Quantitative cineangiographic analysis of ventricular volume and mass in patients with single ventricle: relation to ventricular morphologies.

Abstract

With the use of biplane selective ventriculography, the ventricular volume, ejection fraction, and ventricular mass were evaluated in 28 patients with a single ventricle, and those with the left ventricular type (LV type, 12 patients) and right ventricular type (RV type, 16 patients) were compared. There were no significant differences in terms of age, hemoglobin, systemic oxygen saturation, or pulmonary-to-systemic flow ratio in the two groups. No patients with atrioventricular valve regurgitation were included. The ventricular cavity volume was calculated by the area-length method. The ventricular mass volume was determined as the shell volume created by subtracting the ventricular cavity volume from the total ventricular volume calculated by adding the free wall thickness to the chamber dimensions. The ventricular mass volume was converted to mass by multiplying by the gravity of the heart muscle. There was no significant difference between patients with the LV type and RV type of single ventricle with respect to the end-diastolic ventricular vclume (188 + 53 and 179 + 61 ml/m2 in LV and RV types, respectively), end-systolic volume (88 + 31 and 84 + 27 ml/m2), or ejection fraction (0.54 + 0.06 and 0.52 + 0.06). The following four indexes of the ventricular mass were significantly (p < .001) lower in patients with the RV type of single ventricle: ventricular wall thickness (3.9 ± 1.2 mm in RV type vs 6.9 ± 1.9 mm in LV type), ratio of the ventricular wall thickness to the transverse diameter of the ventricle (6.8 + 1.9% vs 12.1 ± 2.4%), ventricular mass (87 ± 35 vs 160 ± 47 g/m2), and ratio of ventricular mass to end-diastolic volume (0.48 ± 0.11 vs 0.88 + 0.17 g/ml). There was a positive linear correlation between the ventricular mass index and the pulmonary-to-systemic blood flow ratio in patients with LV type (r = .71, p < .01) but no correlation was seen in those with RV type. These results suggest that there is inadequate ventricular hypertrophy (insufficient ventricular mass to ventricular volume) in patients with the RV type of single ventricle compared with that in those with the LV type and this may lead to abnormal contractile state and poor adaptation of ventricular function in patients with the RV type of single ventricle.

B-type natriuretic peptide at the early stage of univentricular circulation reflects inadequate adaptation to volume overload

“…VM/EDV has been used to evaluate this adaptive hypertrophy of the ventricle in response to volume overload, both in acquired and congenital heart disease [2,22]. In the present study, patients with high BNP had low VM/EDV suggesting insufficient adaptation in response to volume overload.…”

“…The cardiac adaptation to chronic volume overload involves enlargement of chamber size and increase in ventricular mass in an attempt to normalize ventricular wall stress [1]. However, some patients with univentricular heart fail to develop sufficient ventricular mass in response to volume overload, which results in sustained elevation in wall stress and ventricular dysfunction [2].…”

Successful pregnancy and delivery in patients with uncorrected single ventricle: Three new cases and literature review

“…The poor prognosis of unoperated patients is ascribed to poor functions of UVH as well as other associated anomalies. It was thought that those with right ventricular morphology as dominant chamber had poorer outcomes due to inadequate Epidural anesthesia M -good N -live, 3000 g ventricular hypertrophy, which causes abnormal contractile state and poor adaptation of ventricular function [7]. Although surgery appears to be able to improve general condition of the patient, the long-term outcomes are still controversial [8].…”

Challenges Posed by Adults With Repaired Congenital Heart Disease

“…23 Left ventricular function in tricuspid atresia is usually better than that in a single ventricle of the left ventricular type, which in turn is better than that in a single ventricle of the right ventricular type. 26 In hearts equipped with 2 ventricles, the ejection fraction of a morphological right ventricle is inherently lower than the ejection fraction of a morphological left ventricle, whether the right ventricle is subpulmonary or subaortic. A case in point is the inherently low ejection fraction of a subaortic morphological right ventricle after an atrial switch operation or after reparative surgery for congenitally corrected transposition of the great arteries.…”