Experimental Study of Right Ventricular Function After Surgical Procedures Involving the Right Ventricle and Pulmonic Valve

Wg, Austen; Lj, Greenfield; Pa, Ebert; Ag, Morrow

doi:10.1097/00000658-196204000-00019

Cited by 41 publications

(8 citation statements)

References 6 publications

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“…Ellison et al (1955) found that complete avulsion of the pulmonary valve in dogs was followed by no disability one year after operation. Austen et al (1962) confirmed these findings. However, right ventriculotomy further compromised right ventricular function, while additional mild pulmonary stenosis reduced the severity of the incompetence.…”

Section: Discussionsupporting

confidence: 69%

Haemodynamic and cine-angiocardiographic findings after one-stage repair of Fallot's tetralogy.

Gotsman¹

1966

Heart

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One-stage repair of Fallot's tetralogy is a satisfactory operative procedure with an acceptable mortality, provided the operation is undertaken by a team who are skilled in managing this heart lesion (Kirklin et al., 1959;Barnard and Schrire, 1961;Malm et al., 1963). The clinical results in the survivors are rewarding because the change in status is remarkable. Several recent reports on the haemodynamics have emphasized the clinical well-being of the patients. The present study set out to confirm this clinical impression, to assess the long-term improvement in the anatomy of the outflow tract, and to study the response of the heart and pulmonary circulation to exercise. PATIENTS AND METHODSEleven patients with the most severe pre-operative disability who had undergone a one-stage repair operation of Fallot's tetralogy were selected from a group of 34 long-term survivors. They were cyanosed before operation with clubbing of the fingers. Three were having recurrent episodes of extreme cyanosis. They were small (below the 25th percentile of height and weight for age). The right ventricle was dominant with a short systolic ejection murmur in the pulmonary area and a loud, apparently single second sound in the aortic area. Electrocardiography, chest radiograph, cardiac catheterization, and selective angiocardiography confirmed the presence of severe cyanotic Fallot's tetralogy, with marked obstruction to the outflow tract of the right ventricle and a large right-to-left shunt through the ventricular septal defect.Pulmonary valvotomy and infundibular resection was performed in all the patients: in 10 an outflow tract prosthesis was inserted, and in 7 it was carried across the pulmonary valve ring into the pulmonary artery. Two patients had such severe outflow tract obstruction that there was only a probe patent communication between the body of the right ventricle and the pulmonary artery. The ventricular septal defect was closed by Received April 26, 1965. * Present address: The Cardiac Clinic, Groote Schuur Hospital Observatory, Cape, South Africa. 448 direct suture in 6 and with a teflon patch in 5. Six patients in whom the prosthesis was extended into the pulmonary artery had severe residual pulmonary incompetence.The patients were all well, living a normal life, and with a near normal exercise tolerance. They were able to run up four flights of stairs, a vertical height of 60 ft. (18-3 m.), without becoming short of breath. The finger clubbing disappeared.In the presence of pulmonary incompetence, the right ventricle was hyperdynamic with a long systolic ejection murmur heard best in the pulmonary area, a single second sound of aortic valve closure, and a diamondshaped early diastolic murmur which was delayed 0 04 sec. after aortic valve closure. Complete right bundle-branch block was present in all the patients (Fig. 1). The pulmonary vascularity had become normal but the heart size had increased since operation. A convex left middle segment was present in patients with an outflow tract prosthesis (Fig. 2). Pul...

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Section: Discussionsupporting

confidence: 69%

Haemodynamic and cine-angiocardiographic findings after one-stage repair of Fallot's tetralogy.

Gotsman¹

1966

Heart

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“…The use of a nonvalved conduit between the right ventricle and pulmonary artery, and its effect on myocardial development and performance is equivocal. [30][31][32][33][34][35][36][37][38][39][40][41][42] Although initial effects of pulmonary insufficiency are well-tolerated, pulmonary insufficiency is probably not a benign lesion. ", 1*, 23,27,[43][44][45][46][47] Except for valve replacement, most intracardiac techniques to relieve valvular pulmonic stenosis cause some degree of valvular insufficiency.…”

Section: Discussionmentioning

confidence: 99%

Double‐Outlet Right Ventricle for Relief of Pulmonic Stenosis in Dogs An Experimental Study

et al. 1984

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Relief of right ventricular outflow obstruction with a valveless Dacron conduit from the right ventricle to pulmonary artery was accomplished in 12 normal dogs. The procedure involved the development of a surgical technique without cardiopulmonary bypass, hypothermia, and/or venous occlusion; the development of a ventricular coring instrument; the fabrication of a wire supported Dacron conduit; the development of a basketed insert cannula; and the creation of an experimental model of pulmonlc stenosis. Of the 12 dogs operated, two died intraoperatively, three died postoperatively, and seven were electively euthanlzed postoperatively. Relief of the right ventricular outflow obstruction was documented in all cases by a reduction in mean peak right ventricular pressure, improvement of mean arterial pressure, decrease in mean right atrial pressure, and an increase in mean pulmonary artery pressure. The pulmonary insufficiency created was considered a tolerable although not benign condition. The technique would be of particular value in dogs with severe right ventricular hypertrophy.BSTRUCTION OF THE RIGHT ventricular outflow 0 tract (pulmonic stenosis) may be supravalvular, * Meadox Cooley Graft Veri-soft, Meadox Medicals, Inc., Oakt " 5 minute" Epoxy, Devcon Cop.,

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“…15 The present study is also in agreement with results of RV function of acute dog experiments after resection of the pulmonary valve. 16 The mechanisms for the depression in RV function could be the increased RV wall stress, and it might be caused by a decrease in coronary reserve. 17 The present study indicates that the primary problem in these patients is an increase in the pulmonary arterial compliance.…”

Section: Discussionmentioning

confidence: 99%

Ventricular and pulmonary artery volumes in patients with absent pulmonary valve. Factors affecting the natural course.

Hiraishi¹,

Bargeron²,

Isabel-Jones³

et al. 1983

Circulation

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SUMMARY Right and left ventricular (RV and LV) volumes were determined in 19 patients with absent pulmonary valve syndrome using Simpson's rule and area-length methods. The volume of the proximal right pulmonary artery (RPAV) was calculated at maximal and minimal size using the area-length method. Patient groups included four newborns who responded to medical management (group 1A), seven critically ill newborns who died (group iB), four infants ages 1-10 months (group 2) and four children ages 2-8 years (group 3). The RVend-diastolic volume in groups 1B and 2 was significantly greater than that in groups 1A and 3. The RV ejection fraction in groups lB and 2 was significantly less than that in normal patients and groups 1A and 3. Maximal RPAV correlated well with RV stroke volume and end-diastolic volume. The maximal RPAV in group 1B was significantly greater than that in groups 1A and 3. Pulmonary arterial compliance was greater than normal in all groups, and the compliance in group 1B was more than two times that in the other groups. We conclude that the increased right pulmonary artery compliance and pulmonary regurgitation in patients with absent pulmonary valve contribute to bronchial obstruction and right-heart failure and are the causes of the high morbidity and mortality in these patients. The management should be directed to the alleviation of bronchial obstruction and right-heart failure.THE ABSENT pulmonary valve syndrome (APVS) usually consists of an absent pulmonary valve, a ventricular septal defect, mild-to-severe right ventricular (RV) outflow obstruction, and aneurysmal dilatation of the pulmonary arteries. The always located at the pulmonary valve ring, and sometimes at the infundibulum as well. 1-3 This combination of the lesions is better known as tetralogy of Fallot with absent pulmonary valve.Calder et al.4 reviewed 233 cases with APVS and reported that many infants die early from severe respiratory distress and intractable cardiac failure. Bronchial compression by distended pulmonary arteries is a particular problem in patients with APVS in early infancy.2 5,6 However, the relationship between RV function and the aneurysmal dilatation of the pulmonary arteries is not known. Furthermore, it is not clear how often RV and left ventricular (LV) function influence the morbidity and mortality of these patients. In this study we describe the characteristics of RV and LV performance in newborns, infants and children

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Experimental Study of Right Ventricular Function After Surgical Procedures Involving the Right Ventricle and Pulmonic Valve

Cited by 41 publications

References 6 publications

Haemodynamic and cine-angiocardiographic findings after one-stage repair of Fallot's tetralogy.

Haemodynamic and cine-angiocardiographic findings after one-stage repair of Fallot's tetralogy.

Double‐Outlet Right Ventricle for Relief of Pulmonic Stenosis in Dogs An Experimental Study

Ventricular and pulmonary artery volumes in patients with absent pulmonary valve. Factors affecting the natural course.

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