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PubMed1997

Left ventricular volume reduction surgery.

Left ventricular volume reduction has recently been introduced as a surgical treatment for end stage dilated cardiomyopathy. This operation involves the resection of a slice of viable left ventricular myocardium in order to reduce the wall tension imposed upon the contracting heart chamber. Early results are encouraging, but clinical evaluation on a larger scale is required. In the present article, we describe the indications, surgical principles and results of left ventricular volume reduction surgery with reference to our group's experience.

Animals↗

PubMed1998

An echocardiographic and magnetic resonance imaging comparative study of right ventricular volume determination.

Assessment of right ventricular volume and function is important in many clinical settings involving heart or lung disease. However, the complexity of the right ventricular anatomy has prevented accurate volume determination by two-dimensional echocardiography. In the present study, 5 models incorporating standard echocardiographic views, were used to determine right ventricular volume in 10 human subjects. Two models were contingent on the true crescentic appearance of the right ventricle, whereas the remaining 3 calculated the right ventricular volume as a pyramid, an ellipsoid or other tapering geometrical figures, respectively. Subsequently, echocardiographic right ventricular volumes were compared to magnetic resonance imaging derived volumes. Correlation analysis and agreement measurement between the echocardiographic and magnetic resonance end-diastolic volume were performed in 10 out of 10 subjects and in 9 out of 10 subjects for the end-systolic volume. The 2 crescentic models resulted in the most reliable estimation of right ventricular volume. Those findings suggest that models based on right ventricular anatomical landmarks are feasible and should be preferred in echocardiographic studies.

Adult↗

PubMed2001

Residual stress produced by ventricular volume reduction surgery has little effect on ventricular function and mechanics: a finite element model study.

OBJECTIVES: Residual stress is the stress (force per unit area) that remains when all external loads (eg, left ventricular chamber and pericardial pressures) are removed. It has been suggested that ventricular volume reduction surgery can reconstitute the residual stress-strain state of the left ventricle. To determine the extent to which residual stress is involved, we used a mathematical (finite element) model to simulate the effect of volume reduction operations on left ventricular stroke volume/end-diastolic pressure (Starling) relationships, as well as on regional distributions of stress in the local muscle fiber direction (fiber stress). METHODS: The nonlinear stress-strain relationship for the diastolic myocardium was anisotropic with respect to the local muscle fiber direction. An elastance model for active fiber stress was incorporated in an axisymmetric geometric model of the dilated, poorly contractile left ventricular wall. RESULTS: When residual stress is implemented in the model simulation of volume reduction operations, the additional decrease in stroke volume at fixed left ventricular end-diastolic pressure is small (10% volume reduction: 2.0% at 1 mm Hg and 2.0% at 20 mm Hg; 20% volume reduction: 2.2% at 1 mm Hg and 3.1% at 20 mm Hg). Furthermore, there is little change in the mean fiber stress throughout the left ventricular wall (10% volume reduction: +1.0% at end-diastole and -0.3% at end-systole; 20% volume reduction: +2.1% at end-diastole and -1.0% at end-systole). CONCLUSIONS: These results suggest that residual stress produced by volume reduction operations has little effect on left ventricular function and the mean fiber stresses at end-diastole and end-systole.

Anisotropy↗

PubMed1978

Partial volume summation: a simple approach to ventricular volume determination from CT.

The accurate determination of ventricular volume from computed tomography (CT) is not a trivial problem. The direct approach of measuring the area within a visually determined boundary or contour level and multiplying by the nominal slice thickness may be subject to large errors because such boundaries are not, in general, well defined. When the ventricles are filled with a high-contrast material such as metrizamide, we may use the technique of 'partial volume summation,' a simple but accurate, clinically applicable method which may be performed on a standard DeltaScan-50 or similar system.

Cerebral Ventricles↗

PubMed1988

Correlation of right ventricular volume using axial angulated ventriculography to known right ventricular cast volumes in infants and children with congenital heart disease.

To calculate right ventricular (RV) volumes from biplane cineangiography obtained in nonstandard views, regression equations were developed from RV casts of known volume. Volumes were calculated using Simpson's rule from casts ranging from 2 to 42 ml from 25 postmortem specimens with various congenital heart diseases. The casts were divided into 2 groups: group 1 (n = 15) with abnormal or group 2 (n = 10) with normal RV hemodynamic measurements. Biplane cinegrams were taken in the anterolateral, anterior and long axis oblique, hepatoclavicular and sitting up projections. The true volume of each cast was determined from its weight and specific gravity. Excellent correlations were obtained between measured and true volumes (r = 0.92 to 0.96) in all projections, although each projection overestimated the true volume (slope value less than 1). The regression equations obtained from group 1 were not statistically different from those in group 2 in any view. Although the application of different regression equations is required in measuring RV volumes by multiple angulated angiography, these regression equations appear not to be affected by the hemodynamic state of the ventricle. These results are important in assessing RV volume in pediatric patients with congenital heart disease using axial angulated ventriculography.

Cineangiography↗

PubMed1997

The apical long-axis rather than the two-chamber view should be used in combination with the four-chamber view for accurate assessment of left ventricular volumes and function.

BACKGROUND: Most biplane methods for the echocardiographic calculation of left ventricular volumes assume orthogonality between paired views from the apical window. Our aim was to study the accuracy of biplane left ventricular volume calculations when either the apical two-chamber or long-axis views are combined with the four-chamber view. The left ventricular volumes calculated from three-dimensional echocardiographic data sets were used as a reference. Twenty-seven patients underwent precordial three-dimensional echocardiography using rotational acquisition of planes at 2-degree intervals, with ECG and respiratory gating. End-diastolic and end-systolic left ventricular volumes and ejection fraction on three-dimensional echocardiography were calculated by (1) Simpson's methods (3DS) at 3 mm short-axis slice thickness (reference method) and by (2) biplane ellipse from paired views using either apical four- and two-chamber views (BE-A) or apical four- and long-axis views (BE-B). Observer variabilities were studied by the standard error of the estimate % (SEE) in 19 patients for all methods. RESULTS: The spatial angles (mean +/- SD) between the apical two-chamber, long-axis and four-chamber views were 63.3 degrees +/- 19.7 and 99.1 degrees +/- 25.6, respectively. The mean +/- SD of end-diastolic and end-systolic left ventricular volumes (ml) and ejection fraction (%) by 3DS were 142.2 +/- 60.9, 91.8 +/- 59.6 and 39.6 +/- 17.5, while that by BE-A were 126.7 +/- 60.4, 84.0 +/- 57.9 and 39 +/- 17 and by BE-B were 134.3 +/- 62.4, 88.6 +/- 59.7 and 39.1 +/- 16.7, respectively. BE-B intra-observer (8.4, 6.7 and 3.5) and inter-observer (9.8, 11.5 and 5.4) SEE for end-diastolic and end-systolic left ventricular volumes (ml) and ejection fraction (%), respectively, were smaller than that for BE-A (10.8, 8.8 and 4.1 and 11.4, 14.7 and 6.1, respectively). There was excellent correlation between 3DS and BE-A (r = 0.99, 0.98 and 0.98) and BE-B (0.98, 0.98 and 0.98) for calculating end-diastolic and end-systolic left ventricular volume and ejection fractions, respectively. There were no significant differences between BE-A and BE-B with 3DS for end-diastolic and end-systolic left ventricular volume and ejection fraction calculations (P = 0.2, 0.3 and 0.4 and P = 0.5, 0.5 and 0.4, respectively). There were closer limits of agreement (mean +/- 2 SD) between 3DS and BE-B 7.9 +/- 18.8, 3.2 +/- 14.2 and 0.8 +/- 5.8 than that between 3DS and BE-A 15.5 +/- 19.6, 7.8 +/- 16.2 and 1.1 +/- 7.4 for calculating end-diastolic and end-systolic left ventricular volume and ejection fractions, respectively. CONCLUSION: Both apical two-chamber and apical long-axis views are not orthogonal to the apical four-chamber view. Observer variabilities of BE-B were smaller than that for BE-A. BE-A and BE-B have excellent correlation and non-significant differences with 3DS for left ventricular volume and ejection fraction calculations. There were closer limits of agreement between BE-B with 3DS for left ventricular volume and ejection fraction calculations than that between BE-A and 3DS. Therefore, we recommend the use of the apical long-axis rather than the two-chamber view in combination with the four-chamber view for accurate biplane left ventricular volume and ejection fraction calculations.

Adult↗

PubMed1994

Total biventricular volume and total left ventricular volume by ultrafast computed tomography: prediction of left ventricular mass.

Since LV hypertrophy is an independent predictor of increased cardiac mortality, a simple noninvasive measure of LV mass would be a valuable screening tool. A retrospective assessment of 50 UFCT studies was performed. Measurements of LV mass, TBV, and TLV were determined in each case. There was excellent correlation between TBV and LVM (R = 0.93) and between TLV and LV mass (R = 0.92). Also, there was minimal interobserver variability between two independent observers for estimates of both TBV (R = 0.995) and TLV (R = 0.99). Thus these preliminary data indicate that LV mass may be estimated from TBV or TLV and that these tools may assist in the identification of patients potentially at high risk for future coronary events, as indicated by the presence of increased LV mass and coronary atherosclerosis.

Adult↗

PubMed1994

Conductance catheter measurements of left ventricular volume in the intact dog: parallel conductance is independent of left ventricular size.

OBJECTIVE: It has recently been suggested that conductance catheter parallel conductance (alpha Vc) is a function of left ventricular volume. To confirm this, alpha Vc was measured in this study over a wide range of steady state volumes. In addition, conductance derived volumes were compared to those obtained by radionuclide angiography to determine if the conductance catheter can be used to measure absolute left ventricular volume accurately in the intact dog heart. METHODS: Seven dogs were anaesthetised and instrumented with left ventricular conductance and pressure tip catheters, a flow through rho cuvette to continually measure blood resistance, a thermodilution catheter, and a venous catheter for volume infusion/withdrawal. Conductance and angiographic data were acquired at 8(SD 1) variably loaded states. Parallel conductance was measured twice at each state using a saline dilution technique and a new non-linear algorithm that allows variability in the observations of both maximum and minimum conductance volumes. RESULTS: The mean value of alpha Vc was 89.1(18.0) ml (71.8 to 111.3 ml) with a mean within-animal coefficient of variation of 7.3(3.4)%. Multiple linear regression using dummy variables to account for the large interanimal variability did not reveal any relationship between alpha Vc and either maximum or minimum left ventricular volume. Furthermore, no difference was found when alpha Vc values measured at the lowest and highest loading levels in each dog were compared. Linear regression showed good agreement between conductance and radionuclide derived end diastolic volumes (slope = 0.94, R = 0.9, p < 0.001). CONCLUSIONS: While alpha Vc varies between animals, it remains constant within any given animal over a broad range of left ventricular volumes. Thus the conductance catheter can provide reliable absolute left ventricular volume measurements under steady state conditions.

Animals↗

PubMed1993

Three-dimensional echocardiography. In vivo validation for left ventricular volume and function.

BACKGROUND: Current two-dimensional quantitative echocardiographic methods of volume assessment require image acquisition from standardized scanning planes. Left ventricular volume and ejection fraction are then calculated by assuming ventricular symmetry and geometry. These assumptions may not be valid in distorted ventricles. Three-dimensional echocardiography can quantify left ventricular volume without the limitations imposed by the assumptions of two-dimensional methods. We have developed a three-dimensional system that automatically integrates two-dimensional echocardiographic images and their positions in real time and calculates left ventricular volume directly from traced endocardial contours without geometric assumptions. METHODS AND RESULTS: To study the accuracy of this method in quantifying left ventricular volume and performance in vivo, a canine model was developed in which instantaneous left ventricular volume can be measured directly with an intracavitary balloon connected to an external column. Ten dogs were studied at 84 different cavity volumes (4 to 85 cm3) and in conditions of altered left ventricular shape produced by either coronary occlusion or right ventricular volume overload. To demonstrate clinical feasibility, 19 adult human subjects were then studied by this method for quantification of stroke volume. Left ventricular volume, stroke volume, and ejection fraction calculated by three-dimensional echocardiography correlated well with directly measured values (r = .98, .96, .96 for volume, stroke volume, and ejection fraction, respectively) and agreed closely with them (mean difference, -0.78 cm3, -0.60 cm3, -0.32%). In humans, there was a good correlation (r = .94, SEE = 4.29 cm3) and agreement (mean difference, -0.98 +/- 4.2 cm3) between three-dimensional echocardiography and Doppler-derived stroke volumes. CONCLUSIONS: Three-dimensional echocardiography allows accurate assessment of left ventricular volume and systolic function.

Adult↗

PubMed1983

Radionuclide stroke count ratios for assessment of right and left ventricular volume overload in children.

The ratio of left ventricular to right ventricular stroke counts measured by radionuclide angiography has been used in adults to estimate the severity of left-sided valvular regurgitation. The validation of this technique in children for assessment of right and left ventricular volume overload is reported herein. Radionuclide stroke count ratios in 60 children aged 0.5 to 19 years (mean 11) were determined. Based on their diagnoses, the patients were divided into 3 groups: (1) normal--40 patients with no shunts or valvular regurgitation, (2) left ventricular volume overload--13 patients with mitral or aortic regurgitation, or both, and (3) right ventricular volume overload--7 patients, 2 with severe tricuspid regurgitation, 3 with atrial septal defects, and 2 with total anomalous pulmonary venous drainage. The radionuclide stroke count ratio clearly differentiated these groups (p less than 0.05): normal patients had a stroke count ratio of 1.04 +/- 0.17 (mean +/- 1 standard deviation), the left ventricular volume overload group had a stroke count ratio of 2.43 +/- 0.86, and the right ventricular volume overload group had a stroke count ratio of 0.44 +/- 0.17. In 22 of our 60 patients, radionuclide stroke count ratios were compared with cineangiographic stroke volume ratios, resulting in a correlation coefficient of 0.88. It is concluded that radionuclide ventriculography is an excellent tool for qualitative and quantitative assessment of valvular regurgitation in children.

Adolescent↗

PubMed2005

Effects of gender, age, and body parameters on the ventricular volume of Korean people.

The purpose of this study was to measure the average ventricular volume of normal Koreans (aged in their 20s or 40s) and to analyze the effects of gender, age, and body parameters, such as height and weight on ventricle size. Magnetic resonance brain images were recorded for 118 people in their 20s (58 men, 60 women) and 100 in their 40s (41 men, 59 women). Using automatic and manual segmentation techniques, the volumes of the lateral and the third and fourth ventricles were calculated. To investigate the different and interactive effects of gender and age on ventricular volume, two-way analysis of variance (ANOVA) with gender and age as independent variables was carried out. Multiple regression analysis was used to investigate the effect of body parameters, such as height and weight according to gender on changes in ventricular volume. The average ventricular volume for people in their 20s was 16.2 cm3, and that for people in their 40s was 24.9 cm3. The average ventricular volume for men and women was 22.9 and 18.1 cm3, respectively. The average ventricular volume for men was greater than that for women, and that for people in their 40s was greater than that in their 20s. Enlargement of the ventricles on aging was more markedly observed in men than in women. There was a positive relationship between the body height and ventricular volume for men but not for women. There was no relationship between weight and ventricular volume for either men or women.

Adult↗

PubMed1986

A new three-dimensional echocardiographic method of right ventricular volume measurement: in vitro validation.

Right ventricular volume is difficult to measure accurately from one or two views because the complexity of right ventricular shape invalidates simplifying geometric assumptions. This article describes a new three-dimensional echocardiographic reconstruction method of right ventricular volume calculation, and reports the results of testing this method in vitro using normal animal hearts and pathologic specimens from infants and children who died with aortic stenosis or hypoplastic left heart. The correlation with reference volumes was excellent for both groups (r = 0.98, n = 25 for the animal data; r = 0.97, n = 15 for the human data). Given the calculated echocardiographic volume (Vc), the reference volume (Vr) was best estimated by the equation Vr = 1.16 Vc for the animal data and Vr = 0.92 Vc for the human data. Three-dimensional echocardiographic measurement of right ventricular volume is an accurate method that deserves further study and application in a clinical setting.

Animals↗

PubMed1984

[Usefulness of ECG gated cardiac computed tomography in measurement of left ventricular volume and wall thickness].

Electrocardiogram gated cardiac computed tomography (CT) was performed to evaluate the usefulness in the measurement of left ventricular volume and left ventricular wall thickness in 25 patients; five with angina pectoris, five with old myocardial infarction, eight with hypertrophic cardiomyopathy, four with dilated cardiomyopathy, and three healthy men. The left ventricular volume was calculated as the sum of the volume of each slice, which was area times thickness of the slice. The left ventricular wall thickness was measured in reconstructed short-axis view at the level of the mitral valve and papillary muscle. The left ventricular volume and left ventricular wall thickness determined by CT were compared with that by left ventriculography (LVG), and that by two-dimensional echocardiography (2 DE), respectively. The following results were obtained. There were good relationships between left ventricular volume, end-diastolic volume, end-systolic volume, ejection fraction by CT and those by LVG, but left ventricular volume by CT was smaller by about 20% than that by LVG. In the measurement of stroke volume, no relationship was recognized between CT and LVG. Concerning the measurement of left ventricular wall thickness, more available figures were obtained by CT than by 2 DE, particularly at the apical region, lateral wall, and posterior wall. In the other segments of the left ventricle, CT was also more suitable for the measurement of the wall thickness. Interventricular septal thickness was correlated between reconstructed short-axis view of CT (Y) and transverse view of CT (X), and the equations Y = 0.66X + 2.13 (r = 0.79) at the mitral valve level, and Y = 0.56X + 3.00 (r = 0.81) at the papillary muscle level were obtained. Therefore, reconstructed short-axis view should be used for the measurement of the left ventricular wall thickness not to overestimate the thickness.

Angina Pectoris↗

PubMed1998

[The compensation method for the effects of system resolution to the left ventricular volume measurements using QGS program].

We evaluated the accuracy of left ventricular volume calculations performed using the left ventricular function automatic analysis software (QGS program), which automatically extracts the left ventricular profile from ECG-gated myocardial SPECT data and then measures the left ventricular volume. We used a myocardial phantom for this evaluation. The results of our experiments showed that the left ventricular volume was underestimated by up to 13% as the SPECT spatial resolution deteriorated. To overcome this problem, we have developed a method for correcting the left ventricular volume measured by the QGS program according to the SPECT spatial resolution of the detectors. This new correction method permits the left ventricular volume of the phantom to be calculated with an error of less than 1.4%.

Cardiac Volume↗

PubMed2006

Ventricular volume and dementia progression in the Cardiovascular Health Study.

Elevated cerebral ventricular volume may be associated with dementia risk and progression. A fully-automated technique that agreed highly with radiological readings was used to estimate lateral ventricle volume on MR scans done at baseline in 1997-99 of 377 subjects in the Cardiovascular Health Study (CHS) from the Pittsburgh Center. 327 subjects were normal or diagnosed with mild cognitive impairment (MCI) at baseline and were evaluated 4 years later. Baseline ventricular volume was analyzed in multivariate models with age, gender, education level, presence and incidence of cerebral infarcts, and dementia category (normal, MCI, or dementia) at baseline and follow-up as fixed effects. Ventricular volume at baseline was significantly higher among subjects normal at baseline and demented 4 years later. Age, gender, education level, and dementia progression were significant factors affecting ventricular volume. Ventricular volume was higher in dementia compared to MCI, higher in MCI compared to controls, and higher in Possible-Alzheimer's-disease (AD) dementia compared to Probable-AD. Larger ventricles in healthy subjects may indicate susceptibility to, or progression of, dementia-related pathology.

Aged↗

PubMed2001

Normal myocardial function in severe right ventricular volume overload hypertrophy.

Severe left ventricular volume overloading causes myocardial and cellular contractile dysfunction. Whether this is also true for severe right ventricular volume overloading was unknown. We therefore created severe tricuspid regurgitation percutaneously in seven dogs and then observed them for 3.5-4.0 yr. All five surviving operated dogs had severe tricuspid regurgitation and right heart failure, including massive ascites, but they did not have left heart failure. Right ventricular cardiocytes were isolated from these and from normal dogs, and sarcomere mechanics were assessed via laser diffraction. Right ventricular cardiocytes from the tricuspid regurgitation dogs were 20% longer than control cells, but neither the extent (0.171 +/- 0.005 microm) nor the velocity (2.92 +/- 0.12 microm/s) of sarcomere shortening differed from controls (0.179 +/- 0.005 microm and 3.09 +/- 0.11 microm/s, respectively). Thus, despite massive tricuspid regurgitation causing overt right heart failure, intrinsic right ventricular contractile function was normal. This finding for the severely volume-overloaded right ventricle stands in distinct contrast to our finding for the left ventricle severely volume overloaded by mitral regurgitation, wherein intrinsic contractile function is depressed.

Animals↗

PubMed1988

Alterations in left ventricular compliance due to changes in right ventricular volume, pressure and compliance.

Because of ventricular interdependence, part of the measured left ventricular diastolic pressure can be attributed to the right ventricle. Therefore, we examined the hypothesis that left ventricular diastolic properties are modified by alterations in right ventricular compliance and pressure even without a change in right ventricular volume. To examine this hypothesis, the hearts were removed from six dogs, the coronary arteries perfused with cool cardioplegic solution, and the hearts submerged in cool cardioplegic solution. Balloons were inserted into each ventricle. Left ventricular pressure-volume curves were recorded and approximated by an exponential equation. With no fluid in the right ventricular balloon (control), the exponential coefficient and constant were 0.038 (SD 0.004) ml-1 and 2.38(0.75) mm Hg respectively. With right ventricular pressure held constant at 20 mm Hg, the exponential coefficient and constant were 0.035(0.002) ml-1 and 3.71(1.64) mm Hg (p less than 0.05 v control constant), respectively. With a fixed right ventricular volume, the exponential coefficient and constant were significantly different (p less than 0.05 v control values) at 0.040(0.006) ml-1 and 2.81(0.96) mm Hg, respectively. After decreasing right ventricular free wall compliance by injecting glutaraldehyde into the right coronary artery, the exponential coefficient and constant were significantly different (p less than 0.01 v control values) at 0.058(0.010) ml-1 and 1.86(0.60) mm Hg, respectively. Thus, even with a constant right ventricular pressure or volume, a significant upward shift in the left ventricular pressure-volume relation occurred. Decreasing right ventricular free wall compliance further increased left ventricular pressure. The results of these studies indicate that the diastolic properties of the left ventricle can be modified by changes in right ventricular pressure and compliance even without a change right ventricular volume. Thus indices of left ventricular diastolic properties may be altered by changes in the characteristics of the right ventricle.

Animals↗

PubMed2005

Cerebral ventricular volume assessment by three-dimensional ultrasonography.

We assessed ventricular volume with three-dimensional ultrasonography. The study group consisted of 54 infants admitted to the neonatal intensive care unit (NICU). Gestational age was 32.9+/-3.5 weeks and birth weight was 1774+/-623 g. To obtain images, the transducer was placed on the anterior fontanel. Sagittal sections were serially and automatically scanned from left to right. The angle of scanning was 60 degrees and five seconds were spent on e scanning. Two hundred fifty B-mode images were stored in the built-in computer for later retrieval. We chose the parasagittal sections from the midline to the lateral portion and traced manually an area of the lateral ventricle in each section at intervals of 1 mm. The built-in computer integrated them and measured the ventricular volume. The lateral ventricular size became larger during the first two weeks after birth. The left ventricle was larger than the right one. There was no correlation between lateral ventricular volume and birth weight. Our study shows the normal value of the lateral ventricular volume in neonates.

Cerebral Ventricles↗