The relationship between longitudinal, lateral, and septal contribution to stroke volume in patients with pulmonary regurgitation and healthy volunteers

2014 ◽  
Vol 306 (6) ◽  
pp. H895-H903 ◽  
Author(s):  
Sigurdur Stephensen ◽  
Katarina Steding-Ehrenborg ◽  
Peter Munkhammar ◽  
Einar Heiberg ◽  
Hakan Arheden ◽  
...  
Keyword(s):  
Stroke Volume ◽  
Right Atrium ◽  
Pulmonary Regurgitation ◽  
Volume Overload ◽  
Atrioventricular Plane Displacement ◽  
Cardiac Volumes ◽  
The Right ◽  
Plane Displacement ◽  
The Relationship ◽  
Septal Motion

Septal systolic motion is towards the left ventricle (LV) in healthy hearts. Patients with pulmonary regurgitation (PR) and right ventricular (RV) volume overload have systolic septal motion toward the RV. This may affect the longitudinal contribution from atrioventricular plane displacement (AVPD) and septal and lateral contribution to stroke volume (SV). The study aimed to quantify these contributions to SV in patients with PR. Cardiac magnetic resonance imaging was used for assessment of cardiac volumes. Patients ( n = 30; age 9–59 yr) with PR due to surgically corrected tetralogy of Fallot and 54 healthy controls (age 10–66 yr) were studied. Longitudinal contribution to RVSV was 47 ± 2% (means ± SE) in patients with PR and 79 ± 1% in controls ( P < 0.001). Lateral contribution to RVSV and LVSV was 40 ± 1 and 62 ± 2% in patients and 31 ± 1 and 36 ± 1% in controls ( P < 0.001 for both). Septal motion contributed to RVSV by 8 ± 1% in patients and by 7 ± 1% to LVSV in controls ( P < 0.001). PR patients have decreased longitudinal contribution to RVSV and increased lateral pumping, resulting in larger outer volume changes and septal motion towards the RV. The changes in RV pumping physiology may be explained by RV remodeling resulting in lower systolic inflow of blood into the right atrium in relation to SV. This avoids the development of pendulum volume between the caval veins and right atrium, which would occur in PR patients if longitudinal contribution to SV was preserved. Decreased AVPD suggests that tricuspid annular excursion, a marker of RV function, is less valid in these patients.

Combined hybrid pulmonary valve placement and atrial septal defect closure: case report and literature review

2020 ◽  
Vol 30 (5) ◽  
pp. 737-739
Author(s):  
Omar Abu-Anza ◽  
Kaitlin Carr ◽  
Osamah Aldoss
Keyword(s):  
Atrial Septal Defect ◽  
Septal Defect ◽  
Pulmonary Valve ◽  
Pulmonary Regurgitation ◽  
Volume Overload ◽  
Pulmonary Valve Replacement ◽  
Device Closure ◽  
Atrial Septal Defect Closure ◽  
Valve Placement ◽  
The Right

AbstractWe report a case of a 15-year-old female who underwent combined hybrid pulmonary valve replacement and transcatheter atrial septal defect device closure, which was performed due to severe volume overload of the right side of the heart secondary to pulmonary regurgitation and atrial septal defect.

scholarly journals Quantification of left and right atrial kinetic energy using four-dimensional intracardiac magnetic resonance imaging flow measurements

2013 ◽  
Vol 114 (10) ◽  
pp. 1472-1481 ◽  
Author(s):  
Per M. Arvidsson ◽  
Johannes Töger ◽  
Einar Heiberg ◽  
Marcus Carlsson ◽  
Håkan Arheden
Keyword(s):  
Magnetic Resonance ◽  
Kinetic Energy ◽  
Right Atrial ◽  
Elastic Recoil ◽  
Flow Measurements ◽  
Ventricular Systole ◽  
Atrial Contraction ◽  
Atrioventricular Plane Displacement ◽  
The Right ◽  
Plane Displacement

Kinetic energy (KE) of atrial blood has been postulated as a possible contributor to ventricular filling. Therefore, we aimed to quantify the left (LA) and right (RA) atrial blood KE using cardiac magnetic resonance (CMR). Fifteen healthy volunteers underwent CMR at 3 T, including a four-dimensional phase-contrast flow sequence. Mean LA KE was lower than RA KE (1.1 ± 0.1 vs. 1.7 ± 0.1 mJ, P < 0.01). Three KE peaks were seen in both atria: one in ventricular systole, one during early ventricular diastole, and one during atrial contraction. The systolic LA peak was significantly smaller than the RA peak ( P < 0.001), and the early diastolic LA peak was larger than the RA peak ( P < 0.05). Rotational flow contained 46 ± 7% of total KE and conserved energy better than nonrotational flow did. The KE increase in early diastole was higher in the LA ( P < 0.001). Systolic KE correlated with the combination of atrial volume and systolic velocity of the atrioventricular plane displacement ( r2 = 0.57 for LA and r2 = 0.64 for RA). Early diastolic KE of the LA correlated with left ventricle (LV) mass ( r2 = 0.28), however, no such correlation was found in the right heart. This suggests that LA KE increases during early ventricular diastole due to LV elastic recoil, indicating that LV filling is dependent on diastolic suction. Right ventricle (RV) relaxation does not seem to contribute to atrial KE. Instead, RA KE generated during ventricular systole may be conserved in a hydraulic “flywheel” and transferred to the RV through helical flow, which may contribute to RV filling.

Initial hemodynamic responses to mild exercise in trained dogs

1965 ◽  
Vol 20 (3) ◽  
pp. 437-442 ◽  
Author(s):  
Harold Smulyan ◽  
Richard P. Cuddy ◽  
William A. Vincent ◽  
Udomporn Kashemsant ◽  
Robert H. Eich
Keyword(s):  
Heart Rate ◽  
Cardiac Output ◽  
Oxygen Consumption ◽  
Stroke Volume ◽  
Right Atrium ◽  
Initial Reaction ◽  
Hemodynamic Responses ◽  
Heart Rates ◽  
Infusion Method ◽  
The Right

The transient changes in cardiac output at the onset of mild exercise were measured in dogs trained to walk on a treadmill. Cardiac output was obtained using a krypton 85 infusion method, which permitted frequent determinations of flow. The first go sec of exercise were marked by a prompt rise and overshoot of heart rate and cardiac output, whereas increases in stroke volume occurred later after the onset of exercise, and to a lesser extent than heart rate. At rest, the right atrium was electrically driven at rates slightly faster than heart rates attained spontaneously with exercise and the studies repeated. Changes in cardiac output with exercise were similar to those in unpaced animals, but when the heart rate was fixed stroke volume increased immediately. These studies show a consistent rise in heart rate and cardiac output in the initial reaction to exercise, but when the prompt rise in heart rate was prevented by pacing from the right atrium, increases in stroke volume provided a comparable response in cardiac output. krypton 85; cardiac output; stroke volume; pacing of heart; oxygen consumption Submitted on September 23, 1964

scholarly journals Changes in left and right ventricular longitudinal function after pulmonary valve replacement in patients with Tetralogy of Fallot

2020 ◽  
Vol 318 (2) ◽  
pp. H345-H353 ◽  
Author(s):  
Pia Sjöberg ◽  
Ellen Ostenfeld ◽  
Erik Hedström ◽  
Håkan Arheden ◽  
Ronny Gustafsson ◽  
...  
Keyword(s):  
Tetralogy Of Fallot ◽  
Valve Replacement ◽  
Pulmonary Valve ◽  
Pulmonary Regurgitation ◽  
Pulmonary Valve Replacement ◽  
Left Ventricular ◽  
Longitudinal Function ◽  
Before And After ◽  
Atrioventricular Plane Displacement ◽  
Plane Displacement

Timing and indication for pulmonary valve replacement (PVR) in patients with repaired Tetralogy of Fallot (rToF) and pulmonary regurgitation (PR) are uncertain. To improve understanding of pumping mechanics, we investigated atrioventricular coupling before and after surgical PVR. Cardiovascular magnetic resonance was performed in patients ( n = 12) with rToF and PR > 35% before and after PVR and in healthy controls ( n = 15). Atrioventricular plane displacement (AVPD), global longitudinal peak systolic strain (GLS), atrial and ventricular volumes, and caval blood flows were analyzed. Right ventricular (RV) AVPD and RV free wall GLS were lower in patients before PVR compared with controls ( P < 0.0001; P < 0.01) and decreased after PVR ( P < 0.0001 for both). Left ventricular AVPD was lower in patients before PVR compared with controls ( P < 0.05) and decreased after PVR ( P < 0.01). Left ventricular GLS did not differ between patients and controls ( P > 0.05). Right atrial reservoir volume and RV stroke volume generated by AVPD correlated in controls ( r = 0.93; P < 0.0001) and patients before PVR ( r = 0.88; P < 0.001) but not after PVR. In conclusion, there is a clear atrioventricular coupling in patients before PVR that is lost after PVR, possibly because of loss of pericardial integrity. Impaired atrioventricular coupling complicates assessment of ventricular function after surgery using measurements of longitudinal function. Changes in atrioventricular coupling seen in patients with rToF may be energetically unfavorable, and long-term effects of surgery on atrioventricular coupling is therefore of interest. Also, AVPD and GLS cannot be used interchangeably to assess longitudinal function in rToF. NEW & NOTEWORTHY There is a clear atrioventricular coupling in patients with Tetralogy of Fallot (ToF) and pulmonary regurgitation before surgical pulmonary valve replacement (PVR) that is lost after operation, possibly because of loss of pericardial integrity. The impaired atrioventricular coupling complicates assessment of ventricular function after surgery when using measurements of longitudinal function. Left ventricular atrioventricular plane displacement (AVPD) found differences between patients and controls and changes after PVR that longitudinal strain could not detect. This indicates that AVPD and strain cannot be used interchangeably to assess longitudinal function in repaired ToF.

scholarly journals NT-proBNP level and lesion of the right ventricle in patients with pulmonary embolism

2021 ◽  
Vol 28 (2) ◽  
pp. 50-57
Author(s):  
V. I. Tseluyko ◽  
L. M. Yakovleva ◽  
S. M. Sukhova ◽  
O. V. Radchenko ◽  
T. V. Pylova ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Pulmonary Artery ◽  
Left Atrium ◽  
Right Atrium ◽  
Troponin I ◽  
Echocardiographic Study ◽  
Echocardiographic Parameters ◽  
Highly Sensitive Troponin ◽  
The Right ◽  
The Relationship

The aim – to study the relationship between the level of NT-proBNP, clinical-anamnestic and echocardiographic parameters in patients with pulmonary embolism (PE).Materials and methods. The study was carried out on 45 patients with PE, which was confirmed by computed tomo­­graphy. An echocardiographic study was carried out during hospitalization of patients according to the standard protocol. The examination plan of patients, along with standard laboratory tests, included the determination of the level of highly sensitive troponin I, C-reactive peptide (CRP) and NT-proBNP.Results and discussion. The level of NT-proBNP is increased in patients with PE, even in the absence of heart failure (2932±266 pg/ml). There were no significant differences in the level of the indicator depending on the gender of patients (p=0.3), on the presence of arterial hypertension (p=0.92) and the concomitant oncological process (p=0.88). A correlation was found between NT-proBNP level and the size of the right and left atrium: right atrium (p=0.014), left atrium (p=0.025). The relationship between the level of NT-proBNP and the pressure in the pulmonary artery according to ultrasound data was proved (in patients with PE without signs of pulmonary hypertension, the level of NT-proBNP is 405 pg/ml, versus 4067 pg/ml in the group of patients with increased pressure in the pulmonary artery (p=0.0047). A correlation was found between the levels of NT-proBNP and CRP.Conclusions. There is a significant increase in the level of NT-proBNP in patients with PE, the degree of which correlates with an increase in the size of the right atrium and pressure in the pulmonary artery (p=0.0047).

scholarly journals Decreased atrioventricular plane displacement after acute myocardial infarction yields a concomitant decrease in stroke volume

2020 ◽  
Vol 128 (2) ◽  
pp. 252-263
Author(s):  
J. Berg ◽  
R. Jablonowski ◽  
D. Nordlund ◽  
S. Kopic ◽  
S. Bidhult ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Stroke Volume ◽  
Ischemia Reperfusion ◽  
Size Estimation ◽  
Before And After ◽  
Atrioventricular Plane Displacement ◽  
Plane Displacement

Acute myocardial infarction (AMI) can progress to heart failure, which has a poor prognosis. Normally, 60% of stroke volume (SV) is attributed to the longitudinal ventricular shortening and lengthening evident in the atrioventricular plane displacement (AVPD) during the cardiac cycle, but there is no information on how the relationship changes between SV and AVPD before and after AMI. Therefore, the aim of this study was to determine how SV depends on AVPD before and after AMI in two swine models. Serial cardiac magnetic resonance imaging was carried out before and 1–2 h after AMI in a microembolization model ( n = 12) and an ischemia-reperfusion model ( n = 14). A subset of pigs ( n = 7) were additionally imaged at 24 h and at 7 days. Cine and late gadolinium enhancement images were analyzed for cardiac function, AVPD measurements and infarct size estimation, respectively. AVPD decreased ( P < 0.05) in all myocardial regions after AMI, with a concomitant SV decrease ( P < 0.001). The ischemia-reperfusion model affected SV to a higher degree and had a larger AVPD decrease than the microembolization model (−29 ± 14% vs. −15 ± 18%; P < 0.05). Wall thickening decreased in infarcted areas ( P < 0.001), and A-wave AVPD remained unchanged ( P = 0.93) whereas E-wave AVPD decreased ( P < 0.001) after AMI. We conclude that AVPD is coupled to SV independent of infarct type but likely to a greater degree in ischemia-reperfusion infarcts compared with microembolization infarcts. AMI reduces diastolic early filling AVPD but not AVPD from atrial contraction. These findings shed light on the physiological significance of atrioventricular plane motion when assessing acute and subacute myocardial infarction. NEW & NOTEWORTHY The link between cardiac longitudinal motion, measured as atrioventricular plane displacement (AVPD), and stroke volume (SV) is investigated in swine after acute myocardial infarction (AMI). This cardiac magnetic resonance study demonstrates a close coupling between AVPD and SV before and after AMI in an experimental setting and demonstrates that this connection is present in ischemia-reperfusion and microembolization infarcts, acutely and during the first week. Furthermore, AVPD is equally and persistently depressed in infarcted and remote myocardium after AMI.

Collapsibility of caval vessels and right ventricular afterload: decoupling of stroke volume variation from preload during mechanical ventilation

2021 ◽  
Author(s):  
Elisa Valenti ◽  
Per Werner Moller ◽  
Jukka Takala ◽  
David Christian Berger
Keyword(s):  
Stroke Volume ◽  
Right Ventricular ◽  
Right Atrium ◽  
Airway Pressure ◽  
Stroke Volume Variation ◽  
Right Atrial ◽  
Right Ventricular Afterload ◽  
Volume Variation ◽  
Ventricular Afterload ◽  
The Right

Background: Collapsibility of caval vessels and stroke volume and pulse pressure variations (SVV, PPV) are used as indicators of volume responsiveness. Their behavior under increasing airway pressures and changing right ventricular afterload is incompletely understood. If the phenomena of SVV and PPV augmentation are manifestations of decreasing preload, they should be accompanied by decreasing transmural right atrial pressures. Methods: Eight healthy pigs equipped with ultrasonic flow probes on the pulmonary artery were exposed to positive end-expiratory pressure of 5 and 10 cmH2O and three volume states (Euvolemia, defined as SVV < 10%, Bleeding and Retransfusion). SVV and PPV were calculated for the right and PPV for the left side of the circulation at increasing inspiratory airway pressures (15, 20, 25 cmH2O). Right ventricular afterload was assessed by surrogate flow profile parameters. Transmural pressures in the right atrium and the inferior and superior caval vessels (IVC and SVC) were determined. Results: Increasing airway pressure led to increases in ultrasonic surrogate parameters of right ventricular afterload, increasing transmural pressures in the right atrium and SVC, and a drop in transmural IVC pressure. SVV and PPV increased with increasing airway pressure, despite the increase in right atrial transmural pressure. Right ventricular stroke volume variation correlated with indicators of right ventricular afterload. This behavior was observed in both PEEP levels and all volume states. Conclusions: Stroke volume variation may reflect changes in right ventricle afterload, rather than changes in preload.

The quantitative relationship between longitudinal and radial function in left, right, and total heart pumping in humans

2007 ◽  
Vol 293 (1) ◽  
pp. H636-H644 ◽  
Author(s):  
Marcus Carlsson ◽  
Martin Ugander ◽  
Einar Heiberg ◽  
Hakan Arheden
Keyword(s):  
Flow Measurement ◽  
Radial Function ◽  
Quantitative Relationship ◽  
Cine Mri ◽  
Heart Volume ◽  
Flow Measurements ◽  
Volume Variation ◽  
Atrioventricular Plane Displacement ◽  
The Right ◽  
Plane Displacement

The total heart volume variation (THVV) during systole has been proposed to be caused by radial function of the ventricles, but definitive data for both ventricles have not been presented. Furthermore, the right ventricle (RV) has been suggested to have a greater longitudinal pumping component than the left ventricle (LV). Therefore, we aimed to compare the stroke volume (SV) generated by radial function to the volume variation of the left, right, and total heart. To do this, we also needed to develop a new method for measuring the contribution of the longitudinal atrioventricular plane displacement (AVPD) to the RVSV (RVSVAVPD). For our study, 11 volunteers underwent cine MRI in the short- and long-axis planes and MRI flow measurement in all vessels leading to and from the heart. The left, right, and total heart showed correlations between volume variation from flow measurements and radial function calculated as SV minus the longitudinal function ( r = 0.81, P < 0.01; r = 0.80, P < 0.01; and r = 0.92, P < 0.001, respectively). Compared with the LV, the RV had a greater AVPD (23.4 ± 0.8 vs. 16.4 ± 0.5 mm), center of volume movement (13.0 ± 0.7 vs. 7.8 ± 0.4 mm), and, RVSVAVPD(82 ± 2% vs. 60 ± 2%) ( P < 0.001 for all). We found that THVV is predominantly caused by radial function of the ventricles. Longitudinal AVPD accounts for ∼80% of the RVSV, compared with ∼60% for the LVSV. This difference explains the larger portion of THVV found on the left side of the heart.

scholarly journals Volume Overload Initiates an Immune Response in the Right Ventricle at the Neonatal Stage

2021 ◽  
Vol 8 ◽  
Author(s):  
Qing Cui ◽  
Sijuan Sun ◽  
Hongbin Zhu ◽  
Yingying Xiao ◽  
Chuan Jiang ◽  
...  
Keyword(s):  
Immune Response ◽  
Immune Responses ◽  
Rat Model ◽  
Flow Cytometric Analysis ◽  
Pulmonary Regurgitation ◽  
Vena Cava ◽  
Volume Overload ◽  
Time Integral ◽  
Neonatal Stage ◽  
The Right

Background: Pulmonary regurgitation caused by the correction or palliation of pediatric tetralogy of Fallot (TOF) leads to chronic right ventricular (RV) volume overload (VO), which induces adolescent RV dysfunction. A better understanding of the molecular mechanism by which VO initiates neonatal RV remodeling may bring new insights into the post-surgical management of pediatric TOF.Methods and Results: We created a fistula between the abdominal aorta and inferior vena cava on postnatal day 1 (P1) using a rat model to induce neonatal VO. Echocardiography revealed that the velocity and velocity- time-integral of the pulmonary artery (PA) were significantly elevated, and hematoxylin and eosin (H&amp;E) staining showed that the diameter of the RV significantly increased. RNA-seq analysis of the RV on P7 indicated that the top 10 enriched Gene Ontology (GO) terms and the top 20 enriched terms in the Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis were associated with immune responses. Flow-cytometric analysis demonstrated that the number of CD4+and CD8+ immune cells were significantly augmented in the VO group compared with the sham group.Conclusions: A neonatal cardiac VO rat model on P1 was successfully created, providing a platform for studying the molecular biology of neonatal RV under the influence of VO. VO - induces an immune response at the neonatal stage (from P1 to P7), suggesting that immune responses may be an initiating factor for neonatal RV remodeling under the influence of VO and that immunosuppressants may be used to prevent pediatric RV remodeling caused by VO.

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