Septal Flash-like Motion of the Earlier Activated Ventricular Wall Represents the Pathophysiology of Mechanical Dyssynchrony in Single-Ventricle Anatomy

Hayama, Yohsuke; Miyazaki, Aya; Ohuchi, Hideo; Miike, Hikari; Negishi, Jun; Sakaguchi, Heima; Kurosaki, Kenichi; Shimizu, Shuji; Kawada, Toru; Sugimachi, Masaru

doi:10.1016/j.echo.2019.11.016

Cited by 6 publications

(5 citation statements)

References 23 publications

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“…The previous study showed the usefulness of the 2D-STE to evaluate interventricular dyssynchrony in single-ventricular physiology. 11) In the 2D-STE analysis, the LV wall is divided into six segments, graphing the peak strain value of each segment. Then, the early shortening and systolic rebound stretch can be visually and objectively detected, contributing to the detection and evaluation of regional dyssynchrony.…”

Section: Discussionmentioning

confidence: 99%

The Ventricular Hypokinesis at the Apical Pacing Site due to the Early Shortening and Rebound Stretch in a Case with Fontan Procedure

et al. 2022

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The left ventricular (LV) apex is recommended as the first choice for positioning the epicardial pacing. We encountered a patient with congenital heart disease (CHD) showing hypokinesis of the LV apical pacing site after implantation of a pacemaker with epicardial leads. This phenomenon was revealed by the early shortening and systolic rebound stretch of the same lesion on two-dimensional speckle tracking echocardiography, which developed in the intraventricular dyssynchrony between the LV apex and base. Cardiac resynchronization therapy provided an excellent result around the hypokinetic lesion. It is wise to arrange detailed evaluations in each patient with complicated CHD, aiming at a successful treatment to enable ventricular synchronicity.

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Section: Discussionmentioning

confidence: 99%

The Ventricular Hypokinesis at the Apical Pacing Site due to the Early Shortening and Rebound Stretch in a Case with Fontan Procedure

et al. 2022

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“…1 a, b), because the bundle of His proceeds along with the rudimentary septum and branches into the apex-forming dominant ventricle and the non-dominant chamber wall [ 16 ], conduction disturbance at a branch can induce the delay of an activation onset between the two walls. By comparing the times to peak strain between the two walls, we judged a wall that exhibited a relatively delayed contraction compared with the other wall and denoted it as a delayed wall [ 10 ]. As for patients with intact ventricular septum (Fig.…”

Section: Methodsmentioning

confidence: 99%

“…A length ratio of the delayed wall (LR delayed ) is calculated as the length of the delayed wall divided by the global baseto-base longitudinal length. An area ratio of the delayed The extent of an uncoordinated wall motion, which is characterized by a dyskinetic dilation during the ejection period at an earlier activated ventricular wall, was quantified by the strain ratio (R strains ) derived from two strain values (%) during the isovolumic contraction period and ejection periods; R strains = (100 + Strain ejection )/ (100 + Strain isovolumic ) [10]. This index increases if the earlier activated ventricular wall is forcedly dilated and fails to shorten after the delayed ventricular wall starts contraction.…”

Section: Echocardiography and Strain Analysesmentioning

confidence: 99%

“…Besides the anatomically normal left ventricle, we have reported that a characteristic motion similar to the septal flash could be detected at the earlier activated ventricular wall in pediatric patients with functional single ventricle [ 10 ]. In that study, however, the effect of morphological variations on ventricular function was not fully examined.…”

Section: Introductionmentioning

confidence: 99%

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Impact of delayed ventricular wall area ratio on pathophysiology of mechanical dyssynchrony: implication from single-ventricle physiology and 0D modeling

et al. 2020

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Electrical disparity can induce inefficient cardiac performance, representing an uncoordinated wall motion at an earlier activated ventricular wall: an early shortening followed by a systolic rebound stretch. Although regional contractility and distensibility modulate this pathological motion, the effect of a morphological factor has not been emphasized. Our strain analysis in 62 patients with single ventricle revealed that those with an activation delay in 60-70% of ventricular wall area suffered from cardiac dysfunction and mechanical discoordination along with prolonged QRS duration. A computational simulation with a two-compartment ventricular model also suggested that the ventricle with an activation delay in 70% of the total volume was most vulnerable to a large activation delay, accompanied by an uncoordinated motion at an earlier activated wall. Taken together, the ratio of the delayed ventricular wall has a significant impact on the pathophysiology due to an activation delay, potentially highlighting an indicator of cardiac dysfunction.

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“…250,252 Indications for CRT and the choice of pacing sites should be determined by the ventricular morphology and the type of ventricular dyssynchrony. 13,249, 257 In patients with a systemic RV or single ventricular physiology, the ventricular dyssynchrony is distinct. There is little evidence for CRT in this cohort, and thus the level of recommendation is low.…”

Section: Interventricular Dyssynchronymentioning

confidence: 99%

JCS 2022 Guideline on Management and Re-Interventional Therapy in Patients With Congenital Heart Disease Long-Term After Initial Repair

Ohuchi

Kawata²,

Uemura

et al. 2022

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9JCS 2022 Guideline on Management/Re-Intervention in ACHD comorbidity, 172 and cardiac catheterization is fundamental for its evaluation. 173 ▋ 3.4.4 Left Heart Catheterization and Coronary Angiography Echocardiography, CT, and MRI are often substituted for left ventriculography, aortography, or coronary angiography. CT precisely illustrates abnormal origins and courses of the coronary arteries in many cases, which is why coronary angiography is not recommended as a routine examination (Class III). In some patients, nonetheless, coronary angiography is quite informative beyond CT resolution; for example, anastomotic stenosis at the coronary arterial origin would be better demonstrated by catheter angiography after the arterial switch procedure. 174 ▋ 3.4.5 Endomyocardial Biopsy Endomyocardial biopsy is rarely required in patients with postoperative CHD. ▋ 3.4.6 Catheter InterventionTranscatheter closure of atrial septal defect or patent ductus arteriosus is carried out routinely in the cardiac catheterization room, as is percutaneous pulmonary angioplasty. Interventional closure of ventricular septal defect needs more evidence before becoming established in Japan.Transcatheter pulmonary valve replacement will be introduced in the near future.Electrophysiological study and catheter ablation are common practices for arrhythmias in the CHD field. Recent advances in technology and devices, such as 3D mapping systems, have contributed to notable results in anti-arrythmic treatments in patients with repaired CHD. 175

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Septal Flash-like Motion of the Earlier Activated Ventricular Wall Represents the Pathophysiology of Mechanical Dyssynchrony in Single-Ventricle Anatomy

Cited by 6 publications

References 23 publications

The Ventricular Hypokinesis at the Apical Pacing Site due to the Early Shortening and Rebound Stretch in a Case with Fontan Procedure

The Ventricular Hypokinesis at the Apical Pacing Site due to the Early Shortening and Rebound Stretch in a Case with Fontan Procedure

Impact of delayed ventricular wall area ratio on pathophysiology of mechanical dyssynchrony: implication from single-ventricle physiology and 0D modeling

JCS 2022 Guideline on Management and Re-Interventional Therapy in Patients With Congenital Heart Disease Long-Term After Initial Repair

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