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PubMed2000

Left atrial fibrillation with regular right atrial activation and a single left-to-right electrical interatrial connection: multisite mapping of dissimilar atrial rhythms.

We report two patients who had isolated atrial fibrillation in the left atrium and regular activation of the entire right atrium. Mapping of the arrhythmia was performed using a 64-electrode basket catheter that was inserted intravenously and deployed in the right and left atria. Both patients manifested a single, stable interatrial electrical connection conducting in a left-to-right direction, consistent with Bachmann's bundle location. The right and left sides of the interatrial septum were activated discordantly, each reflecting activation characteristics of the respective atria. A filtering effect at the level of interatrial septum was demonstrated by calculating the fibrillation intervals on both sides of the operative interatrial connection. It was concluded that differences in activation of the left and right surfaces of the interatrial septum and preferential use and the filtering effect of the interatrial connections play a significant role in explaining the differences in activation patterns of the left and right atria in patients with atrial fibrillation.

Atrial Fibrillation↗
PubMedDate not supplied

Right heart growth after the Bjork connection in tricuspid atresia.

BACKGROUND: Atrioventricular (Bjork) connection used for the correction of tricuspid atresia has become of little more than historical interest. However, the optimal form of management of patients undergoing this repair still requires continued assessment of the long-term outcome. We review our experience with valveless atrioventricular connection focusing on the morphological changes seen in the heart chambers. METHODS: Between October 1978 and March 1986, seven patients with tricuspid atresia having concordant ventriculoarterial connection underwent atrioventricular connection. Configuration of the surgical connection included Dacron extracardiac conduit without valve insertion. End-diastolic volumes were calculated in the respective heart chambers. A group of patients undergoing atriopulmonary connection was used as control subjects. RESULTS: The diminutive right ventricle showed conspicuous growth at 1.1 +/- 1.1 years after the initial repair, with the end-diastolic volume index increasing from 25.0 +/- 8.7% of normal value at a preoperative state to 80.4 +/- 31.1% of normal value postoperatively. Further operation was done in three patients because of the obstructive atrioventricular pathway. At reoperation, reconstruction of the connection with an addition of either atriopulmonary or cavopulmonary anastomosis afforded clinical improvement in our series. CONCLUSIONS: This study suggests that volume load resulting from the widely patent atrioventricular connection combined with backward regurgitation affects the development of young heart muscle of the right ventricle. The optimal choice of surgical strategy should be made at reintervention through recognition of the particular postsurgical anatomy.

Adolescent↗
PubMed2005

Systolic right ventricular function assessment by pulsed wave tissue Doppler imaging of the tricuspid annulus.

BACKGROUND: Systolic right ventricular (RV) function is an important predictor in the course of various congenital and acquired heart diseases. So far, tricuspid annular motion velocity in systole as obtained by pulsed wave tissue Doppler imaging (TDI) has rarely been investigated for RV function assessment in a sizeable adult patient population. METHODS: 258 individuals were included in the study. Among them, there were 107 individuals without cardiovascular disease, 71 patients with predominant RV dysfunction, 40 patients with pulmonary artery hypertension, and 40 patients with predominant left ventricular dysfunction. The reference methods for RV systolic function assessment were biplane two-dimensional echocardiography and magnetic resonance imaging (MRI; n = 31) for the calculation of RV ejection fraction (EF). Lateral tricuspid valve annular motion velocities in systole (TVlat, cm/s) were recorded using pulsed wave TDI from the apical 4-chamber view (long axis function). RESULTS: RV EF as determined by biplane echocardiography correlated significantly with respective values as assessed by MRI: RVEFecho = RV EFMRI + 1.6; r2 = 0.569, p <0.0001. Using the best TVlat threshold of 12 cm/s, distinction between the group with RV dysfunction and the other groups was possible with 86% sensitivity and 83% specificity. There was a direct and significant correlation between TVlat and RV ejection fraction (p <0.0001). Using TVlat thresholds of 12 and 9 cm/s, distinction between normal RV EF (>55%), moderately reduced (30-55%) and severely reduced RV EF (<30%) was possible with 84% sensitivity and 81% specificity, respectively with 83% sensitivity and 67% specificity. CONCLUSION: Systolic long axis velocity measurement of the lateral tricuspid annulus is useful and accurate to assess RV systolic function in a broad patient population. Thresholds of 12 and 9 cm/s allow differentiation between normal, moderately reduced and severely reduced RV ejection fraction.

Adult↗
PubMed1994

Frequency of chronic obstructive airways disease and pulmonary hypertension in patients with acute inferior myocardial infarction with or without right ventricular infarction.

OBJECTIVE: Factors influencing the incidence of right ventricular infarction among patients with acute inferior myocardial infarction have not yet been fully established. Chronic obstructive airways disease and right ventricular hypertrophy were suggested as possible predisposing factors but no definite evidence was shown. This study analyses the frequency of chronic obstructive airway disease and of Doppler assessed pulmonary hypertension among patients with acute inferior myocardial infarction with or without right ventricular infarction. DESIGN AND PATIENTS: Sixty consecutive patients with acute inferior myocardial infarction were prospectively enrolled into the study. MEASUREMENTS: Standard 12-lead ECG with right precordial leads (V3-6R) were recorded on admission to the Coronary Care Unit and on days 2 and 3. Doppler echocardiography was performed within 48 h after the onset of myocardial infarction and repeated 6 weeks later together with a pulmonary function test. Routine biochemical and clinical data were collected. RESULTS: Right ventricular infarction occurred in 35% of patients with acute inferior myocardial infarction. No differences in respiratory indices of chronic obstructive airways disease or in Doppler echocardiography parameters of pulmonary hypertension were revealed among patients with and without right ventricular infarction. Peak total creatine kinase level and creatine kinase myocardial isoenzyme levels were higher in patients with right ventricular infarction than in those without (2925 +/- 1321 vs. 1682 +/- 1216 U/l; P < 0.001 and 207 +/- 108 vs. 127 +/- 102 U/l; P < 0.05, respectively). CONCLUSIONS: In the course of acute inferior myocardial infarction, the frequencies of chronic obstructive airways disease and/or pulmonary hypertension were not higher among patients with right ventricular infarction than among those without right ventricular infarction. Thus, history of chronic obstructive airways disease and/or pulmonary hypertension do not necessitate specific precautions in respect of right ventricular infarction.

Aged↗
PubMed1999

Pulmonary embolism due to right ventricular thrombus in a case of Behcet's disease.

Right ventricular thrombus is a very rare manifestation of cardiovascular Behcet's disease. A 25-year-old man was admitted to hospital due to cough and fever of unknown origin. He experienced repetitive pulmonary embolism due to a right ventricular thrombus, which was surgically removed. A diagnosis of Behcet's disease was made based on his clinical course and the histological findings of the right ventricular wall and the skin lesion. He was quickly relieved of his symptoms after warfarinization and cyclosporine therapy.

Adult↗
PubMed2006

Acute smoking-induced alterations in Doppler echocardiographic measurements in chronic smokers.

Acute effects of smoking on left ventricular function have been studied previously. However, effects on right ventricular function have not yet been investigated. In this study, we attempted to investigate, through a combination of conventional and tissue Doppler imaging (TDI), the acute effects of smoking on both left and right ventricular function in chronic smokers. Thirty chronic smokers (with smoking habits of > or =1 pack/day for 74 +/- 1.3 years) underwent a complete transthoracic echocardiographic examination (2-dimensional, pulsed-wave Doppler transmitral and transtricuspid recordings, and TDI recordings of mitral and tricuspid annular velocities) by 3.5-MHz sector transducer. Pulsed-wave Doppler indices of left and right ventricular diastolic function-such as mitral and tricuspid inflows, peak early (E) and late (A) velocities, and E/A ratios-were obtained by conventional Doppler and TDI. Echocardiographic indices of the left and right ventricles--including isovolumetric relaxation time, isovolumetric contraction time, ejection time, and myocardial performance index of right ventricle-were also measured before and 30 minutes after each subject smoked a cigarette. Both mitral and tricuspid inflow measurements changed significantly after smoking a cigarette. Among the TDI measurements, mitral lateral annulus and tricuspid lateral annulus (diastolic, but not systolic) velocities changed after smoking a cigarette. Also, the right ventricular myocardial performance index increased immediately after smoking a cigarette. We found that acute cigarette smoking impaired both left and right ventricular diastolic function in chronic smokers.

Adult↗
PubMed1996

Mechanisms of cardiopulmonary resuscitation in a patient with right ventricular dilatation--an echocardiographic contribution.

The mechanism of cardiopulmonary resuscitation is still debated. Two different theories have been proposed: direct cardiac compression versus intrathoracic pressure. A patient with dilated right cardiac chambers, who underwent a transesophageal echocardiography study during cardiopulmonary resuscitation, is reported. The direct compression mechanism was clearly demonstrated.

Adult↗
PubMed1996

Impact of medical therapy on pulmonary hypertension in patients with congestive heart failure awaiting cardiac transplantation.

Pulmonary artery (PA) hypertension in transplant recipients increases mortality from right heart failure following heart transplantation. We examined the impact of long-term medical therapy on the severity of PA hypertension in patients with end-stage congestive heart failure on a transplant waiting list. The initial and final, quarterly right heart catheterization data on 60 patients (50 men, aged 50 +/- 9 years, New York Heart Association class III to IV) awaiting heart transplantation were analyzed and the patients divided into 2 groups: group A, those with persistent elevated systolic PA pressures throughout the 10-month follow-up (n = 31 of 60), and group B, those who had any decrease in systolic PA pressure during that period (n = 29 of 60). Group A had no change in hemodynamics. Group B had a significant decrease( +/- SD) in right atrial (11 +/- 7 to 5 +/- 4 mm Hg), PA (57 +/- 11 to 37 +/- 11 mm Hg), and PA wedge (25 +/- 9 to 14 +/- 7 mm Hg) pressures, with increases in cardiac output (3.8 +/- 0.9 to 4.7 +/- 1.1 L/min) and ejection fraction (18 +/- 6% to 27 +/- 11%) (p < 0.05). The combined end point of transplant or death occurred in 28 of 31 patients (90%) in group A versus 14 of 29 (50%) in group B (p = 0.0004). Ischemic etiology was present in 71 % of patients in group A versus 68% with idiopathic dilated cardiomyopathy in group B (p = 0.003). The reversibility of PA hypertension rather than its initial severity is predictive of patient clinical outcome. Idiopathic, as opposed to ischemic, cardiomyopathy responds better to medical therapy.

Antihypertensive Agents↗
PubMed1995

Mechanical ventricular assistance for the failing right ventricle after cardiac transplantation.

Right ventricular failure secondary to elevated pulmonary vascular resistance (PVR) following orthotopic cardiac transplant is a complication with a high mortality; and patients with high resistance are often not accepted on transplant waiting lists. We describe six cases of right ventricular failure after cardiac transplant managed by right ventricular assist device (RVAD), four of whom died and two patients who survived following life-threatening complications.

Adult↗
PubMed2005

Pulmonary regurgitation: not a benign lesion.

Pulmonary regurgitation (PR) is a common complication after surgical or percutaneous relief of pulmonary stenosis and following repair of tetralogy of Fallot. Significant PR is usually well tolerated in childhood. However, in the long term, chronic PR has a detrimental effect on right ventricular (RV) function and exercise capacity and leads to an increased risk of arrhythmia and sudden cardiac death (SCD). Recent advances in non-invasive imaging and, in particular, wider availability of cardiovascular magnetic resonance (CMR), have improved the assessment of PR and RV function in these patients. This in turn has facilitated decision making on the optimal timing for elective pulmonary valve replacement (PVR), which should be performed before irreversible RV dysfunction ensues.

Arrhythmias, Cardiac↗
PubMed2007

Assessment of right ventricular infarction with contrast-enhanced magnetic resonance imaging.

OBJECTIVE: Evaluation of contrast-enhanced magnetic resonance imaging to assess right ventricular infarction in patients with acute inferior myocardial infarction. BACKGROUND: Contrast-enhanced magnetic resonance imaging has been used for assessing scar tissue after left ventricular infarction. The value of contrast-enhanced magnetic resonance imaging to assess right ventricular infarction is unknown and was evaluated. METHODS: Consecutive patients (n=18) with first acute inferior infarction were included. Resting electrocardiogram and right-sided electrocardiogram were acquired to assess right ventricular involvement. Resting cine magnetic resonance imaging was performed to evaluate right ventricular function and volumes, whereas the extent of right ventricular scar tissue was assessed by contrast-enhanced magnetic resonance imaging. Cine magnetic resonance imaging was repeated at 6-months follow-up to re-assess right ventricular function and volumes. RESULTS: Sensitivity and specificity of magnetic resonance imaging were 100 and 78%, respectively, to detect right ventricular infarction (using the right-sided electrocardiogram as the gold standard). At 6 months follow-up, patients with scar tissue on contrast-enhanced magnetic resonance imaging showed right ventricular dilatation. Moreover, the extent of right ventricular scar tissue was linearly related to the severity of right ventricular dilatation. CONCLUSIONS: Contrast-enhanced magnetic resonance imaging permits accurate assessment of right ventricular scar tissue. Patients with extensive right ventricular infarction demonstrate right ventricular dilatation at 6 months follow-up.

Adult↗
PubMed2001

Five-year clinical experience with Abiomed BVS 5000 as a ventricular assist device for cardiac failure.

Mechanical support for the failing heart has interested and challenged cardiac specialists for decades. In the United States alone, there are close to 375,000 cardiac surgical procedures performed each year, and, despite the recent advances in myocardial protection, surgical techniques, intra-aortic balloon therapy and maximal pharmacological support, postoperative ventricular dysfunction continues to occur in 0.5-1.0% of all patients undergoing cardiac surgery. This retrospective review describes our 5-year clinical experience at the Brigham and Women's Hospital with the Abiomed BVS 5000 as a means of ventricular support. During the period of 1994 to present, 7,428 cardiac surgical operations were performed at our institution. The Abiomed BVS 5000 has been implanted in 47 patients exhibiting ventricular failure. There were 38 patients in the bridge-to-recovery group and nine patients in the bridge-to-transplantation group. Twenty-five patients (66%) in the bridge-to-recovery group were weaned and 16 patients (42%) went on to discharge. In the bridge-to-transplantation group, one patient actually recovered myocardial function and one expired on the device. The remaining seven patients (77%) underwent cardiac transplantation with post-transplant survival at 66%. Overall, patients were supported in the isolated left ventricular mode (28%), in the biventricular mode (45%) and in the isolated right ventricular mode (28%). The Abiomed BVS 5000 has been shown to be a safe and simple cardiac support system with no mechanical failure. Our experience shows that a substantial number of patients suffering from ventricular failure will benefit from the use of this device. The results also justify the use of this device in groups of patients other that of postcardiotomy ventricular failure.

Adolescent↗
PubMed2005

Right heart failure due to an unroofed coronary sinus in an adult.

An unroofed coronary sinus is a rare congenital malformation with a strong association to a persistent left vena cava superior. In most cases it occurs together with complex cardiac anomalies such as left isomerism. We report on a 72-year-old man with clinical signs of right heart failure caused by an isolated unroofed coronary sinus: The diagnosis was made by means of transesophageal echocardiography with contrast injection.

Aged↗
PubMedDate not supplied

Optimal 3-dimensional method for right and left ventricular fourier phase analysis in electrocardiography-gated blood-pool SPECT.

BACKGROUND: To overcome some of the limitations imposed by planar imaging, we aimed to optimize the use of first harmonic Fourier phase analysis (FPA) in electrocardiography-gated blood-pool single photon emission computed tomography (GBPS) by comparing different quantitative, 3-dimensional methods. METHODS AND RESULTS: Three groups of patients who underwent GBPS were evaluated: group 1, 8 patients with no heart disease; group 2, 10 patients with left ventricular disease; and group 3, 6 patients with right ventricular disease. Six different methods for FPA were compared: surface, cylindrical, spherical, and hybrid methods with fixed thresholding and spherical and hybrid methods with multiple thresholding. The hybrid method with multiple thresholding for the left ventricle and the spherical method for the right ventricle provided the highest discrimination score (phase) between normal and abnormal ventricles. Among methods with similar discrimination score for these 2 methods, the cylindrical and hybrid methods for the left ventricle and the spherical method for the right ventricle provided the best homogeneity of phase distribution histogram in normal ventricles. These were considered the optimal methods for FPA. CONCLUSIONS: The hybrid or cylindrical method for the left ventricle and the spherical method for the right ventricle with fixed thresholding are the optimal methods for FPA in GBPS.

Electrocardiography↗
PubMed2000

Right ventricular failure in acute respiratory distress syndrome.

Right ventricular failure can be the result of acute respiratory distress syndrome (ARDS). A patient with eclampsia and sepsis with Staphylococcus aureus developed life-threatening right ventricular failure as a result of ARDS. She finally stabilized after treatment with inhaled nitric oxide (NO). The pathophysiology of right ventricular failure in ARDS is described.

Administration, Inhalation↗
PubMed2005

Cardiac resynchronization therapy: retiming the failing right ventricle.

Cardiac resynchronization therapy (CRT) improves symptoms, reduces hospitalization, and may decrease mortality in patients with moderate/severe heart failure and left bundle branch block. Whether CRT may have a role in the management of patients with adult congenital heart disease and a failing right (systemic) ventricle is unknown. We report the case of an adult patient with transposition of the great arteries and previous Mustard's repair, who successfully underwent CRT using a hybrid transvenous/epicardial approach. Exercise tolerance improved, right ventricular (systemic) ejection fraction improved, diuretic requirements reduced, and renal function improved. CRT may offer a new therapeutic option for this patient population.

Adult↗
PubMed2000

Right ventricular diastolic abnormalities in systemic sclerosis. Relation to left ventricular involvement and pulmonary hypertension.

OBJECTIVES: To investigate right ventricular diastolic function in systemic sclerosis (SSc) and its relation to clinical features of the disease. METHODS: Seventy seven unselected SSc patients and 33 healthy subjects were submitted to echocardiography and echo Doppler study to assess left and right systolic as well diastolic function and to estimate maximal arterial systolic pulmonary pressure (PAP). In addition, the patients were investigated to define the SSc subset and the extent of skin and internal organ involvement. RESULTS: An abnormal right ventricular filling, as expressed by an inverted tricuspidal (Tr) E/A ratio (Tr E/A ratio <1), was detected in 31 of the 77 SSc patients (40%) and in 0 of the 36 controls ( p<0.001 ). All the 31 patients with an inverted Tr E/A ratio were found to have a PAP > 30 mm Hg. Twenty resulted to have an inverted mitral (Mit) E/A ratio (Mit E/A ratio <1), indicating an abnormal left ventricular filling. In multiple regression analysis, Tr E/A ratio resulted to be independently correlated to both PAP (r= -0.35;p<0. 003) and Mit E/A ratio (r=0.39;p<0.001). CONCLUSIONS: This study points out an impaired right ventricular filling in a significant percentage of SSc patients whatever the subset. This alteration is independently correlated to both PAP and left ventricular filling abnormalities.

Adult↗