Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Ventricular Dysfunction, Right”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,639 records · Page 91Linked to original sources
PubMed1998

Effects of thrombolytic therapy in acute inferior myocardial infarction with or without right ventricular involvement. HIT-4 Trial Group. Hirudin for Improvement of Thrombolysis.

OBJECTIVES: This study assessed the prognostic impact of right ventricular involvement (RVI) in streptokinase-treated patients with inferior acute myocardial infarction (AMI) stratified for small or large AMI. BACKGROUND: Only scant data exist from small studies about the impact of reperfusion therapy on survival in patients with RVI during inferior AMI. METHODS: Right ventricular involvement was assessed by ST-segment elevation > or =0.1 mV in lead V4R and infarct size by the extent of ST-segment deviation on the baseline electrocardiogram: small AMI=sum ST-segment elevation < or =0.8 mV and no precordial ST-segment depression (small ST); large AMI=presence of precordial ST-segment depression or sum ST-segment elevation >0.8 mV (large ST) in 522 inferior AMI patients of the Hirudin for Improvement of Thrombolysis (HIT-4) Trial. In 187 patients, 90-min coronary angiography was performed. RESULTS: Right ventricular involvement was present in 169 patients (32%). Higher 30-day cardiac mortality rates with RVI (5.9% vs. 2.5%) were related to larger infarct size rather than to RVI. For large ST, a proximal right coronary artery lesion was observed in 52% with and in 23% without RVI. Patency rates at 90 min were similar (54% vs. 52%). In the 28% of patients who had small ST, cardiac mortality was less than 1% irrespective of the presence of RVI. Coronary artery lesions were mostly located distally. Patency rates were 27% with and 80% without RVI. CONCLUSIONS: ST-segment elevation of > or =0.1 mV in V4R in inferior AMI patients is associated with larger infarct size and higher 30-day mortality rates. Right ventricular involvement is not an independent predictor of survival. In patients with small ST, cardiac mortality is low, even if ST V4R is > or =0.1 mV.

Coronary Angiography↗
PubMed2003

Isolated coronary artery rupture after blunt chest trauma.

After blunt chest trauma, a patient with chronic coronary heart disease sustained an isolated rupture of the right coronary artery. All findings suggested a heart contusion complicated by a non-compromising pericardial effusion and aggravated by anticoagulation with phenprocoumon. After right-ventricular failure occurred, emergency coronary revascularization could not prevent a fatal outcome. This case emphasizes that a coronary artery lesion may be considered in those cases of thoracic trauma with preexisting coronary calcification.

Aged↗
PubMed2002

Echocardiography in the management of pulmonary embolism.

Echocardiography is not recommended as a routine imaging test to diagnose suspected pulmonary embolism. However, it is useful for identifying patients with pulmonary embolism who may have a poor prognosis. It can be used for rapid and accurate risk assessment. Moderate or severe right ventricular hypokinesis, persistent pulmonary hypertension, a patent foramen ovale, and free-floating right-heart thrombus are echocardiographic markers that identify patients at risk for death or recurrent thromboembolism. Such patients warrant consideration for thrombolysis or embolectomy. Serial imaging of right ventricular function can help physicians monitor the effect of treatment and judge whether the selected management strategy is successful. Further research will clarify and define more precisely the utility and limitations of echocardiography in the management of pulmonary embolism.

Echocardiography↗
PubMed2005

Hemodynamic effects of pumpless extracorporeal membrane oxygenation (ECMO) support for chronically pressure-overloaded right heart failure in a canine experimental model.

PURPOSE: This study was done to evaluate the hemodynamic effects of a pumpless implantable extracorporeal membrane oxygenation (ECMO) circuit between the right ventricle (RV) and left atrium (LA) in a chronic canine model with an RV pressure overload. METHOD: We created a model of right-sided heart failure by pulmonary artery banding in ten dogs for a duration of more than 3 months. After demonstrating that the RV pressure increased, a bypass circuit was created between the RV and LA with an in-line oxygenator. Both the hemodynamics and gas exchange were measured. RESULTS: The effects of a pulmonary bypass in nine dogs were studied. Approximately half of the RV output was passively shunted through the bypass circuit, and a marked reduction in the RV pressure and recovery from right heart failure were observed. After a complete ligation of the main pulmonary artery, five of the nine dogs survived more than 6 h. The RV pressure did not change significantly, but the cardiac output and blood pressure gradually decreased. The blood gas state was sufficiently maintained throughout the experiment. CONCLUSION: The present study indicates the hemodynamic benefit of a partial pumpless ECMO system in dogs with chronically pressure-overloaded right heart failure; however, the experimental preparation of the total pumpless ECMO circuit proved to be unstable.

Animals↗
PubMed1998

Tricuspid valve repair in a mountaineer.

Lord Hunt of Everest presented with aortic stenosis but predominant right ventricular failure. He was found to have signs of pulmonary hypertension with a dilated right ventricle, severe tricuspid regurgitation, and right atrial hypertrophy in the absence of elevated pulmonary artery pressures. He is a lifelong mountaineer and we attribute these findings to intermittent prolonged exposure to high altitude.

Adaptation, Physiological↗
PubMed2000

Metastatic hepatocellular carcinoma obstructing the right ventricular outflow tract.

A 49-year-old female with a past history of liver resection due to hepatocellular carcinoma was referred to our Department for treatment of a metastatic cardiac tumor obstructing the right ventricular outflow tract. She underwent operation twice with cardiopulmonary bypass, and symptoms were relieved. Metastasis from hepatocellular carcinoma to the heart is very rare, but should be taken into consideration during follow-up after treatment for a primary liver tumor.

Carcinoma, Hepatocellular↗
PubMed2006

Tissue Doppler assessment of longitudinal right and left ventricular strain and strain rate in pulmonary artery hypertension.

Tissue Doppler imaging (TDI) in 38 adult patients with pulmonary artery hypertension of varied etiology and normal left ventricular systolic function by two-dimensional transthoracic echocardiography showed significantly reduced peak systolic strain (SS) in all three segments of left ventricular free wall and ventricular septum and two of three segments of right ventricular free wall when compared to 29 adults with no clinical or echocardiographic evidence of heart disease and normal left and right ventricular systolic function. A similar reduction in peak diastolic strain (DS) was also noted in all three segments of left ventricular free wall and ventricular septum and one of three segments of right ventricular free wall. This reduction in strain indices in patients with pulmonary hypertension was noted irrespective of whether right ventricular systolic function was normal or reduced as assessed by two-dimensional transthoracic echocardiography. SS and DS rates also showed reductions in patients with pulmonary artery hypertension. Our study shows the potential value of TDI indices in identifying reduced regional left ventricular systolic and diastolic longitudinal function in patients with pulmonary artery hypertension and normal left ventricular systolic function by two-dimensional transthoracic echocardiography. This reduction in left ventricular function was noted in patients with both normal and reduced right ventricular systolic functions by two-dimensional echocardiography.

Adult↗
PubMed2006

Influence of ovariectomy in the right ventricular contractility in heart failure rats.

BACKGROUND: Clinical studies in postmenopausal women suggest that female hormones play an important role in maintaining healthy cardiovascular conditions. The objective of this study was to evaluate the influence of ovarian hormones in the right ventricle contractility in heart failure (HF) rats following myocardial infarction (MI). METHODS: Female Wistar rats were divided into four groups: healthy ovariectomized (OVX), ovariectomized with HF (OVX-HF), HF, and sham operated (SHAM). Ovariectomy was performed in 10-week-old rats, and MI was induced 1 week later. Eight weeks after MI, right ventricular (RV) performance was analyzed using RV strip preparations. RESULTS: Ovariectomy did not change the infarct size (HF: 42 +/- 3.5 vs. OVX-HF: 39 +/- 1.5%). In the presence of isoproterenol (ISO) and calcium, the isometric force was reduced in both HF groups. Ovariectomy did not modify the positive inotropic parameter in the control and in HF rats. Time to peak tension (TPT) was prolonged in both ovariectomized groups compared to SHAM (ISO 10(-7) M OVX: 125 +/- 12( *); SHAM: 81 +/- 4; HF: 87 +/- 4; OVX-HF: 102 +/- 6( *) msec, ( *)p <0.01 vs. SHAM), and relaxation time (RT) was prolonged in OVX (270 +/- 16( *) msec) and OVX-HF (241 +/- 10( *) msec) vs. SHAM (197 +/- 6 msec; ( *)p <0.01 vs. SHAM). CONCLUSIONS: We conclude that the absence of female ovarian hormones during nine weeks does not influence the right ventricle positive inotropic response, but it prolongs the time of contraction and relaxation in normal and in HF rats following MI.

Animals↗
PubMed2002

Electrocardiographic manifestations: right ventricular infarction.

The 12-lead electrocardiogram (EKG) is an essential tool when evaluating the Emergency Department (ED) patient with suspected cardiac ischemia. The standard EKG has limitations when evaluating "remote" areas of the heart such as the left posterior wall or right ventricular wall. Diagnosis of right ventricular infarction (RVI) in the presence of acute inferior wall myocardial infarction (MI) is made utilizing right-sided chest leads with high sensitivities and specificities. RVI is a serious ED problem because morbidity and mortality is higher in acute MIs associated with RVI.

Angioplasty, Balloon, Coronary↗
PubMed1995

Effects of inhaled nitric oxide on right ventricular function in endotoxin shock.

Sepsis has been shown to cause right ventricular (RV) dysfunction, which may be related to pulmonary hypertension and increased RV afterload. This study evaluates the effects of inhaled nitric oxide (NO), a selective pulmonary vasodilator, on RV function in a porcine model of endotoxemia. After an infusion of Escherichia coli lipopolysaccharide (LPS; 200 micrograms/kg), animals were resuscitated with saline (1 mL/kg/min) and observed for 3 hours while being mechanically ventilated (Fio2 = 0.6, tidal volume = 12 mL/kg, and peak end-expiratory pressure = 5 cm H2O). The LPS group (n = 5) received no additional treatment. The NO group (n = 5) received inhaled NO (40 ppm) for the last 2 hours. The control group (n = 5) received only saline without LPS. Hemodynamic data and blood gases were collected hourly for 3 hours. LPS resulted in pulmonary hypertension and RV dysfunction as indexed by a decreased RV ejection fraction and increased RV end-diastolic volume. Inhaled NO significantly decreased pulmonary hypertension and significantly increased RV ejection fraction and oxygen delivery without adverse effects. In conclusion, inhaled NO significantly improved pulmonary hypertension and RV dysfunction in a porcine model of endotoxemia and should be a useful therapeutic modality in selected septic patients.

Administration, Inhalation↗
PubMed2006

Ventricular size and function assessed by cardiac MRI predict major adverse clinical outcomes late after tetralogy of Fallot repair.

BACKGROUND: Factors associated with impaired clinical status in a cross-sectional study of patients with repaired tetralogy of Fallot (TOF) have been reported previously. OBJECTIVES: To determine independent predictors of major adverse clinical outcomes late after TOF repair in the same cohort during follow-up evaluated by cardiac magnetic resonance (CMR). METHODS: Clinical status at latest follow-up was ascertained in 88 patients (median time from TOF repair to baseline evaluation 20.7 years; median follow-up from baseline evaluation to most recent follow-up 4.2 years). Major adverse outcomes included (a) death; (b) sustained ventricular tachycardia; and (c) increase in NYHA class to grade III or IV. RESULTS: 22 major adverse outcomes occurred in 18 patients (20.5%): death in 4, sustained ventricular tachycardia in 8, and increase in NYHA class in 10. Multivariate analysis identified right ventricular (RV) end-diastolic volume Z >or=7 (odds ratio (OR) = 4.55, 95% confidence interval (CI) 1.10 to 18.8, p = 0.037) and left ventricular (LV) ejection fraction <55% (OR = 8.05, 95% CI 2.14 to 30.2, p = 0.002) as independent predictors of outcome with an area under the receiver operator characteristic curve of 0.850. LV ejection fraction could be replaced by RV ejection fraction <45% in the multivariate model. QRS duration >or=180 ms also predicted major adverse events but correlated with RV size. CONCLUSIONS: In this cohort, severe RV dilatation and either LV or RV dysfunction assessed by CMR predicted major adverse clinical events. This information may guide risk stratification and therapeutic interventions.

Adolescent↗
PubMed2001

Cardiac troponin I levels in patients with left heart failure and cor pulmonale.

Cardiac troponin levels are regarded as the most specific of currently available biochemical markers of myocardial damage. Elevated levels of troponin have been previously reported in patients with left heart failure, reflecting small areas of undetected myocardial cell death. The aim of this study was to compare the levels of the cardiac troponin I (cTnI) in patients with left- and right-sided heart failure. Cardiac troponin I levels were studied with immunochemical methods in patients with right heart failure (n = 17) resulting from chronic obstructive pulmonary disease, ischemic left heart failure (n = 23), and nonischemic left heart failure (n = 18) who were admitted to departments of cardiology and chest diseases. Also, cTnI levels were measured in 32 healthy subjects as control group. Protein markers of myocardial injury (cTnI and myoglobin) in patients with left and right heart failure were collected approximately 12 to 36 hours after onset of obvious symptoms. Serum creatine kinase MB band was determined on admission and thereafter twice a day during the first 3 days. Elevated levels of serum cTnI were found in patients with nonischemic (0.83 +/- 0.6 ng/mL, p<0.01) and ischemic left heart failure (0.9 +/- 0.5 ng/mL, p<0.01) when compared to healthy subjects, whereas serum cTnI levels in patients with right heart failure due to chronic obstructive pulmonary disease were not significantly different from those of control subjects (0.22 +/- 0.1 vs 0.16 +/- 0.1 ng/mL, p>0.05). In addition, creatine kinase MB band and myoglobin levels were not significantly different between patient and healthy groups. The mean of cTnI levels in ischemic and even nonischemic left heart failure were increased compared to the mean of values in healthy individuals but without significant creatine kinase MB band and myoglobin elevations. But cTnI levels were not increased in patients with right heart failure due to chronic obstructive pulmonary disease. These data indicate that the cTnI levels are abnormal in left heart failure but not in cor pulmonale.

Adult↗
PubMed2006

Efficacy of sildenafil as a rescue therapy for patients with severe pulmonary arterial hypertension and given long-term treatment with prostanoids: 2-year experience.

BACKGROUND: Both prostanoids and sildenafil are effective treatments for severe pulmonary arterial hypertension (PAH). The combined use of these drugs to maximize the clinical benefit is an emerging treatment option. This study describes a 2-year experience with adjunct sildenafil as a rescue therapy for patients with severe PAH treated long term with prostanoids and who showed clinical deterioration or onset of heart failure. METHODS: Twenty patients (11 men, 9 women; mean age 42 +/- 11 years) with severe PAH, who showed clinical or functional worsening despite ongoing treatment with prostanoids (8 subcutaneous, 7 intravenous, 5 inhaled), were started on adjunct oral sildenafil. New York Heart Association (NYHA) functional class, 6-minute walking test, signs of right ventricular failure and echocardiography were assessed before and after 1 and 2 years of combined therapy. RESULTS: There was a significant improvement of NYHA functional class and signs of right heart failure after 1- and 2-year follow-up. Patients showed a mean increase in 6-minute walking distance of 79 m and 105 m after 1 and 2 years of adjunct sildenafil, respectively. Two patients died during follow-up. The echocardiographic parameters showed a significant reduction of right ventricular end-diastolic diameter and left ventricular diastolic eccentricity index. No serious side effects related to sildenafil were observed. CONCLUSIONS: Adjunct sildenafil to long-term prostacyclin therapy in patients with severe PAH provided sustained clinical stabilization and an improved clinical situation, exercise capacity and echocardiographic parameters of right ventricular function. The beneficial effects were strong and lasted >24 months.

Adult↗
PubMed1997

Right ventricular cardiomyopathy: diffuse dilatation, focal dysplasia or biventricular disease.

Non-coronary ventricular tachyarrhythmias originating from the right ventricle are frequent events associated in many cases with structural and functional abnormalities of the right ventricle. Primary right ventricular affections such as arrhythmogenic right ventricular dysplasia and secondary right ventricular involvements such as in dilated cardiomyopathy must be distinguished. The value of conventional diagnostic procedures is undetermined. A total of 73 patients (41 males, mean age 40.6 +/- 11.4 years) with left bundle branch block ventricular arrhythmias and angiographic aspects of right ventricular outpouchings or aneurysms were divided into three groups: Group 1: diffuse right ventricular dilatation without left ventricular affection, Group 2: focal right ventricular abnormalities (dysplasia) Group 3: biventricular disease. The results of standard ECG, angiography and programmed ventricular stimulation were analysed retrospectively. Clinical monomorphic ventricular tachycardia was more often in diffuse dilatation (82%) and focal dysplasia (57%). In these two groups programmed ventricular stimulation was able to induce clinical tachycardias at a high degree (57-82%). In cases of biventricular disease cardiac arrest as the primary event without inducibility of monomorphic ventricular tachycardia was the predominant feature (44%). Standard ECG disclosed localised right precordial QRS prolongation in 'normal' QRS morphology, incomplete and complete right bundle branch block in 66 patients in all three subgroups. Other ECG findings such as left ventricular hypertrophy in four patients with heart failure and single premature beats and left bundle branch block in a patient with rapid ventricular tachycardia and ventricular fibrillation was found only in group 3 supposed to be the most heterogeneous group. In summary, angiographic classification used in this study demonstrates different morphological aspects of right ventricular cardiomyopathy with ventricular tachyarrhythmias as the major clinical aspect. High risk patients with diffuse dilatation or biventricular disease can be identified. Only patients with the angiographic aspect of focal dysplasia seem to be possible candidates for catheter ablation techniques.

Adult↗
PubMed2001

Systemic right ventricular failure after atrial switch operation: midterm results of conversion into an arterial switch.

BACKGROUND: Failure of the systemic right ventricle after atrial switch operation can be treated by conversion into an arterial switch operation. METHODS: Four patients, age 38 to 59 months, presented with right ventricular failure after Senning operation and ventricular septal defect closure. One patient had elevated left ventricular pressure; in the other three patients the left ventricle was retrained to a left ventricular/right ventricular pressure ratio of 0.8 or greater by pulmonary artery banding in 12 to 24 months. RESULTS: Postoperative course after arterial switch operation was prolonged, but clinical condition was good at discharge. Fractional shortening ranged from 20% to 28%. Trace-to-moderate aortic regurgitation was present; only 1 patient had preserved sinus rhythm. After a mean follow-up of 43.5 months 1 patient had died due to left ventricular dysfunction. The survivors are in New York Heart Association functional class I to II. Fractional shortening has improved (29% to 37%); aortic regurgitation has not increased. No patient has undisturbed sinus rhythm. CONCLUSIONS: Conversion of an atrial into an arterial switch is an alternative to cardiac transplantation in childhood. However, the procedure is demanding. Long-term morbidity is caused by rhythm disturbances. Aortic valve performance and left ventricular function require close observation.

Cardiac Surgical Procedures↗
PubMed1998

Surgical management of radiation-induced heart disease.

BACKGROUND: With the increasing population of patients with prior mediastinal irradiation, cardiac surgeons will encounter patients with radiation-induced damage to the heart and the great vessels. Awareness of the pathology and the surgical management is essential to provide optimal care for these patients. METHODS: Eight patients with radiation-induced heart disease were encountered in the last 10 years. After a brief clinical presentation, the surgical management of radiation-induced heart disease is reviewed. RESULTS: Radiation can affect all the structures in the heart, including the coronary arteries, the valves, and the conduction system. The pericardium is the most commonly involved, and the conduction system is the least involved. Pericardiectomy is quite effective in patients with symptomatic pericardial effusion or constriction. The coronary lesions are located predominantly in the ostial or proximal regions of the epicardial vessels. Percutaneous transluminal coronary angioplasty alone appears to have a high rate of restenosis. Surgical revascularization has good long-term results, and the internal mammary artery should be used if it is satisfactory. The aortic and mitral valves are more commonly involved than the tricuspid and pulmonary valves. Myocardial dysfunction predominantly affects the right ventricle and requires particular attention during cardiopulmonary bypass and in the postoperative period. Restoration of sinus rhythm is essential in view of stiffness of the ventricles. Flexibility in the surgical approach with selective use of thoracotomy will facilitate the surgical procedure in certain patients. CONCLUSIONS: Surgeons should be well versed in all the manifestations and the management of radiation-induced heart disease.

Adult↗
PubMed2000

Postoperative acute refractory right ventricular failure: incidence, pathogenesis, management and prognosis.

Isolated acute refractory right ventricular failure is extremely uncommon. There are greater prospects of seeing a right dominant biventricular failure, as the two ventricular chambers are contiguous. The overall clinical spectrum is determined by the relative ischemic involvement of the right or left ventricle. The postoperative acute refractory right ventricular failure that develops after cardiotomy, heart transplant, or during a left ventricular assist device support, may have somewhat dissimilar elements of origin, but the resultant clinical picture and the management are essentially similar. In this collective review, the authors have summarized the incidence, pathogenesis, management and prognosis of postoperative acute refractory right ventricular failure, in adult cardiac surgical practice. The incidence of post-cardiotomy acute refractory right ventricular failure ranges from 0.04 to 0.1%. Acute refractory right ventricular failure has also been reported in 2-3% patients after a heart transplant and in almost 20-30% patients who receive a left ventricular assist device support. The main contributor to this problem is a disproportionate ischemic involvement of the right ventricle. Other pertinent contributors to this problem are pulmonary hypertension and an altered interventricular balance. The latter component is predominant in recipients of a left ventricular assist device support. Postoperative acute refractory right ventricular failure has been successfully managed with conventional pulmonary vasodilators, mechanical support with a pulmonary artery balloon pump, a right ventricular assist device, or cavopulmonary diversion. Unfortunately, the reported initial salvage rate is only 25-30%. This problem is often underestimated. Support measures are often started late or terminated prematurely. These factors have contributed to a poor initial salvage rate in this group of patients.

Acute Disease↗