Contribution of left ventricular contraction to the generation of right ventricular systolic pressure in the human heart.

Feneley, Michael P.; Gavaghan, T. P.; Baron, D.; Branson, John; Roy, Probal; Morgan, John J. B.

doi:10.1161/01.cir.71.3.473

Cited by 128 publications

(66 citation statements)

References 52 publications

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“…In normal subjects, both LV effects on RV function [1][2][3]5,28 and RV effects on LV function 2,4,28 have been observed. These effects are important in functional single ventricles because there is no second ventricle to augment the function of the systemic ventricle.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5][6]28 The mechanism of free wall contribution is the fact that the myocardium is a "syncytium of muscle fibers tethered within a collagen network" 28 with muscle fibers in continuity between RV and LV. 29 Santamore et al 2 showed in rabbits that the free wall of one ventricle affects the contralateral ventricle.…”

Section: Discussionmentioning

confidence: 99%

“…N ormally, left ventricles (LVs) and right ventricles (RVs) affect each other's mechanics [1][2][3][4][5] by augmenting the function of the other ventricle. LV effects on RV pressure generation have been demonstrated in the human 1,3 and animal 2,5 heart as well as RV effects on LV function.…”

mentioning

confidence: 99%

“…LV effects on RV pressure generation have been demonstrated in the human 1,3 and animal 2,5 heart as well as RV effects on LV function. 2,4 We have also recently described the effects of a pulmonary LV on systemic RV mechanics.…”

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confidence: 99%

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Mechanics of the Single Left Ventricle

et al. 1998

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Background-Left ventricular (LV) effects on right ventricular (RV) function are well known. Less is understood about the effect of the RV on systemic LV mechanics. To determine this interaction, we compared systemic LVs with and without an RV mechanically coupled to them. Methods and Results-MR myocardial tagging was used to examine 18 subjects with systemic LVs: 10 with functional single LVs (SLV) and 8 normal subjects (NL). Tracking the systolic motion of the intersecting stripes were used to determine regional twist and radial motion. Finite strain analysis was applied to derive principal strains at the atrioventricular valve (AVV) and apical short-axis levels and in 4 anatomic wall regions. Similar E 1 (circumferential shortening) strain and heterogeneity of strain were noted between SLV and NL except in the septal wall. At the septal wall, NL displayed greater absolute strain (AVVϭϪ0.16Ϯ0.02, apexϭϪ0.17Ϯ0.02) and less heterogeneity of strain than SLV (AVVϭϪ0.12Ϯ0.02, apexϭϪ0.13Ϯ0.02). Similar E 2 (wall thickening) strain and heterogeneity of strain were also noted between SLV and NL except again at the septal wall. At the septal wall, SLV displayed greater absolute E 2 strain (AVVϭ0.17Ϯ0.08, apexϭ0.19Ϯ0.09) and less heterogeneity of strain than NL (AVVϭ0.07Ϯ0.07, apexϭ0.05Ϯ0.05). SLV twisted significantly less counterclockwise than NL in 6 of 8 wall regions and actually twisted clockwise at the AVV lateral wall. Although there was no significant difference between groups in radial wall motion, the septal and inferior walls of SLV demonstrated significantly less radial motion compared with other SLV walls. Conclusions-A major influence of the RV on systemic LV strain and radial motion occurs in the septal wall, whereas absence of the RV causes marked differences in LV twist. These findings may yield clues to the long-term functioning of the SLV and be useful in determining strategies for RV augmentation of LV function. (Circulation. 1998;98:330-338.)

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Mechanics of the Single Left Ventricle

et al. 1998

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“…1,2 Over the last 60 years, both experimental data and clinical experience show that a significant portion of the RV systolic pressure is a result of the left ventricle (LV) generating pressure that is transmitted through the interventricular septum (IVS). [3][4][5][6] This left to right ''ventricular assistance'' is influenced by RV volume and pressure and the transseptal pressure gradient. 7,8 The clinical impact of this interaction increases with increasing RV dysfunction.…”

Section: Résumémentioning

confidence: 99%

Case report: paradoxical ventricular septal motion in the setting of primary right ventricular myocardial failure

Maslow

Schwartz

Mahmood

et al. 2009

Can J Anesth/J Can Anesth

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Purpose In this report, a case of right ventricular (RV) failure, hemodynamic instability, and systemic organ failure is described to highlight how paradoxical ventricular systolic septal motion (PVSM), or a rightward systolic displacement of the interventricular septum, may contribute to RV ejection. Clinical features Multiple inotropic medications and vasopressors were administered to treat right heart failure and systemic hypotension in a patient following combined aortic and mitral valve replacement. In the early postoperative period, echocardiographic evaluation revealed adequate left ventricular systolic function, akinesis of the RV myocardial tissues, and PVSM. In the presence of PVSM, RV fractional area of contraction was C35% despite akinesis of the primary RV myocardial walls. The PVSM appeared to contribute toward RV ejection. As a result, the need for multiple inotropes was re-evaluated, in considering that end-organ dysfunction was the result of systemic hypotension and prolonged vasopressor administration. After discontinuation of phosphodiesterase inhibitors, native vascular tone returned and the need for vasopressors declined. This was followed by recovery of systemic organ function. Echocardiographic re-evaluation two years later, revealed persistent akinesis of the RV myocardial tissues and PVSM, the latter appearing to contribute toward RV ejection. Conclusions This case highlights the importance of left to RV interactions, and how PVSM may mediate these hemodynamic interactions. RésuméObjectif Dans ce compte-rendu, un cas de de´faillance ventriculaire droite (VD), d'instabilite´he´modynamique et de de´faillance organique syste´mique est de´crit afin de souligner la manie`re dont le mouvement systolique paradoxal du septum interventriculaire (PVSM), ou un de´placement systolique de la cloison interventriculaire vers la droite, peut jouer un rôle dans l'e´jection du VD. É léments cliniques De nombreux me´dicaments inotropes et vasopresseurs ont e´te´administre´s pour traiter une de´faillance cardiaque droite ainsi qu'une hypotension syste´mique chez un patient a`la suite d'une chirurgie valvulaire aortique et mitrale combine´e. Au de´but de la pe´riode postope´ratoire, l'e´valuation e´chocardiographique a re´ve´le´une fonction systolique ade´quate du ventricule Electronic supplementary material The online version of this article

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Considerations in the Single Ventricle

Fogel¹

2005

Ventricular Function and Blood Flow in Congenital Heart Disease

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Contribution of left ventricular contraction to the generation of right ventricular systolic pressure in the human heart.

Cited by 128 publications

References 52 publications

Mechanics of the Single Left Ventricle

Mechanics of the Single Left Ventricle

Case report: paradoxical ventricular septal motion in the setting of primary right ventricular myocardial failure

Considerations in the Single Ventricle

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