Short-term Variations of the Right Ventricular/Left Ventricular Pressure Ratio following Repair of Tetralogy of Fallot

1983 ◽  
Vol 35 (4) ◽  
pp. 427-429 ◽  
Author(s):  
Enrique G. Bertranou ◽  
Michèle Thibert ◽  
Jacques Aigueperse
Keyword(s):  
Right Ventricular ◽  
Tetralogy Of Fallot ◽  
Pressure Ratio ◽  
Left Ventricular Pressure ◽  
Left Ventricular ◽  
Ventricular Pressure ◽  
Short Term ◽  
The Right

Levels of brain natriuretic peptide in children with right ventricular overload due to congenital cardiac disease

2005 ◽  
Vol 15 (4) ◽  
pp. 396-401 ◽  
Author(s):  
Thomas S. Mir ◽  
Jan Falkenberg ◽  
Bernd Friedrich ◽  
Urda Gottschalk ◽  
Throng Phi Lê ◽  
...  
Keyword(s):  
Right Ventricle ◽  
Brain Natriuretic Peptide ◽  
Right Ventricular ◽  
Natriuretic Peptide ◽  
Cardiac Disease ◽  
Left Ventricular Pressure ◽  
Left Ventricular ◽  
Ventricular Pressure ◽  
Congenital Cardiac Disease ◽  
The Right

Objective:To evaluate the role of the concentration of brain natriuretic peptide in the plasma, and its correlation with haemodynamic right ventricular parameters, in children with overload of the right ventricle due to congenital cardiac disease.Methods:We studied 31 children, with a mean age of 4.8 years, with volume or pressure overload of the right ventricle caused by congenital cardiac disease. Of the patients, 19 had undergone surgical biventricular correction of tetralogy of Fallot, 11 with pulmonary stenosis and 8 with pulmonary atresia, and 12 patients were studied prior to operations, 7 with atrial septal defects and 5 with anomalous pulmonary venous connections. We measured brain natriuretic peptide using Triage®, from Biosite, United States of America. We determined end-diastolic pressures of the right ventricle, and the peak ratio of right to left ventricular pressures, by cardiac catheterization and correlated them with concentrations of brain natriuretic peptide in the plasma.Results:The mean concentrations of brain natriuretic peptide were 87.7, with a range from 5 to 316, picograms per millilitre. Mean end-diastolic pressure in the right ventricle was 5.6, with a range from 2 to 10, millimetres of mercury, and the mean ratio of right to left ventricular pressure was 0.56, with a range from 0.24 to 1.03. There was a positive correlation between the concentrations of brain natriuretic peptide and the ratio of right to left ventricular pressure (r equal to 0.7844, p less than 0.0001) in all patients. These positive correlations remained when the children with tetralogy of Fallot, and those with atrial septal defects or anomalous pulmonary venous connection, were analysed as separate groups. We also found a weak correlation was shown between end-diastolic right ventricular pressure and concentrations of brain natriuretic peptide in the plasma (r equal to 0.5947, p equal to 0.0004).Conclusion:There is a significant correlation between right ventricular haemodynamic parameters and concentrations of brain natriuretic peptide in the plasma of children with right ventricular overload due to different types of congenital cardiac disease. The monitoring of brain natriuretic peptide may provide a non-invasive and safe quantitative follow up of the right ventricular pressure and volume overload in these patients.

scholarly journals Percutaneous Balloon Pulmonary Valvuloplasty of Critical Pulmonary Stenosis and severe pulmonary stenosis in Neonates and Early Infancy: A Challenge in the Cyanotic

2021 ◽  
Vol 13 (2) ◽  
pp. 156-161
Author(s):  
Hojjat Mortezaeian ◽  
Mohammadrafie khorgami ◽  
Negar Omidi ◽  
Yasaman khalili ◽  
Maryam Moradian ◽  
...  
Keyword(s):  
Pulmonary Valve ◽  
Ductus Arteriosus ◽  
Pressure Ratio ◽  
Pulmonary Stenosis ◽  
Pulmonary Regurgitation ◽  
Left Ventricular Pressure ◽  
Left Ventricular ◽  
Ventricular Pressure ◽  
Percutaneous Balloon ◽  
The Right

Introduction: Pulmonary stenosis with an intact ventricular septum (PS-IVS) is one of the common causes of cyanotic heart disease in neonates with diverse morphologies as well as management and treatment protocols. The aim of this study was to evaluate short and midterm results of balloon pulmonary valvuloplasty (BPV) for this disorder. Methods: Between 2012 and 2016, Totally 45 neonates and infants under 6 months old were evaluated.The patients had a minimum right-to-left ventricular pressure ratio of 1, right-to-left shunting at the patent foramen ovale or atrial septal defect level, and tricuspid valve Z-scores higher than -4. Results: Immediately after the procedure, the right ventricular pressure dropped to the normal values in 8 (20%) patients. The immediate procedural success rate was seen in 42 (93.3%) cases: the right-to-left ventricular pressure ratio dropped to below 50% or the level of O2 saturation rose above 75%. Of three cases unresponsive to BPV, two of them underwent patent ductus arteriosus (PDA) stenting and one procedural death occurred. At 6 months’ follow-up, of 42 patients, this pressure was still with in the normal range in 36 (80%) infants, while it had returned to high values in 9 (20%) patients and necessitated repeat valvuloplasty. After BPV, severe pulmonary valve regurgitation was observed in14.2% patients; the condition was more common when high-profile noncompliant balloons were used. Conclusion: Balloon pulmonary valvuloplasty in infants with PS-IVS confers acceptable results insofar as it improves echocardiographic parameters and hemodynamic changes at short- and midterm followups.Balloon selection with sizes more than 1.2 of the diameter of the pulmonary valve annulus and the use of noncompliant high-pressure balloons results in higher degrees of pulmonary regurgitation.

Effects of regional ischemia and ventricular pacing on LV dP/dtmax-end-diastolic volume relation

1987 ◽  
Vol 252 (5) ◽  
pp. H933-H940 ◽  
Author(s):  
W. C. Little ◽  
R. C. Park ◽  
G. L. Freeman
Keyword(s):  
Coronary Artery ◽  
Right Ventricular ◽  
Left Ventricular Pressure ◽  
Left Ventricular ◽  
Ventricular Free Wall ◽  
Ventricular Pressure ◽  
Free Wall ◽  
Ventricular Pacing ◽  
End Diastolic Volume ◽  
The Right

We investigated the effects of coronary artery occlusion and pacing from ventricular sites on the relation of the maximum rate of rise of left ventricular pressure (dP/dtmax) to the end-diastolic volume (VED) in dogs previously instrumented to measure left ventricular pressure and to determine left ventricular volume from three ultrasonically measured dimensions. The dP/dtmax-VED relation was generated by vena caval occlusion and compared with the simultaneously produced end-systolic pressure-end-systolic volume (PES-VES) relation. The dP/dtmax-VED relation was described by a straight line during all conditions. Occlusion of the left circumflex coronary artery produced a rightward shift of the dP/dtmax-VED relation, increasing the volume intercept by 11.3 +/- 5.3 (SD) ml (P less than 0.05). Compared with atrial pacing, the dP/dtmax-VED relation was shifted to the right with the volume intercept increasing by 4.8 +/- 4.4 ml (P less than 0.05) during pacing from the right ventricular free wall, 3.7 +/- 5.0 ml (P less than 0.05) during pacing from the right ventricular apex, and 3.7 +/- 2.4 ml (P less than 0.05) during pacing from the left ventricular free wall. Similar increases were observed in the volume intercepts of the PES-VES relations during coronary occlusion or ventricular pacing. These results are consistent with the predictions of the time-varying elastance model and support its use as a conceptual framework to understand left ventricular performance during isovolumic contraction and at end systole, both in the normal ventricle and the ventricle with regional abnormalities of contraction.

Malignant Hyperthermia Phenotype

2000 ◽  
Vol 92 (6) ◽  
pp. 1777-1788 ◽  
Author(s):  
Daniel C. Sigg ◽  
Paul A. Iaizzo
Keyword(s):  
Malignant Hyperthermia ◽  
Right Ventricular ◽  
Left Ventricular Pressure ◽  
Left Ventricular ◽  
Ventricular Pressure ◽  
High Dose ◽  
Central Venous ◽  
Induced Hypotension ◽  
Arterial Blood ◽  
Left And Right

Background Succinylcholine causes immediate and severe arterial hypotension in swine with the malignant hyperthermia phenotype. The underlying mechanisms are unknown. Methods Malignant hyperthermia-susceptible (MHS; n = 10) and normal swine (n = 5) were anesthetized with thiopental. The following were monitored: electrocardiogram; arterial blood pressure; pulmonary artery, central venous, and left and right ventricular pressure; cardiac output; end-tidal carbon dioxide; core temperature; peripheral-blood flows; and arterial blood gases. After a control period, 2 mg/kg succinylcholine was given intravenously. Three MHS animals received 1 mg/kg vecuronium and two MHS animals received 2.5 mg/kg dantrolene intravenously. The effects of succinylcholine on left and right ventricular pressure and contractility were analyzed in isolated hearts. The effects of 0.06 mm succinylcholine on isometric tension development were recorded in isolated femoral artery rings. Results Succinylcholine caused an early, severe decrease in blood pressure, cardiac output, left ventricular pressure, and left ventricular contractility in MHS swine but not in normal swine; no significant differences were found in heart rate, right ventricular parameters, systemic vascular resistance, and preload (pulmonary diastolic pressure, central venous pressure). The succinylcholine-induced hypotension and associated effects were not prevented by dantrolene. However, pretreatment with high-dose vecuronium prevented not only the cardiovascular depression, but also MH. In addition, no phenotypic differences of succinylcholine on contractility or left ventricular pressure were observed in the isolated working hearts. Similary, succinylcholine did not cause a significantly different relaxation in rings in either phenotype. Conclusion Succinylcholine-induced hypotension occurred before muscle hypermetabolism in MHS swine. Succinylcholine had no differential physiologic effects on either the isolated heart or on isolated arteries. This hypotension could not be prevented by dantrolene but was prevented by pretreatment with high-dose vecuronium. Thus, an indirect mechanism such as the release of a cardiac depressant from skeletal muscle may have caused this hypotensive response.

scholarly journals Influence of Right Ventricular Filling Pressure on Left Ventricular Pressure and Dimension

1974 ◽  
Vol 34 (4) ◽  
pp. 498-504 ◽  
Author(s):  
CHARLES E. BEMIS ◽  
JUAN R. SERUR ◽  
DAVID BORKENHAGEN ◽  
EDMUND H. SONNENBLICK ◽  
CHARLES W. URSCHEL
Keyword(s):  
Right Ventricular ◽  
Left Ventricular Pressure ◽  
Left Ventricular ◽  
Filling Pressure ◽  
Ventricular Pressure ◽  
Ventricular Filling Pressure ◽  
Right Ventricular Filling ◽  
Ventricular Filling

Left ventricular pressure effects on right ventricular pressure and volume outflow

1990 ◽  
Vol 19 (4) ◽  
pp. 269-278 ◽  
Author(s):  
Ralph J. Damiano ◽  
James L. Cox ◽  
James E. Lowe ◽  
William P. Santamore
Keyword(s):  
Right Ventricular ◽  
Left Ventricular Pressure ◽  
Left Ventricular ◽  
Pressure Effects ◽  
Ventricular Pressure

Abstract 5728: Abrupt Early Intraventricular Septal Motion In Not Passive But Active In Left Bundle Brunch Block

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Azusa Furugen ◽  
Naoki Matsuda ◽  
Tsuyoshi Shiga ◽  
Daigo Yagishita ◽  
Asako Mochida ◽  
...  
Keyword(s):  
Speckle Tracking ◽  
Interventricular Septum ◽  
Left Ventricular Pressure ◽  
Left Ventricular ◽  
Ventricular Pressure ◽  
Speckle Tracking Imaging ◽  
Systolic Phase ◽  
Qrs Duration ◽  
The Right ◽  
Septal Motion

Abnormal early septal motion observed in patients with left bundle brunch block (LBBB) has been explained as a difference in right-to-left ventricular pressure. The interventricular septum was thought to be displaced passively into the LV because the right ventricle contracts prior to the LV and the right ventricular pressure exceeds the LV pressure during early systolic phase. Assuming that this theory is right, the interventricular septal wall would be stretched and shown positive strain value in circumferential and longitudinal directions during early systolic phase. We investigated the mechanism of the early septal motion with LBBB using speckle tracking imaging (STI). Methods: Systolic septal motion on the middle LV portion level was analyzed in 44 patients with complete LBBB (mean QRS duration 166 ± 35 ms) using M-mode echocardiography and speckle tracking imaging (STI). Time from onset of QRS configuration to peak circumferential strain and longitudinal strain were measured in parasternal short axis and apical views by STI. Furthermore, 20 healthy individuals (mean QRS duration 84 ± 6 ms) were also analyzed. Changes in LV pressure and septal strain were simultaneously measured to evaluate the relationship between them in 6 patients with LBBB. Results: Septal displacement into the LV was early and abrupt on M-mode echocardiograms from all patients with LBBB. During this displacement, the STI of the interventricular septum of all patients showed negative strain in both the circumferential and longitudinal directions. Furthermore, early septal displacement almost coincided with peak negative strain. Time to peak septal strain in LBBB patients was significantly shorter than in normal controls in the circumferential (296 ± 80 vs. 356 ± 30 ms; p < 0.05) and longitudinal (317 ± 104 vs. 369 ± 17 ms; p < 0.05) directions. The peak of septal negative strain was followed by an increase in LV pressure in all patients. Conclusion: Early motion of the interventricular septum is provoked by its active contraction in LBBB. The septal contraction starts very early and almost isotonically toward a very low load. However, further shortening is suppressed by a subsequently increased load of pressure elevation due to the contraction of other LV segments.

A prospective, randomised trial evaluating transatrial and transventricular approaches to repair of tetralogy of Fallot

1997 ◽  
Vol 7 (3) ◽  
pp. 258-265 ◽  
Author(s):  
Sunil K. Kaushal ◽  
Rajesh Sharma ◽  
Krishna S. Iyer ◽  
Shyam Sunder Kothari ◽  
Panangipalli Venugopal
Keyword(s):  
Right Ventricle ◽  
Right Ventricular ◽  
Ventricular Function ◽  
Tetralogy Of Fallot ◽  
Right Ventricular Function ◽  
Randomised Trial ◽  
Short Term ◽  
Ventricular Ejection Fraction ◽  
The Right

AbstractThe traditional approach to repair of tetralogy of Fallot involves a right ventriculotomy for closure of ventricular septal defect. During the past two decades, reports of progressive right ventricular dilation and dysfunction, and late occurrence of ventricular arrhythmias, have led investigators to re-evaluate this approach and advocate instead the transatrial-transpulmonary approach, hoping to preserve global right ventricular function. We studied the short term effects on right ventricular function of either of the two approaches through a prospective randomised study, involving two comparable groups of patients operated in the same time frame.Between June 1993 and February 1994, 40 patients having tetralogy of Fallot with comparable preoperative characteristics, were assigned randomly to each of two groups for surgical correction.In 20 patients, correction was achieved via the transatrial-transpulmonary route. In the other 20 patients, transventricular correction was the chosen option. Six months after surgery, patients were evaluated clinically, by Doppler echocardiography, cardiac catheterisation, first pass radionuclide angiography and by 24 hours ambulatory electrocardiographic monitoring, taking note of hemodynamics, abnormalities in rhythm, and global right ventricular function.There were no early deaths or morbidity in either group. Mean immediate postoperative ratio between peak right ventricular and systemic pressures was 0.62 ± 0.22 after transatrial and 0.70 ± 0.007 after transventricular correction. All patients were in functional class I. Six months after surgery the mean ratio between peak ventricular pressures was similar in the two groups (transatrial group: 0.37 ± 0.02, transventricular group: 0.38 ( 0.01), but significantly lower than that measured in the operating room. There were no significant arrythmias in either group. Mean right ventricular ejection fraction was nearly the same in both groups (transatrial group versus transventricular group; 44.83 ± 5.65% versus 42.37 ± 8.70%). Significant global hypokinesia of the right ventricle was documented in three patients, and mild hypokinesia in another three, undergoing repair through the transventricular route while in the group undergoing transatrial repair only one patient had mild hypokinesia.We conclude that comparable hemodynamic results are obtained on short term follow-up after repair of tetralogy of Fallot by either the transatrial or transventricular route. Although more patients in the transventricular group were found to have global hypokinesia of the right ventricle, longer follow-up is necessary to establish the clinical relevence of these findings.

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