The Events of the Left Side of the Normal Heart as Studied by Cineradiography

Gribbe, Peo; Lind, John; Linko, E; Wegelius, C

doi:10.1159/000166350

Cited by 20 publications

(6 citation statements)

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“…However, whether this single measurement adequately expresses the corresponding variation in the atrial size is open to question. Angiographic studies of Gribbe et al 21 demonstrated that the left atrial cavity possessed a spherical shape and contracted in an eccentric fashion. Tsakiris et a P assessed the variability in multiple diameters of the left atrium throughout the cardiac cycle and concluded that atrial filling and emptying is…”

Section: Discussionmentioning

confidence: 99%

Role of the left atrium in adaptation of the heart to chronic mitral regurgitation in conscious dogs.

Kihara

Sasayama

Miyazaki

et al. 1988

Circulation Research

111

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The manner in which the left atrium adapts to chronic mitral regurgitation and the role of the adapted left atrium as a modulator of excessive central blood volume were analyzed in seven conscious dogs, instrumented with high-fidelity pressure transducers and ultrasonic dimension gauges for measurement of left atrial and left ventricular pressure and cavity size. After obtaining data in a control situation, mitral regurgitation was produced by transventricular chordal sectioning. Heart rate was matched by right atrial pacing. In the "early" stage (7-14 days), left ventricular end-diastolic and mean left atrial pressures increased from 6 to 16 mm Hg and from 4 to 12 mm Hg, respectively. Both left ventricular end-diastolic segment length and left atrial diameter prior to atrial contraction increased by 7%. In the "late" stage (20-35 days), despite significant decreases in left ventricular filling pressure (11 mm Hg) and left atrial pressure (8 mm Hg), there was a continuous increase in left ventricular end-diastolic dimension (10%) and atrial end-diastolic diameter (10%). After the onset of mitral regurgitation, the left atrium performed greater work with a more enlarged cavity. Left atrial chamber stiffness was progressively decreased. These changes were associated with progressive increase in the left atrial diameter at zero stress, and there was a significant increase in the diameter of the left atrial myocyte. These results indicate that during chronic mitral regurgitation, the left atrium enlarges in size and mass, with a more potent booster action. The left atrial chamber becomes more compliant. Thus, the enlarged left atrium appears to exert an important compensatory mechanism in the case of T he left atrium, a muscular contractile chamber located in the inflow path to the left ventricle, functions both as a pump and as a reservoir for blood.1 During mitral regurgitation, the left ventricle decompresses into the left atrium as the mitral orifice, in parallel with the aortic valve, acts as a pressuredependent outlet for the ventricle. The physiological consequences to the left atrium are characterized by increases in left atrial size and pressure; however, the magnitude of these changes depends chiefly on the rapidity and severity with which the regurgitation develops. In animal experiments, we observed that the atrial diameter suddenly increased following the onset of acute mitral regurgitation. Hence, atrial shortening was initially augmented, in accord with the FrankStarling mechanism in atrial muscle. However, progressive increase in regurgitation was associated with further increases in atrial size but diminished atrial stroke; hence, the atrial chamber was rendered less compliant.2 These changes in left atrial compliance were postulated as follows: the atrium subjected to From the Third Division, Department of Internal Medicine, Faculty of Medicine, Kyoto University, Kyoto, Japan, and the Second Department of Internal Medicine, Toyama Medical and Pharmaceutical University, Toyama, Japan.Presented in pa...

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Section: Discussionmentioning

confidence: 99%

Role of the left atrium in adaptation of the heart to chronic mitral regurgitation in conscious dogs.

Kihara

Sasayama

Miyazaki

et al. 1988

Circulation Research

111

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“…This is consistent with the observations by Myhre et al (21), who found that peak negative RV dP/dt occurs an average of 60 ms before end ejection and that there is no RV isovolumic relaxation period. In humans, RV isovolumic relaxation is shorter than that in the LV: the pulmonary valve closes after the aortic valve (6,34,36) and the tricuspid valve opens before the mitral valve (15). Our results are consistent with the "hangout phenomenon" (measured by the time between the dicrotic notch values of RV and PA pressures), which is believed to occur because PA pressure is low and blood can flow easily into the pulmonary vascular bed because of its low resistance and high capacitance (36).…”

Section: Discussionmentioning

confidence: 99%

Assessment of right ventricular diastolic suction in dogs with the use of wave intensity analysis

Sun¹,

Belenkie²,

Wang³

et al. 2006

American Journal of Physiology-Heart and Circulatory Physiology

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-Diastolic suction (DS) can be defined as that property of the ventricle by means of which it tends to refill itself during early diastole, independent of any force from the atrium. Although thought to be significant in the left ventricle (LV), DS in the right ventricle (RV) has received little attention, probably because of RV geometry. Our recent LV studies have shown that DS is related to both decreased elastance (i.e., , the relaxation time constant) and end-systolic volume (V LVES), thus reconciling the two mechanisms that have been used to explain the concept of DS. We hypothesized that RV DS would similarly depend on and V RVES. In six anesthetized open-chest dogs, aortic, RV, right atrial (RA), pulmonary arterial (PA), and RV pericardial pressure, tricuspid velocity, and PA flow were measured. VRVES was calculated by measuring distances between eight ultrasonic crystals. An empirical index of relaxation, Ј, and VRVES were manipulated by volume loading/caval constriction and isoproterenol/esmolol. We calculated the total energy (IWϪ) of the backward expansion wave generated during RV relaxation and that component causing DS [IWϪ(DS)]; i.e., the energy remaining after tricuspid valve opening. IWϪ [IWϪ(DS) also] was found to be inversely related to Ј and to VRVES {i.e., IWϪ ϭ Ϫ8.85 ⅐ e (Ϫ0.0423Ј) ⅐ e [Ϫ0.0665(%VRVES)] }. Thus, as for the LV, the energy of the backward-going wave generated by the RV during relaxation depends on both the rate at which elastance decreases and the completeness of ejection. Despite the thin wall and nonspherical shape of the RV, DS appears to be an important mechanism. diastole; hemodynamics; tricuspid valve; velocity; pressure THE UNIQUE CAPABILITIES of wave intensity analysis (WIA) could provide information regarding the dynamics and mechanisms of early right ventricular (RV) filling. Conceptually, diastolic suction (DS) is that property of the ventricle by which it tends to refill itself during early diastole, independent of any force from the atrium. Two apparently different types of mechanistic explanations have emerged. One is decreasing elastance; the other is the degree to which the ventricle empties (i.e., endsystolic volume) (11,12,19,22,38,42). Sabbah and colleagues (31, 32) indicated that RV early diastolic pressure is negative in both humans and dogs (perhaps reflecting RV DS) and that the RV can create a sucking effect during early diastole that may contribute to the filling process. Recently, our group clarified the mechanisms of left ventricular (LV) DS using WIA (41).The purpose of this study was to measure the energy associated with RV relaxation (I WϪ , see below) and to test the hypothesis that I WϪ depends on both the rate at which elastance decreases (Ј, an index of the exponential time constant of RV relaxation) and the completeness of RV emptying [RV end-systolic volume (V RVES )]. In particular, the energy associated with RV DS was identified as that component of I WϪ that remains after the opening of the tricuspid valve [I WϪ(DS) ]. METHODSExperimental ...

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“…The introduction of angiocardiography made it possible to visualize the heart cavities. The cineroentgen technique has provided the possibility of an almost continuous recording of the passage of the contrast-loaded blood through the heart (7). Used in combination with synchronous electrocardio graphic recording with exposure markings, a method is available for following the volume changes through the cardiac cycle in detail (11,1).…”

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confidence: 99%

“…The visualization of the left atrium and the left ventricle was so clear that the borders were distinct and the measurements could be made in 3-6 cycles in which the opacity was strongest. More details of the angiocardiographic procedure are given in a previous paper (7).…”

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confidence: 99%

Cineangiocardiographic Recordings of the Cyclic Changes in Volume of the Left Ventricle

et al. 1959

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The Events of the Left Side of the Normal Heart as Studied by Cineradiography

Cited by 20 publications

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Role of the left atrium in adaptation of the heart to chronic mitral regurgitation in conscious dogs.

Role of the left atrium in adaptation of the heart to chronic mitral regurgitation in conscious dogs.

Assessment of right ventricular diastolic suction in dogs with the use of wave intensity analysis

Cineangiocardiographic Recordings of the Cyclic Changes in Volume of the Left Ventricle

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