Análisis de la interdependencia ventricular en pacientes con cardiopatía congénita con disfunción sistólica y diastólica del ventrículo derecho (original) (raw)
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2015
La interdependencia ventricular (IV) se entiende como la respuesta de un ventriculo a los cambios en la presion y el volumen restante en el otro. Hasta hoy, este comportamiento en la enfermedad cardiaca congenita no esta claro, especialmente en las que afectan al ventriculo derecho (VD). Objetivo: Determinar y comparar los diferentes tipos de IV en pacientes con enfermedad cardiaca congenita (ECC) que implica al ventriculo derecho con disfuncion sistolica y diastolica. Metodos: Estudio transversal y comparativo que se realizo en pacientes de enfermedad coronaria con mecanismo de sobrecarga de volumen (defectos del tabique auricular, defectos septales ventriculares, ductus arterioso permeable y conexion venosa pulmonar anomala total), asi como en pacientes con mecanismo de presion de sobrecarga (tetralogia de Fallot, atresia pulmonar con comunicacion interventricular y anomalia de Ebstein). Un estudio ecocardiografico se realizo en todos los pacientes y con base en cada fraccion de e...
2015
The right ventricle (RV) and its dysfunction have been directly associated to negative prognosis in patients with ischemic heart disease. In congenital heart disease (CHD), right ventricle dysfunction results from volume (diastolic) and pressure (systolic) overload mechanisms, considering the many embryonic alterations they hold. Currently, there are no operational definitions to classify right ventricle dysfunction (RVD) in patients with congenital heart disease; and both prognostic or recovery factors are different to those in patients with right coronary ischemic disease. In this paper, we review causes of RVD, etiologic mechanisms and related prognostic variables. RESUMEN El ventriculo derecho (VD) y su disfuncion han sido directamente asociados con un pronostico desfavorable en pacientes con cardiopatias isquemica. En las cardiopatias congenitas (CC) la disfuncion ventricular derecha resulta de mecanismos de sobrecarga, ya sea de volumen (diastolica) o de presion (sistolica), c...
Revista de Chimie
The aim of the study is to quantify ventricular interactions by comparing tissue and spectral systolic echocardiographic parameters to allow the early identification of ventricular dysfunction. Clinical, paraclinical, electrocardiographic and echocardiographic evaluations were performed. Right ventricular hypertrophy was diagnosed in the M mode subcostal echocardiographic section. RV hypertrophy was defined by a right ventricular free wall thickness of > 5 mm in diastole. We assessed the following RV and LV tissue and spectral systolic indices: apical systolic excursion of the lateral mitral ring (MAPSE), apical systolic excursion of the lateral tricuspid ring (TAPSE), left (Svs) and right (Svd) ventricular tissue systolic velocities, and RV and LV ejection times. We calculated the following to assess systolic ventricular interdependence: MAPSE/TAPSE, the normal value of which was considered as 0.66 ± 0.14, and Svs/Svd, the normal value of which was considered as 0.76 ± 0.21. The...
The overloaded right heart and ventricular interdependence
Cardiovascular Research, 2017
The right and the left ventricle are interdependent as both structures are nested within the pericardium, have the septum in common and are encircled with common myocardial fibres. Therefore, right ventricular volume or pressure overloading affects left ventricular function, and this in turn may affect the right ventricle. In normal subjects at rest, right ventricular function has negligible interaction with left ventricular function. However, the right ventricle contributes significantly to the normal cardiac output response to exercise. In patients with right ventricular volume overload without pulmonary hypertension, left ventricular diastolic compliance is decreased and ejection fraction depressed but without intrinsic alteration in contractility. In patients with right ventricular pressure overload, left ventricular compliance is decreased with initial preservation of left ventricular ejection fraction, but with eventual left ventricular atrophic remodelling and altered systolic function. Breathing affects ventricular interdependence, in healthy subjects during exercise and in patients with lung diseases and altered respiratory system mechanics. Inspiration increases right ventricular volumes and decreases left ventricular volumes. Expiration decreases both right and left ventricular volumes. The presence of an intact pericardium enhances ventricular diastolic interdependence but has negligible effect on ventricular systolic interdependence. On the other hand, systolic interdependence is enhanced by a stiff right ventricular free wall, and decreased by a stiff septum. Recent imaging studies have shown that both diastolic and systolic ventricular interactions are negatively affected by right ventricular regional inhomogeneity and prolongation of contraction, which occur along with an increase in pulmonary artery pressure. The clinical relevance of these observations is being explored. Keywords Right ventricle • Pulmonary hypertension • Ventricular interdependence • Diastole • Systole • Inotropy • Lusitropy • Ventricular asynchrony • Heart • lung interactions • Right heart failure This article is part of the Spotlight Issue on Right Ventricle.
Circulation, 2008
I n 1616, Sir William Harvey was the first to describe the importance of right ventricular (RV) function in his seminal treatise, De Motu Cordis: "Thus the right ventricle may be said to be made for the sake of transmitting blood through the lungs, not for nourishing them." 1,2 For many years that followed, emphasis in cardiology was placed on left ventricular (LV) physiology, overshadowing the study of the RV. In the first half of the 20th century, the study of RV function was limited to a small group of investigators who were intrigued by the hypothesis that human circulation could function adequately without RV contractile function. 3 Their studies, however, were based on an open pericardial dog model, which failed to take into account the complex nature of ventricular interaction. In the early 1950s through the 1970s, cardiac surgeons recognized the importance of right-sided function as they evaluated procedures to palliate right-heart hypoplasia. Since then, the importance of RV function has been recognized in heart failure, RV myocardial infarction, congenital heart disease and pulmonary hypertension. More recently, advances in echocardiography and magnetic resonance imaging have created new opportunities for the study of RV anatomy and physiology.
Evidence of adverse ventricular interdependence in patients with atrial septal defects
The American Journal of Cardiology, 2004
Right ventricular (RV) volume overload is associated with left ventricular (LV) distortion and dysfunction. The availability of transcatheter device closure of secundum atrial septal defect (ASD) provides an ideal model for investigating the immediate effects of elimination of RV volume overload and avoiding the confounding effects of surgery on LV function. Echocardiograms before and after device closure of ASD were analyzed for ejection fraction, percent changes in cross-sectional area and circumference, percent changes in free wall and septal endocardial lengths, and eccentricity. We enrolled 34 patients (median age 9 years) who underwent device closure of ASD (pulmonary to systemic shunt 1.6 ؎ 0.4). Ejection fraction and LV end-diastolic volume, reflective of chamber preload, were significantly decreased in the presence of RV volume overload and normalized after defect closure with normalization of LV shape. Altered LV geometry secondary to RV volume overload was associated with regional variation in preload,such that diastolic circumference, a surrogate of myofiber preload, increased after closure of ASD secondary to a small increase in LV free wall arc length in conjunction with a much more significant increase in septal length. Thus, LV dysfunction associated with RV volume overload is secondary to altered chamber geometry and decreased myofiber preload. This physiology is immediately reversible and is independent of heart rate and afterload. ᮊ2004 by Excerpta Medica, Inc.
The American Journal of Cardiology, 2009
Heart failure guidelines classify patients into subgroups with asymptomatic versus symptomatic ventricular dysfunction versus heart failure with a preserved ejection fraction. In this study, this approach was applied in a series of patients with complete transposition of the great arteries after atrial switch to assess to what extent this classification fits patients with systemic right ventricles. The study included stable adult patients after atrial switch, stratified according to preserved versus impaired systolic function (fractional area change >0.40 vs <0.40), absence versus presence of symptoms, absence versus presence of significant tricuspid regurgitation (TR), and normal versus elevated brain natriuretic peptide (BNP) levels. Twenty-two of 42 participants (52.4%; mean age 18.2 ؎ 2.8 years) had preserved systolic function, and 20 (47.6%) had impaired systolic function; 10 patients (23.8%) had asymptomatic right ventricular (RV) dysfunction. The latter more frequently had significant TR (p ؍ 0.04) and elevated BNP levels (p ؍ 0.008), compared with asymptomatic patients with preserved systolic function. Normal BNP levels independently predicted preserved RV function in all patients (odds ratio 6.4, 95% confidence interval 1.03 to 39.1, p ؍ 0.04) and in asymptomatic patients (odds ratio 14.4, 95% confidence interval 1.2 to 176.2, p ؍ 0.03). Heart failure symptoms with preserved systolic function were present in 5 patients (11.9%), including 3 patients with significant TR. In conclusion, asymptomatic RV dysfunction and heart failure symptoms with preserved systolic function are common in patients with systemic right ventricles. BNP levels can be used to predict preserved systolic RV function, especially in asymptomatic patients. Heart failure symptoms with preserved RV systolic function can be frequently explained by the coexistence of significant TR.
Diagnosis and treatment of right ventricular dysfunction in congenital heart disease
Cardiovascular Diagnosis and Therapy, 2020
Right ventricular (RV) function is important for clinical status and outcomes in children and adults with congenital heart disease (CHD). In the normal RV, longitudinal systolic function is the major contributor to global RV systolic function. A variety of factors contribute to RV failure including increased pressure-or volume-loading, electromechanical dyssynchrony, increased myocardial fibrosis, abnormal coronary perfusion, restricted filling capacity and adverse interactions between left ventricle (LV) and RV. We discuss the different imaging techniques both at rest and during exercise to define and detect RV failure. We identify the most important biomarkers for risk stratification in RV dysfunction, including abnormal NYHA class, decreased exercise capacity, low blood pressure, and increased levels of NTproBNP, troponin T, galectin-3 and growth differentiation factor 15. In adults with CHD (ACHD), fragmented QRS is independently associated with heart failure (HF) symptoms and impaired ventricular function. Furthermore, we discuss the different HF therapies in CHD but given the broad clinical spectrum of CHD, it is important to treat RV failure in a disease-specific manner and based on the specific alterations in hemodynamics. Here, we discuss how to detect and treat RV dysfunction in CHD in order to prevent or postpone RV failure.