Pre‐implant right ventricular free wall strain predicts post‐LVAD right heart failure

2021 ◽  
Author(s):  
Keith A. Dufendach ◽  
Toby Zhu ◽  
Carlos Diaz Castrillon ◽  
Yeahwa Hong ◽  
Malamo E. Countouris ◽  
...  
Keyword(s):  
Heart Failure ◽  
Right Ventricular ◽  
Right Heart Failure ◽  
Ventricular Free Wall ◽  
Free Wall ◽  
Right Ventricular Free Wall ◽  
Right Heart

Surgical Options for Uhl’s Anomaly

2017 ◽  
Vol 8 (4) ◽  
pp. 470-474 ◽  
Author(s):  
Jyoti Prasad Kalita ◽  
Nilajan Dutta ◽  
Neeraj Awasthy ◽  
Kuntal Roy Chowdhuri ◽  
Sumir Girotra ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Heart Failure ◽  
Right Ventricular ◽  
Right Heart Failure ◽  
Failure Diagnosis ◽  
Free Wall ◽  
Resonance Imaging ◽  
Right Heart ◽  
The Right ◽  
Heart Failure Diagnosis

Background: Uhl’s anomaly is an extremely rare congenital heart defect characterized by a near total absence of the myocardium of the parietal wall of the right ventricle. Few reports of surgical management exist in literature. We present three patients with this anomaly who were managed with different surgical strategies. Patients and Methods: Patient 1: This 43-month-old girl had maternal rubella syndrome with speech and hearing deficits and gross right heart failure. Diagnosis was made on echocardiography and magnetic resonance imaging. She underwent partial excision and plication of the right ventricular parietal wall and total cavopulmonary connection. Patient 2: This 19-month-old boy presented with progressive cyanosis and features of right heart failure. Diagnosis was confirmed on echocardiography. He underwent right ventricular exclusion by tricuspid valve closure and free wall plication followed by a bidirectional Glenn procedure. Patient 3: This 21-year-old male presented with right heart failure and cyanosis. Diagnosis was established with transesophageal echocardiography and magnetic resonance imaging. As the hemodynamics were not suitable for a Fontan conversion, a one and a half ventricle repair was done along with plication of the right ventricular free wall and tricuspid valve annuloplasty. Results: All three patients were extubated within 24 hours. Patients 2 and 3 were discharged relatively uneventfully, whereas patient 1 had a more prolonged stay due to transient hepatic failure. All were symptomatically and clinically improved on short-term follow-up. Conclusion: Uhl’s anomaly is an extremely rare condition with varied clinical presentation. Surgical exclusion of the right ventricle yields gratifying results; however, surgical technique has to be adapted to the individual patient.

P5370Pulmonary pressure overload stimulates cardiac stem or progenitor cell-derived cardiac regeneration in the right ventricular area

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Kanda ◽  
T Nagai ◽  
N Kondou ◽  
K Tateno ◽  
M Hirose ◽  
...  
Keyword(s):  
Heart Failure ◽  
Pulmonary Hypertension ◽  
Right Ventricular ◽  
Progenitor Cell ◽  
Pressure Overload ◽  
Right Heart Failure ◽  
Left Ventricular ◽  
Free Wall ◽  
Right Heart ◽  
The Right

Abstract Introduction and purpose The number of patients with right heart failure due to pulmonary hypertension has been increasing. Although several drugs have reportedly improved pulmonary hypertension, no treatments have been established for decompensated right heart failure. The heart has an innate ability to regenerate, and cardiac stem or progenitor cells (e.g., side population [SP] cells) have been reported to contribute to the regeneration process. However, their contribution to right ventricular pressure overload has not been clarified. Here, this regeneration process was evaluated using a genetic fate-mapping model. Methods and results We used Cre-LacZ mice, in which more than 99.9% of the cardiomyocytes in the left ventricular field were positive for 5-bromo-4-chloro-3-indolyl-β-D-galactoside (X-gal) staining immediately after tamoxifen injection. Then, we performed either a pulmonary binding (PAB) or sham operation on the main pulmonary tract. In the PAB-treated mice, the right ventricular cavity was significantly enlarged (right-to-left ventricular [RV/LV] ratio, 0.24±0.04 in the sham group and 0.68±0.04 in the PAB group). Increased peak flow velocity in the PAB group (1021±80 vs 1351±62 mm/sec) was confirmed by echocardiography. One month after the PAB, the PAB-treated mice had more X-gal-negative (newly generated) cells than the sham mice (94.8±34.2 cells/mm2 vs 23.1±10.5 cells/mm2; p<0.01). The regeneration was biased in the RV free wall (RV free wall, 225.5±198.7 cells/mm2; septal area, 88.9±56.5/mm2; LV lateral area, 46.8±22.0/mm2; p<0.05). To examine the direct effects of PAB on the cardiac progenitor cells, bromodeoxyuridine was administered to the mice daily until 1 week after the PAB operation. Then, the hearts were isolated and SP cells were harvested. The SP cell population increased from 0.65±0.23% in the sham mice to 1.87% ± 1.18% in the PAB-treated mice. Immunostaining analysis revealed a significant increase in the number of BrdU-positive SP cells, from 11.6±2.0% to 44.0±18%, therefore showing SP cell proliferation. Conclusions Pulmonary pressure overload stimulated cardiac stem or progenitor cell-derived regeneration with a RV bias, and SP cell proliferation may partially contribute to this process. Acknowledgement/Funding JSPS KAKENHI Grant Number JP 17K17636, GSK Japan Research Grant 2016

scholarly journals P931 Feasibility of comprehensive multi-plane right ventricular free wall longitudinal strain evaluation pre-LVAD implantation - preliminary results from a single centre experience

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
D J Bowen ◽  
M Strachinaru ◽  
J S Mcghie ◽  
A E Van Den Bosch ◽  
O Soliman ◽  
...  
Keyword(s):  
Heart Failure ◽  
Right Ventricular ◽  
Negative Correlation ◽  
Longitudinal Strain ◽  
Advanced Heart Failure ◽  
Free Wall ◽  
Right Ventricular Free Wall ◽  
Right Heart ◽  
Mean Values ◽  
Heart Failure Patients

Abstract Introduction Right ventricular failure (RVF) is recognized as a major cause of morbidity and mortality after left ventricular assist device (LVAD) implantation and identifying patients at risk remains a challenge. Given its structural complexity, it is not possible to fully assess the RV from one echocardiographic 2D plane and entire free wall visualization is more challenging in advanced heart failure patients with very severely dilated left ventricles. Our centre previously introduced a novel multi-plane approach whereby four different RV free wall segments (lateral, anterior, inferior and inferior coronal – figure 1) can be imaged from the same echocardiographic position using focused RV views and electronic plane rotation. Purpose The aim of the study was to determine the feasibility of using multi-plane echocardiography (MPE) to quantify right ventricular free wall longitudinal strain (RV-FWLS) in a small cohort of advanced heart failure patients prior to LVAD implantation. Methods Sixteen advanced heart failure patients underwent detailed RV assessment by MPE prior to LVAD implantation (median - 15 [6.3-29.8] days before). Feasibility and values of RV-FWLS were retrospectively assessed by an experienced sonographer on each of the 4 free wall segments using specialised RV strain analysis software. Feasibility was confirmed if all regions of the free wall were visualised and tracked appropriately throughout the cardiac cycle. Standard right heart 2D echo parameters and pre-implant right heart catheterisation (RHC) data were also collated. Results Mean RV-FWLS and feasibility in the four segments were as follows: lateral -12.4 ± 4.3% (81.3%); anterior -12.7 ± 6.1% (62.5%); inferior -11.8 ± 4.7% (75.0%); inferior coronal -11.6 ± 3.9% (43.8%). TAPSE values on the same segments were feasible in 100% of cases and mean values were as follows: lateral 15.1 ± 4.9mm; anterior 15.3 ± 4.7mm; inferior 13.4 ± 5.2mm; inferior coronal 11.4 ± 5.1mm. Mean pulmonary artery pressure (mPAP) measured by RHC was 27.2 ± 11mmHg. There was a slightly stronger negative correlation of RV-FWLS with increased mPAP in the lateral, anterior and inferior RV free wall segments compared to TAPSE (r²: -0.07-0.11 v -0.01-0.05). Conclusion There is reasonable feasibility for assessing RV-FWLS using MPE in 3 out of the 4 free wall segments and mean values were considerably lower than normal reference values. A stronger negative correlation with increasing mPAP suggests that RV dysfunction may be detected better by strain than by TAPSE measurement in pre-LVAD recipients. Larger, multi-centre studies are required to further assess these preliminary findings. Abstract P931 Figure. Multi-plane RV imaging with strain

Prognostic value of right ventricular free wall longitudinal strain in a large cohort of outpatients with left-side heart disease

2019 ◽  
Vol 21 (9) ◽  
pp. 1013-1021 ◽  
Author(s):  
Mara Gavazzoni ◽  
Luigi P Badano ◽  
Enrico Vizzardi ◽  
Riccardo Raddino ◽  
Davide Genovese ◽  
...  
Keyword(s):  
Heart Failure ◽  
Heart Disease ◽  
Right Ventricular ◽  
Longitudinal Strain ◽  
Structural Heart Disease ◽  
Ventricular Free Wall ◽  
Free Wall ◽  
Heart Failure Hospitalization ◽  
Right Ventricular Free Wall ◽  
Echocardiographic Parameters

Abstract Aims Right ventricular free wall longitudinal strain (RVFWLS) has been proposed as an accurate and sensitive measure of right ventricular function that could integrate other conventional parameters such as tricuspid annulus plane systolic excursion (TAPSE) and fractional area change (FAC%). The aim of the present study was to evaluate the relationship between RVFWLS and outcomes in stable asymptomatic outpatients with left-sided structural heart disease. Methods and results We enrolled 458 asymptomatic patients with left-side heart diseases and any ejection fraction who were referred for echocardiography to two Italian centres. The composite endpoint of death for any cause and heart failure hospitalization was used as primary outcome of this analysis. After a mean follow-up of 5.4 ± 1.2 years, 145 patients (31%) reached the combined endpoint. Most of echocardiographic parameters were related to outcomes, including right ventricular functional parameters. Mean value of RVFWLS in our cohort was −21 ± 8% and it was significantly related to the combined endpoint and in multivariable Cox-regression model; when tested with other echocardiographic parameters that were significantly related to outcome at univariate analysis, RVFWLS maintained its independent association with outcome (hazard ratio 0.963, 95% confidence interval 0.948–0.978; P = 0.0001). The best cut-off value of RVFWLS to predict outcome was −22% (area under the curve 0.677; P &lt; 0.001; sensitivity 70%; 65% specificity). Conclusion RVFWLS may help clinicians to identify patients with left-sided structural heart disease at higher risk for first heart failure hospitalization and death for any cause.

scholarly journals Right Ventricular Free wall Longitudinal Strain in Heart Failure with Mid-range and Preserved Ejection Fraction. Application and Prognostic Implications.

2021 ◽  
Author(s):  
Daniel Grados-Saso ◽  
Juan Manuel Salvador ◽  
Anyuli Gracia-Gutiérrez ◽  
Jorge Rubio-Gracia ◽  
Juan Ignacio Perez-Calvo ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Right Ventricular ◽  
Cardiovascular Mortality ◽  
Longitudinal Strain ◽  
Left Ventricular ◽  
Ventricular Free Wall ◽  
Free Wall ◽  
Right Ventricular Free Wall ◽  
Prognostic Implications

Abstract Purpose: Right ventricle plays an important role in heart failure with preserved and mid-range ejection fraction. Right ventricular dysfunction is common and associated with increased morbidity and mortality in this population. Quantification of right ventricular functional parameters by echocardiography is challenging. Right ventricular strain represents a tool that can provide useful information in the assessment of RV function, offering information with potential prognostic implications.Methods: In a cohort of 71 prospectively included patients admitted for an episode of heart failure with mid-range and preserved ejection fraction (LVEF >40%) right ventricular function was evaluated through right ventricular free wall longitudinal strain. Left ventricular global longitudinal strain was also calculated. Relationship with variables such as hospital readmission and cardiovascular mortality was studied. Results: Worse right ventricular free wall longitudinal strain was associated to higher probability of cardiovascular mortality at six months. In a multivariate analysis RV free wall strain remained a predictor of cardiovascular mortality at 6 months. Significant linear correlation (p <0.01) was observed between longitudinal deformation indices of both ventricles. Conclusion In patients with heart failure with preserved and mid-range ejection fraction, impairment of right ventricular free wall strain is common and is related to worse clinical outcome (increased cardiovascular mortality at six months) regardless of other right ventricular functional parameters and left ventricular ejection fraction. Therefore, representing a sensitive non-invasive prognostic indicator in these patients, and could be useful in stratifying the risk of adverse events. RV and LV strain are correlated indicating biventricular involvement of deformation parameters with prognostic significance.

Right Ventricular Free Wall Strain Is Associated With Long-Term Renal Function in Heart Failure With Preserved Ejection Fraction

2018 ◽  
Vol 24 (10) ◽  
pp. 719-720
Author(s):  
Kevin Bryan Lo ◽  
Pradhum Ram ◽  
Napatt Kanjanahattakij ◽  
Shuchita Gupta ◽  
Gregg S. Pressman ◽  
...  
Keyword(s):  
Heart Failure ◽  
Renal Function ◽  
Ejection Fraction ◽  
Right Ventricular ◽  
Ventricular Free Wall ◽  
Free Wall ◽  
Preserved Ejection Fraction ◽  
Right Ventricular Free Wall
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