Right ventricular infarction: Frequency, size and topography in coronary heart disease: A prospective study comprising 107 consecutive autopsies from a coronary care unit

Abstract

During a 14 month period autopsies were performed on 107 patients with coronary heart disease and the results were evaluated prospectively with special reference to right ventricular infarction. A total of 214 regional infarcts were found, 107 (50%) of which involved the right ventricle. Right ventricular infarction was found in 90 hearts (84%), but only three isolated right ventricular infarcts were seen. Right ventricular involvement was found with equal frequency in anterior and posterior infarction (64 versus 66%), but posterior right ventricular infarcts were much larger (15% of the right ventricle was infarcted versus 1%). Proximal right coronary artery occlusion caused larger right ventricular infarction than did distal occlusion (15 versus 5 g). Right ventricular infarct size was not influenced by coronary artery disease (evaluated angiographically) in noninfarct-related vessels. Anterior right ventricular infarcts were predominantly located near the apex of the heart (to the left of the sternum), whereas posterior right ventricular infarcts were located near the atrioventricular groove (along the right sternal border). Infarct size was equal in patients who died from a first acute anterior or posterior infarct. However, posterior infarcts had more right ventricular involvement (28% of total infarct size versus 7% in anterior infarcts) leaving more of the left ventricular myocardium intact (79 versus 64%). These differences in infarct topography may explain why right ventricular involvement seldom is diagnosed clinically in patients with anterior infarction, and why left ventricular function and prognosis usually are better after posterior compared with anterior infarcts of enzymatically equal size.

Right ventricular dilatation in patients with coronary heart disease without myocardial infarction: According to the data of the Coronary Angiography Surgery Registry

“…Поэтому у больных ИБС можно ожидать выявления связи дилатации ПЖ с множественными коронарными стенозами или с бόльшим размером асинергии ЛЖ. ИМ ПЖ чаще развивается в ре-зультате поражения проксимального отдела недоминиру-ющей правой КА [10,11], поэтому дилатация ПЖ у наших пациентов могла быть связана с поражением этой локали-зации при левом типе коронарного кровообращения. Од-нако по типу коронарного кровообращения, распростра-ненности или локализации поражений КА и индекса аси-нергии ЛЖ межгрупповых различий не выявлено.…”

Right ventricular segmentation in cardiac MRI with moving mesh correspondences

“…More details about the data can be found at the RVSC website. 2 Ground truth manual segmentations were provided only for the training set. For testing data sets, initial manual contours were drawn using a programme developed in-house that uses spline smoothing, and therefore, require a small number of points to be provided by the user.…”

“…Although clinically evidenced with several studies [2,3], the importance of RV analysis was overlooked in the last decade. Andersen et al [2] showed that up to 50% of all regional infarcts are RV related.…”

“…Although clinically evidenced with several studies [2,3], the importance of RV analysis was overlooked in the last decade. Andersen et al [2] showed that up to 50% of all regional infarcts are RV related. Cor pulmonale, the enlargement of the RV due to pulmonary hypertension, is the third most common cause of cardiac dysfunction in patients over the age of 50 [3].…”

Diretrizes

“…Dessa forma, a oclusão da artéria coronária direita antes de seus ramos leva à isquemia do ventrículo direito 364 . O infarto do ventrículo direito hemodinamicamente significante ocorre quase exclusivamente na presença de infarto inferior 365 . Pelo fato de o ventrículo direito ter massa muscular muito menor que o ventrículo esquerdo (principalmente pela menor resistência vascular do circuito pulmonar), sua demanda de oxigênio …”