scholarly journals Right Ventricular Remodeling Due to Pulmonary Regurgitation Is Associated With Reduced Left Ventricular Free Wall Strain in Surgically Repaired Tetralogy of Fallot

2014 ◽  
Vol 78 (8) ◽  
pp. 1960-1966 ◽  
Author(s):  
Akihiro Nakamura ◽  
Hitoshi Horigome ◽  
Yoshihiro Seo ◽  
Tomoko Ishizu ◽  
Ryo Sumazaki
Keyword(s):  
Right Ventricular ◽  
Tetralogy Of Fallot ◽  
Ventricular Remodeling ◽  
Pulmonary Regurgitation ◽  
Left Ventricular ◽  
Ventricular Free Wall ◽  
Free Wall ◽  
Left Ventricular Free Wall ◽  
Repaired Tetralogy Of Fallot ◽  
Right Ventricular Remodeling

scholarly journals Altered biventricular hemodynamic forces in patients with repaired tetralogy of Fallot and right ventricular volume overload because of pulmonary regurgitation

2018 ◽  
Vol 315 (6) ◽  
pp. H1691-H1702 ◽  
Author(s):  
Pia Sjöberg ◽  
Johannes Töger ◽  
Erik Hedström ◽  
Per Arvidsson ◽  
Einar Heiberg ◽  
...  
Keyword(s):  
Blood Flow ◽  
Right Ventricular ◽  
Tetralogy Of Fallot ◽  
Flow Direction ◽  
Pulmonary Regurgitation ◽  
Ventricular Volume ◽  
Left Ventricular ◽  
Hemodynamic Forces ◽  
Control Subjects ◽  
Repaired Tetralogy Of Fallot

Intracardiac hemodynamic forces have been proposed to influence remodeling and be a marker of ventricular dysfunction. We aimed to quantify the hemodynamic forces in patients with repaired tetralogy of Fallot (rToF) to further understand the pathophysiological mechanisms as this could be a potential marker for pulmonary valve replacement (PVR) in these patients. Patients with rToF and pulmonary regurgitation (PR) > 20% ( n = 18) and healthy control subjects ( n = 15) underwent MRI, including four-dimensional flow. A subset of patients ( n = 8) underwent PVR and MRI after surgery. Time-resolved hemodynamic forces were quantified using 4D-flow data and indexed to ventricular volume. Patients had higher systolic and diastolic left ventricular (LV) hemodynamic forces compared with control subjects in the lateral-septal/LV outflow tract ( P = 0.011 and P = 0.0031) and inferior-anterior ( P < 0.0001 and P < 0.0001) directions, which are forces not aligned with blood flow. Forces did not change after PVR. Patients had higher RV diastolic forces compared with control subjects in the diaphragm-right ventricular (RV) outflow tract (RVOT; P < 0.001) and apical-basal ( P = 0.0017) directions. After PVR, RV systolic forces in the diaphragm-RVOT direction decreased ( P = 0.039) to lower levels than in control subjects ( P = 0.0064). RV diastolic forces decreased in all directions ( P = 0.0078, P = 0.0078, and P = 0.039) but were still higher than in control subjects in the diaphragm-RVOT direction ( P = 0.046). In conclusion, patients with rToF and PR had LV hemodynamic forces less aligned with intraventricular blood flow compared with control subjects and higher diastolic RV forces along the regurgitant flow direction in the RVOT and that of tricuspid inflow. Remaining force differences in the LV and RV after PVR suggest that biventricular pumping does not normalize after surgery. NEW & NOTEWORTHY Biventricular hemodynamic forces in patients with repaired tetralogy of Fallot and pulmonary regurgitation were quantified for the first time. Left ventricular hemodynamic forces were less aligned to the main blood flow direction in patients compared with control subjects. Higher right ventricular forces were seen along the pulmonary regurgitant and tricuspid inflow directions. Differences in forces versus control subjects remain after pulmonary valve replacement, suggesting that altered biventricular pumping does not normalize after surgery.

scholarly journals Right ventricular systolic dysfunction but not dilatation correlates with prognostically significant reductions in exercise capacity in repaired Tetralogy of Fallot

2019 ◽  
Vol 21 (8) ◽  
pp. 906-913 ◽  
Author(s):  
Imran Rashid ◽  
Adil Mahmood ◽  
Tevfik F Ismail ◽  
Shamus O’Meagher ◽  
Shelby Kutty ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Tetralogy Of Fallot ◽  
Exercise Capacity ◽  
Multivariable Analysis ◽  
Cardiopulmonary Exercise Testing ◽  
Pulmonary Regurgitation ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Peak Vo2 ◽  
Repaired Tetralogy Of Fallot

Abstract Aims The optimal timing for pulmonary valve replacement in asymptomatic patients with repaired Tetralogy of Fallot (rTOF) and pulmonary regurgitation remains uncertain but is often guided by increases in right ventricular (RV) end-diastolic volume. As cardiopulmonary exercise testing (CPET) performance is a strong prognostic indicator, we assessed which cardiovascular magnetic resonance (CMR) parameters correlate with reductions in exercise capacity to potentially improve identification of high-risk patients. Methods and results In all, 163 patients with rTOF (mean age 24.5 ± 10.2 years) who had previously undergone CMR and standardized CPET protocols were included. The indexed right and left ventricular end-diastolic volumes (RVEDVi, LVEDVi), right and left ventricular ejection fractions (RVEF, LVEF), indexed RV stroke volume (RVSVi), and pulmonary regurgitant fraction (PRF) were quantified by CMR and correlated with CPET-determined peak oxygen consumption (VO2) or peak work. On univariable analysis, there was no significant correlation between RVEDVi and PRF with peak VO2 or peak work (% Jones-predicted). In contrast, RVEF and RVSVi had significant correlations with both peak VO2 and peak work that remained significant on multivariable analysis. For a previously established prognostic peak VO2 threshold of &lt;27 mL/kg/min, receiver-operating characteristic curve analysis demonstrated a Harrell’s c of 0.70 for RVEF (95% confidence interval 0.61–0.79) with a sensitivity of 88% for RVEF &lt;40%. Conclusion In rTOF, CMR indices of RV systolic function are better predictors of CPET performance than RV size. An RVEF &lt;40% may be useful to identify prognostically significant reductions in exercise capacity in patients with varying degrees of RV dilatation.

Right ventricular free wall strain predicts functional capacity in patients with repaired Tetralogy of Fallot

2020 ◽  
Vol 36 (4) ◽  
pp. 595-604 ◽  
Author(s):  
Cuitlahuac Arroyo-Rodríguez ◽  
Juan Francisco Fritche-Salazar ◽  
Edith Liliana Posada-Martínez ◽  
Jose Antonio Arías-Godínez ◽  
Xochitl A. Ortiz-León ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Tetralogy Of Fallot ◽  
Functional Capacity ◽  
Ventricular Free Wall ◽  
Free Wall ◽  
Right Ventricular Free Wall ◽  
Repaired Tetralogy Of Fallot

Comparison of left ventricular free wall and septal diastolic compliance in the dog

1978 ◽  
Vol 234 (4) ◽  
pp. H392-H398 ◽  
Author(s):  
R. S. Kent ◽  
T. E. Carew ◽  
M. M. LeWinter ◽  
J. W. Covell
Keyword(s):  
Right Ventricular ◽  
Diastolic Pressure ◽  
Left Ventricular ◽  
Ventricular Free Wall ◽  
Segment Length ◽  
Free Wall ◽  
Left Ventricular Free Wall ◽  
Average Maximum ◽  
Diastolic Compliance ◽  
Regional Compliance

Septal to free wall dimensions are frequently employed for the analysis of diastolic compliance. However, the diastolic properties of these anatomically distinct regions of left ventricle are not well characterized. Regional compliance was studied in eight open-chest anesthetized dogs. Pairs of 2-mm-diameter piezoelectric crystals were implanted in the left ventricular free wall or septum 1.38 +/- 0.06 cm apart at a midwall location 58% +/- 1.9 of the left ventricular endocardial-epicardial or left ventricular endocardial-right ventricular endocardial distance. Left ventricular end-diastolic pressure was increased from an average of 8.1-21.0 mmHg, with a resulting average maximum end-diastolic strain of 11% (end-diastolic (ED) segment length/control ED length). Regional stiffness was assessed at all sites based on the relationship between left ventricular end-diastolic pressure and regional strain. Neither strain nor calculated stiffness coefficients differed significantly among the three sites. Septal transmural pressure (left ventricular end-diastolic pressure--right ventricular end-diastolic pressure) was nearly constant as left ventricular end-diastolic pressure increased during volume infusion and thus did not account for the observed septal strain.

The effects of pregnancy on right ventricular remodeling in women with repaired tetralogy of Fallot

2013 ◽  
Vol 168 (3) ◽  
pp. 1847-1852 ◽  
Author(s):  
Gabriele Egidy Assenza ◽  
Daiana Cassater ◽  
Michael Landzberg ◽  
Tal Geva ◽  
Jenna Schreier ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Tetralogy Of Fallot ◽  
Ventricular Remodeling ◽  
Repaired Tetralogy Of Fallot ◽  
Right Ventricular Remodeling

scholarly journals Global and regional right ventricular mechanics in repaired tetralogy of Fallot with chronic severe pulmonary regurgitation: a three-dimensional echocardiography study

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Jurate Bidviene ◽  
Denisa Muraru ◽  
Attila Kovacs ◽  
Bálint Lakatos ◽  
Egle Ereminiene ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Tetralogy Of Fallot ◽  
Three Dimensional ◽  
Pulmonary Regurgitation ◽  
Volume Overload ◽  
Free Wall ◽  
Ventricular Mechanics ◽  
Relative Contribution ◽  
Repaired Tetralogy Of Fallot ◽  
Three Dimensional Echocardiography

Abstract Background Data about the right ventricular (RV) mechanics adaptation to volume overload in patients with repaired tetralogy of Fallot (rToF) are limited. Accordingly, we sought to assess the mechanics of the functional remodeling occurring in the RV of rToF with severe pulmonary regurgitation. Methods We used three-dimensional transthoracic echocardiography (3DTE) to obtain RV data sets from 33 rToF patients and 30 age- and sex- matched controls. A 3D mesh model of the RV was generated, and RV global and regional longitudinal (LS) and circumferential (CS) strain components, and the relative contribution of longitudinal (LEF), radial (REF) and anteroposterior (AEF) wall motion to global RV ejection fraction (RVEF) were computed using the ReVISION method. Results Corresponding to decreased global RVEF (45 ± 6% vs 55 ± 5%, p < 0.0001), rToF patients demonstrated lower absolute values of LEF (17 ± 4 vs 28 ± 4), REF (20 ± 5 vs 25 ± 4) and AEF (17 ± 5 vs 21 ± 4) than controls (p < 0.01). However, only the relative contribution of LEF to global RVEF (0.39 ± 0.09 vs 0.52 ± 0.05, p < 0.0001) was significantly decreased in rToF, whereas the contribution of REF (0.45 ± 0.08 vs 0.46 ± 0.04, p > 0.05) and AEF (0.38 ± 0.09 vs 0.39 ± 0.04, p > 0.05) to global RVEF was similar to controls. Accordingly, rToF patients showed lower 3D RV global LS (-16.94 ± 2.9 vs -23.22 ± 2.9, p < 0.0001) and CS (-19.79 ± 3.3 vs -22.81 ± 3.5, p < 0.01) than controls. However, looking at the regional RV deformation, the 3D CS was lower in rToF than in controls only in the basal RV free-wall segment (p < 0.01). 3D RV LS was reduced in all RV free-wall segments in rToF (p < 0.0001), but similar to controls in the septum (p > 0.05). Conclusions 3DTE allows a quantitative evaluation of the mechanics of global RVEF. In rToF with chronic volume overload, the relative contribution of the longitudinal shortening to global RVEF is affected more than either the radial or the anteroposterior components.

scholarly journals IS PREGNANCY ASSOCIATED WITH ADVERSE RIGHT VENTRICULAR REMODELING IN WOMEN WITH REPAIRED TETRALOGY OF FALLOT?

2012 ◽  
Vol 59 (13) ◽  
pp. E797
Author(s):  
Gabriele Egidy Assenza ◽  
Anne Marie Valente ◽  
Daiana Cassater ◽  
Jenna Schreier ◽  
Katherine Economy ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Tetralogy Of Fallot ◽  
Ventricular Remodeling ◽  
Repaired Tetralogy Of Fallot ◽  
Right Ventricular Remodeling

Hemodynamic consequences of ventricular interaction as assessed by model analysis

1991 ◽  
Vol 260 (1) ◽  
pp. H146-H157 ◽  
Author(s):  
W. P. Santamore ◽  
D. Burkhoff
Keyword(s):  
Right Ventricular ◽  
Systemic Vascular Resistance ◽  
Vascular Resistance ◽  
Left Ventricular ◽  
Ventricular Free Wall ◽  
Free Wall ◽  
Left Ventricular Free Wall ◽  
Right Ventricular Free Wall ◽  
Ventricular Interaction ◽  
Ventricular Interdependence

Because of close anatomic association, the pressure and volume in one ventricle can directly influence the pressure and volume in the opposite ventricle. To examine the importance of ventricular interdependence in controlling the circulation, we developed a computer model in which ventricular interdependence could be turned on and off. Left ventricular chamber contractility, as judged by maximal elastance (Emax), was enhanced on the order of 10% as a result of ventricular interaction, whereas right ventricular Emax was affected by as much as 60% under physiological conditions. With increases in systemic vascular resistance, ventricular interaction caused a smaller stroke volume (SV) decrease than with no interaction. For canine data (SV = 21.4 ml), doubling systemic vascular resistance decreased SV by 3.7 without ventricular interdependence, 3.5 with diastolic ventricular interdependence, and 3.3 ml with diastolic and systolic ventricular interdependence. In contrast, with increases in pulmonary vascular resistance, ventricular interaction caused a greater decrease in SV than with no interaction present. Decreasing left ventricular free wall elastance or right ventricular free wall elastance decreased SV. Diastolic ventricular interdependence reduced the SV changes, whereas systolic ventricular interdependence accentuated the SV changes with alterations in right and left ventricular free-wall elastance. The results of the present simulation demonstrate the importance of ventricular interdependence in the observed responses of the right ventricle to volume overload, pressure overload, and ischemia.

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