Right Ventricular Stenosis (Bernheim's Syndrome)

East, Terence; Bain, C. W. Curtis

doi:10.1136/hrt.11.2.145

Cited by 19 publications

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“…Among the clinical syndromes in which wave transmission could be an important, unappreciated factor are the stiff left atrium (LA) syndrome (6,15) and the Bernheim syndrome (1,5,24). To study the transmission of waves generated in the LA, we created a system where a backward-going wave, originating from the LA, could be detected in the proximal pulmonary artery (PA; backward and forward are defined with respect to PA flow.)…”

mentioning

confidence: 99%

Direct and series transmission of left atrial pressure perturbations to the pulmonary artery: a study using wave-intensity analysis

Hollander¹,

Dobson²,

Wang³

et al. 2004

American Journal of Physiology-Heart and Circulatory Physiology

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. Direct and series transmission of left atrial pressure perturbations to the pulmonary artery: a study using wave-intensity analysis. Am J Physiol Heart Circ Physiol 286: H267-H275, 2004. First published September 25, 2003 10.1152/ ajpheart.00505.2002-Pressure waves are thought to travel from the left atrium (LA) to the pulmonary artery (PA) only retrogradely, via the vasculature. In seven anesthetized open-chest dogs, a balloon was placed in the LA, which was rapidly inflated and deflated during diastole, early systole, and late systole. High-fidelity pressures were measured within and around the heart. Measurements were made at low volume [LoV; left ventricular end-diastolic pressure (LVEDP) ϭ 5-9 mmHg], high volume (HiV; LVEDP ϭ 16-19 mmHg), and HiV with the pericardium removed. Wave-intensity analysis demonstrated that, except during late systole, balloon inflation created forwardgoing PA compression waves that were transmitted directly through the heart without measurable delay; backward PA compression waves were transmitted in-series through the pulmonary vasculature and arrived after delays of 90 Ϯ 3 ms (HiV) and 103 Ϯ 5 ms (LoV; P Ͻ 0.05). Direct transmission was greater during diastole, and both direct and series transmission increased with volume loading. Pressure waves from the LA arrive in the PA by two distinct routes: rapidly and directly through the heart and delayed and in-series through the pulmonary vasculature. lung; arteries; hemodynamics; wave transmission WAVE TRANSMISSION through the heart is poorly understood. Among the clinical syndromes in which wave transmission could be an important, unappreciated factor are the stiff left atrium (LA) syndrome (6, 15) and the Bernheim syndrome (1,5,24). To study the transmission of waves generated in the LA, we created a system where a backward-going wave, originating from the LA, could be detected in the proximal pulmonary artery (PA; backward and forward are defined with respect to PA flow.) To create such a wave in a controlled fashion, we used an LA counterpulsation balloon. Pressure and velocity waveforms in the proximal PA were analyzed to evaluate the effects of LA pressure (P LA ) perturbations.Most commonly, pulsatile arterial phenomena have been characterized using Fourier analysis where the observed waveforms are decomposed into sinusoidal wave trains, and the results are expressed as amplitude and phase as a function of frequency (16,17). This frequency-domain analysis has provided much information. However, wave-intensity analysis where the observed waveforms are decomposed into a succession of infinitesimal wave fronts that are described by their amplitude and time (13,19) allows the interaction of forwardand backward-going waves and their relation to primary hemodynamic parameters (pressure, flow, etc.) to be studied directly. This method utilizes changes in pressure and velocity to evaluate the direction, intensity, and type of waves and has been used recently to study the systemic (18), pulmonary (8,11,22), and coronary circulations...

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confidence: 99%

Direct and series transmission of left atrial pressure perturbations to the pulmonary artery: a study using wave-intensity analysis

Hollander¹,

Dobson²,

Wang³

et al. 2004

American Journal of Physiology-Heart and Circulatory Physiology

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“…It has been reported to be caused by AH and aortic stenosis due to the severe rightward movement of the hypertrophied ventricular septum resulting in compression of the RV cavity leading to right-sided heart failure without pulmonary congestion. In 1936, Podestia renamed Bernheim's syndrome and called it dextroventricular stenosis (East et al, 1949). Olivary et al revealed that the development of ECG signs of LV strain is related to the abnormal performance of both sides of the heart and suggested the hypothesis of a functional interdependence of the two ventricles (Olivari et al, 1978).…”

Section: Influence Of Arterial Hypertension On Rv Structure and Functionmentioning

confidence: 99%

Untitled

2021

ESJ

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The structural and functional changes of left and right ventricles as well as the existence of ventricular interaction in patients with arterial hypertenison (AH) were discussed in many research papers. Therefore, published data regarding right ventricular changes under influence of AH are scarce, non-univocal, and sometimes contradictory. Furthermore, there is a significant lack of clinical trials addressing the influence of circadian BP profile on RV structure and function.The importance of right ventricular function in maintaining global cardiac performance was proven. However, the importance of the right ventricular structure and function for cardiovascular morbidity and mortality is still under debate. Despite the abundance of the study data and high vulnerability of the right ventricle under influence of AH, the world's leading contemporary guidelines of the AH management, right ventricular remodeling, its morphology, function, evaluation, predictive and prognostic value are neither discussed nor mentioned. Hence, we strongly believe that further investigations are needed to determine the exact clinical utility and

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“…East e Bain comentavam que, na síndrome de Bernheim, os sintomas sugestivos de insuficiência ventricular direita surgiam precocemente e podiam ser transitórios e que, por não atingir a circulação pulmonar, os pacientes não apresentavam ortopnéia. O diagnóstico clínico seria confirmado na autópsia pela aparência normal dos pulmões com hipertrofia do septo interventricular 13 . No entanto, em 1955, publicou-se o relato de caso de um homem hipertenso com doença coronariana que evoluiu com insuficiência cardíaca sistêmica sem dispnéia, ortopnéia ou congestão pulmonar.…”

Section: Alterações Do Ventrículo Direito Na Vigência De Hipertrofia unclassified

O Ventrículo Direito e a Hipertensão Arterial: Aspectos Ecocardiográficos

Silva¹,

Amodeo²,

Ramires³

2002

Arq. Bras. Cardiol.

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AtualizaçãoO exame ecocardiográfico do ventrículo direito tem muitas limitações. Grande parte da câmara situa-se atrás do esterno, possui formato irregular, paredes trabeculadas e localização variável dentro do tórax, na dependência da posição do paciente. Apesar destes problemas, o ecocardiograma pode fornecer informações úteis sobre o ventrículo direito, incluindo a determinação de suas dimensões 1 . A determinação do tamanho do ventrículo direito pode ser feita qualitativa ou quantitativamente. Na primeira forma, compara-se o seu tamanho ao do ventrículo esquerdo, utilizando-se o corte apical de quatro câmaras. Para a avaliação quantitativa, utiliza-se o modo M ou o bidimensional. Utilizando-se esta segunda modalidade, pode-se medir o volume do ventrículo direito através de várias técnicas, dentre as quais a regra de Simpson. Neste método, o ventrículo direito é dividido numa série de fatias de igual espessura. O volume de cada fatia é calculado com a fórmula: volume = área x altura. O volume da câmara é obtido pela soma dos volumes das fatias individuais. Alternativamente, cada fatia pode ser representada por uma figura geométrica simples e a fórmula volumétrica para esta figura é usada para calcular o volume da fatia. No entanto, até o momento, nenhuma téc-nica para cálculo de volume foi introduzida nos exames de rotina 2 . A sobrecarga de pressão do ventrículo direito é detectada, primariamente, pela hipertrofia da sua parede livre, podendo também ser encontrada hipertrofia do septo interventricular. A sobrecarga de pressão também pode levar a dilatação desta câmara ou a distorção do septo interventricular durante a sístole 2 . A hipertrofia do ventrículo esquerdo na hipertensão arterialEm alguns aspectos, a hipertrofia do ventrículo esquerdo em hipertensos parece ser um paradoxo. Ela atenua o efeito da sobrecarga de pressão que a hipertensão promove sobre a parede do ventrículo esquerdo e aumenta a função contrátil global do coração. Por outro lado, a sua presença está relacionada com maior aumento de risco cardiovascular expresso por insuficiência cardíaca e morte súbita 3 . A hipertrofia ventricular esquerda nos hipertensos parece ser, inicialmente, um mecanismo compensatório ao aumento da pós-carga, mas está associada a alterações estruturais e funcionais do miocárdio. Alguns autores relacionam a massa do ventrículo esquerdo com a pressão arterial medida clinicamente, confirmado em estudos subseqüentes 4,5 . A fraca correlação entre a massa do ventrículo esquerdo e a pressão arterial em grandes séries de pacientes levou alguns investigadores a propor que estímulos não-hemodinâmicos poderiam ter papel fundamental na patogê-nese da hipertrofia ventricular esquerda na hipertensão arterial, contudo, tem sido sugerido que a importância dos fatores hemodinâmicos na determinação da massa do ventrí-culo esquerdo em hipertensos foi subestimada por duas razões: 1) medidas casuais de pressão arterial freqüentemente não são representativas da sobrecarga pressórica imposta pela hipertensão arterial; 2) a sobrecarga...

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Right Ventricular Stenosis (Bernheim's Syndrome)

Cited by 19 publications

References 1 publication

Direct and series transmission of left atrial pressure perturbations to the pulmonary artery: a study using wave-intensity analysis

Direct and series transmission of left atrial pressure perturbations to the pulmonary artery: a study using wave-intensity analysis

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O Ventrículo Direito e a Hipertensão Arterial: Aspectos Ecocardiográficos

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