compares the LVEF determined by recommended 2D echocardiographic algorithms with that by 3D echo, in newborns at birth and just after the normal fall of right ventricular systolic pressure. METHODS: 100 echocardiographic studies (50 at 2 to 6 hours after birth--group I; and 50 at 7 to 14 days old--control group) were performed in 82 normal newborns, to determine LVEF by 4 geometric models (cylinder hemiellipsoid; ellipsoid biplane; single plane area length, in 4- and 2-chamber view; biplane method of discs) and visual estimation, using 3D echocardiography as the reference method. RESULTS: In group I, the correlation between 3D echo and cylinder hemiellipsoid was r = 0.62 (SEE = 4.5%); ellipsoid biplane, r = 0.69 (SEE = 4.1%); single plane area length, 4 chambers, r = 0.66 (SEE = 5.1%) and, 2 chambers, r = 0.72 (SEE = 4.0%); biplane method of discs, r = 0.83 (SEE = 3.6%), and, visual estimation, r = 0.78 (SEE = 3.5%). In the control group, the correlation between 3D echo and cylinder hemiellipsoid was r = 0.70 (SEE = 3.4%); ellipsoid biplane, r = 0.63 (SEE = 3.4%); single plane area length, 4 chambers, r = 0.79 (SEE = 3.5%) and, 2 chambers, r = 0.76 (SEE = 4.1%); biplane method of discs, r = 0.90 (SEE = 2.3%), and, visual estimation, r = 0.64 (SEE = 3.9%). IN CONCLUSION: These data suggest that the biplane method of discs and single plane area length using 2-chamber view allows a more accurate LVEF determination when significant right ventricular pressure overload is present.

Algorithms↗