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PubMed1997

Comparison of transthoracic three dimensional echocardiography with magnetic resonance imaging in the assessment of right ventricular volume and mass.

OBJECTIVE: Assessment of right ventricular volume and mass with three dimensional echocardiography and comparison with magnetic resonance imaging. METHODS: Measurements of right ventricular volumes performed on three dimensional datasets acquired by transthoracic echocardiography were compared to those obtained from magnetic resonance imaging performed on the same day. Volumes were measured in end systole and end diastole and ejection fraction calculated. Right ventricular mass was assessed in end systole. With both methods, the areas of a 2 mm thick slice of the ventricle were manually outlined and multiplied by the slice thickness to obtain slice volume. Slice volumes were multiplied by the number of measured slices to obtain the ventricular volume. PATIENTS: 16 patients were studied: three with normal hearts, three after surgical repair of coarctation of the aorta, nine following repair of tetralogy of Fallot, and one with Mustard atrial repair of complete transposition of the great arteries. RESULTS: Correlation between end diastolic volumes measured by both methods was r = 0.95 with limits of agreement ranging from -3.5 to 12.5 ml; correlation for end systolic volumes was r = 0.87 with limits of agreement between -4.0 and 16.4 ml; correlation for end systolic right ventricular mass was r = 0.81 with limits of agreement between -7.0 and 20.6 g. Interobserver variability ranged from 4.3% (range 0.2% to 9.3%) for end diastolic volume to 7.6% (1.8% to 15.4%) for mass measurements. CONCLUSIONS: With transthoracic three dimensional echocardiography, end diastolic right ventricular volumes can be assessed with acceptable accuracy in normal hearts and those with enlarged right ventricles, whereas the current method of three dimensional echocardiography is less good for end systolic volumes and not satisfactory for right ventricular mass measurements.

Adolescent↗
PubMed1988

Evaluation of right ventricular volumes measured by magnetic resonance imaging.

Right ventricular volumes were determined in 12 patients with different levels of right and left ventricular function by magnetic resonance imaging (MRI) using an ECG gated multisection technique in planes perpendicular to the diastolic position of the interventricular septum. Right ventricular stroke volume was calculated as the difference between end-diastolic and end-systolic volume and compared to left ventricular stroke volume and to stroke volume determined simultaneously by a classical indicator dilution technique. There was good agreement between right ventricular stroke volume determined by MRI and by the indicator dilution method and between right and left ventricular stroke volume determined by MRI. Thus, MRI gives reliable values not only for left ventricular volumes, but also for right ventricular volumes. By MRI it is possible to obtain volumes from both ventricles simultaneously in a noninvasive way and without exposing the patient to radiation.

Adult↗
PubMed2000

Radio frequency heating of chronic ovine infarct leads to sustained infarct area and ventricular volume reduction.

OBJECTIVE: Myocardial infarct expansion and subsequent left ventricular remodeling are associated with increased incidence of congestive failure and mortality. Collagen is known to denature and contract when heated above 65 degrees C. We therefore tested the hypothesis that radio frequency heating of myocardial infarct tissue with application of a restraining patch causes a sustained reduction in myocardial infarct area and left ventricular volume. METHODS: Thirteen male Dorset sheep underwent surgical coronary artery ligation. At least 14 weeks later, animals were randomized to either radio frequency infarct heating (95 degrees C) with application of a restraining patch or a sham operation. Before treatment, after treatment, and 10 weeks later, left ventricular volume was measured with transdiaphragmatic echocardiography and myocardial infarct area was measured with an array of sonomicrometry crystals. RESULTS: Radio frequency infarct heating causes an acute decrease of 34% (-215 +/- 82 mm(2); P =.0002) in infarct area at end-diastole that is maintained at 10 weeks (-144 +/- 79 mm(2); P =.0002). Radio frequency infarct heating causes a downward trend in end-diastolic left ventricular volume measured by echocardiography of 20% (-15.7 +/- 6.3 mL; P = no significant difference) and end-systolic left ventricular volume of 32% (-17.1 +/- 9.8 mL; P =.09), which are significantly decreased at 10 weeks (-13.6 +/- 22.3 mL; P =.007 and -15.3 +/- 21.9 mL; P =.008, respectively). Radio frequency infarct heating causes an acute improvement in systolic function (P <.001), a sustained increase in left ventricular ejection fraction (+0.11%; P =.06), and preserved stroke volume. CONCLUSION: Radio frequency heating of chronic left ventricular myocardial infarct causes a sustained reduction in infarct area and left ventricular volume. This technique may beneficially reverse infarct expansion and left ventricular remodeling after myocardial infarction.

Animals↗
PubMed1981

A method for the estimation of right ventricular volume by equilibrium radionuclide angiography.

To develop a method for estimating right ventricular volume and to assess right ventricular volume at rest, we studied 45 persons with equilibrium radionuclide angiography. The study group comprised 15 normal control subjects (5 with atypical chest pain and normal coronary angiograms) and 30 patients with coronary heart disease (CHD). Each coronary patient and 5/15 control subjects had both right and left heart catheterization studies with intracardiac pressure measurements within 24 hours of the radionuclide study. Using a previously described method for generating right ventricular volume curves, we used the counts at end-diastole, corrected for frame time, the total number of processed heart beats, and blood radioactivity to derive right ventricular end-diastolic volume units. All normal controls (group 1) had a right ventricular ejection fraction greater than or equal to 0.40, with a right ventricular volume index less than or equal to 5.8. The CHD patients consisted of two subgroups: group 2 (N = 20) and group 3 (N = 10), with right ventricular end-diastolic pressures less than 10 mm Hg and greater than or equal to 10 mm Hg, respectively. In group 2, 19/20 had a normal right ventricular ejection fraction, and 18 had a normal end-diastolic volume. In group 3, 4/10 patients had a depressed ejection fraction (less than .40) and 9/10 an increased end-diastolic volume. We conclude that right ventricular volume can be estimated with radionuclide angiography, and that dilation may precede depression of the right ventricular ejection fraction in some patients with CHD.

Angiography↗
PubMed2003

Influence of shunt type on ventricular volume changes in children with hydrocephalus.

OBJECT: The goal of this study was twofold: to investigate the change in ventricular volume in children with hydrocephalus in response to shunt placement and to assess the effects of two different valve types (Medium Pressure [MP] cylindrical valve and Delta [model 1.5] valve). METHODS: Ventricular volume was measured using segmentation techniques on computerized tomography scans and magnetic resonance images obtained in 40 children with hydrocephalus who ranged in age from 4 days to 16 years. Imaging was performed preoperatively and at 5 days and 3, 6, and 12 months postoperatively. The results were compared with measurements obtained in 71 healthy children ranging in age from 1 month to 15 years. Each ventricular volume that was measured was divided by the corresponding sex and age-related mean normal volume to calculate the "x normal" ventricular volume, indicating how many times larger than normal the ventricle was. The mean preoperative ventricular volume was 232 cm3 (range 50-992 cm3). The mean postoperative volumes were 147, 102, 68, and 61 cm3 at 5 days and at 3, 6, and 12 months posttreatment, respectively. The mean preoperative x normal ventricular volume was 14.5 (range 2.2-141.7), and the mean postoperative x normal volumes were 7.9, 5.6, 3.5, and 2.9 at 5 days and 3, 6, and 12 months postimplantation, respectively. The rate of volume reduction was consistently higher in patients who received the MP valve in comparison with those who received the Delta valve, both for new shunt insertions and for shunt revisions. The difference between the two valve groups did not reach statistical significance. Two patients in whom ventricular volumes increased during the study period experienced shunt obstruction at a later time. CONCLUSIONS: Preoperative ventricular volume in children with hydrocephalus can be up to 14 times greater than normal. In response to shunt placement, the ventricular volume continues to fall during the first 6 months after operation. The effect is more profound in children who receive the MP valve than in those who receive the Delta valve, although in this study the authors did not demonstrate statistical significance in the difference between the two valves. Nevertheless, this may indicate that the MP valve produces overdrainage in comparison with the Delta valve, even within the first few months after insertion. There is some indication that sequential ventricular volume measurement may be used to identify impending shunt failure.

Adolescent↗
PubMed1994

Right ventricular volume overload results in depression of left ventricular ejection fraction. Implications for the surgical management of tricuspid valve disease.

BACKGROUND: Right ventricular volume overload (RVVO) occurring in conditions such as Ebstein's anomaly may result in depression of left ventricular ejection fraction (LVEF). This study tests this hypothesis by measuring LVEF in 10 patients with RVVO due to tricuspid valve resection for isolated tricuspid valve endocarditis and in 10 age-matched healthy persons. METHODS AND RESULTS: When the modified Simpson's rule was applied to echocardiographic images, LVEF for patients with RVVO measured significantly lower than for age-matched healthy subjects (51 +/- 4% versus 60 +/- 4%, P < .0001). Depression of LVEF does not result simply from reduced venous return to the left ventricle, since left ventricular end-diastolic volume was not significantly different between patients with RVVO and age-matched healthy persons (84 +/- 26 versus 77 +/- 20 mL, NS). Possible explanations for the depression in LVEF may relate to the decreased relative contribution of left atrial systole to left ventricular filling (demonstrated by transmitral pulsed Doppler) or to the mechanical effects of ventricular septal paradox (demonstrated by the abnormal leftward ventricular septal flattening and increase in short-axis cavity eccentricity at end diastole, which returns to normal at end systole) in patients with RVVO. CONCLUSIONS: These findings suggest that surgical excision of the tricuspid valve results in isolated RVVO, which creates not only diastolic overload of the right heart but also depression of LVEF.

Adult↗
PubMed1985

Comparative angiographic right and left ventricular volumes.

Comparative angiographic right and left ventricular volumes and right and left ventricular ejection fractions have been reported in the same normal infants and children. This relationship was assessed in adult patients to determine if these pediatric observations persist in later life. Seventeen adults, who had both right and left ventricular angiograms and who had no demonstrable organic heart disease, were studied. Right ventricular end-diastolic volume ranged from 54 to 98 (76 +/- 14, mean +/- SD) cc/m2 and left ventricular end-diastolic volume ranged from 48 to 90 (70 +/- 12) cc/m2; p less than 0.03. Right ventricular end-systolic volume ranged from 22 to 47 (33 +/- 8.0) cc/m2 and left ventricular end-systolic volume ranged from 13 to 34 (22 +/- 5.3) cc/m2; p less than 0.00005. Calculated right ventricular stroke volume ranged from 31 to 60 (43 +/- 8.3) cc/m2 and left ventricular stroke volume ranged from 29 to 70 (48 +/- 11) cc/m2; p = NS. Calculated right ventricular ejection fraction ranged from 0.48 to 0.62 (0.57 +/- 0.04) and the left ventricular ejection fraction ranged from 0.57 to 0.84 (0.68 +/- 0.07; p less than 0.00005. Both right ventricular end-systolic and end-diastolic volumes were greater than left ventricular end-systolic and end-diastolic volumes. This resulted in decreased right ventricular ejection fraction compared to left ventricular ejection fraction. The difference between the two ventricles may be due to compliance, muscle mass, and anatomic configuration with a net result of one chamber more completely emptying than the other. Thus it appears that the relationships between right and left ventricular volumes noted in infancy and childhood persist in adult life.

Adolescent↗
PubMed1989

[Left ventricular volume characteristics and its relationship with right ventricle after repair of tetralogy of Fallot].

In order to study the left ventricular volume characteristics and right ventricular influence on left ventricle, cardiac catheterization and biplane cineangiography was performed in 61 patients after repair of tetralogy of Fallot. Preoperative left ventricular volume size was also measured in 25 patients. Postoperative left ventricular end-diastolic volume index (LVEDVI) was 93 +/- 22 ml/m2 (mean +/- standard deviation) and it was 140 +/- 29% of normal left ventricular volume. Left ventricular ejection fraction (LVEF) was 60 +/- 6%. Left ventricular size significantly increased from 109 +/- 25% to 140 +/- 23% of normal by corrective surgery (p less than 0.001). Left ventricular volume characteristics are correlated with right ventricle. LVEDVI increased with increasing right ventricular end-diastolic volume index (RVEDVI) and decreased right ventricular ejection fraction (RVEF). LVEDVI (ml/m2) = 60 + 0.29 RVEDVI (ml/m2), r = 0.52, p less than 0.001, LVEDVI (ml/m2) = 141 - 0.90 RVEF (%), r = -0.30, p less than 0.02. LVEF decreased with increasing RVEDVI and decreased RVEF. LVEF (%) = 68 - 0.075 RVEDVI (ml/m2), r = -0.51, p less than 0.001, LVEF (%) = 43 + 0.32 RVEF (%), r = 0.40, p less than 0.001. On the contrary there was no relationship between right ventricular volume characteristics and right ventricular systolic pressure. There were two cases whose LVEF was less than 50%. In one case right ventricular systolic pressure was as high as 98 mmHg. In the other patient RVEDVI was 299 ml/m2 (453% of normal right ventricular volume) because of severe pulmonary regurgitation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

Left ventricular volume reduction and reconstruction in ischemic cardiomyopathy.

BACKGROUND: Ischemic cardiomyopathy can be the result of large or small myocardial infarctions or due to myocardial hibernation. Patients with an end-systolic volume index >100 mL¿m2 do not benefit from revascularization alone and require an operation that reduces ventricular volume. Various approaches to reduce ventricular volume have been described. We applied several of these techniques in patients with end-stage ischemic cardiomyopathy. METHODS: Forty eight patients with end-stage ischemic cardiomyopathy (Class III-IV) underwent left ventricular volume reduction operations with coronary revascularization and mitral valve repair or Alfieri valvoplasty. Fourteen patients underwent interpapillary resections, 22 anterior resections, 4 posterior resections, 2 anterior and posterior resections, and 6 patients reduction of left ventricular volume with endocavitary patches. RESULTS: All the techniques used improved left ventricular function. Analysis of mortality revealed that extensive resections (interpapillary, anterior, and posterior resection) had a 43% mortality. However, a limited resection or a ventricular reconstruction with an endocavitary patch had only a 12.5% mortality. When we changed our approach to a more conservative one, mortality was reduced from 26% the first 12 months to 13% in the last 15 months of the study. CONCLUSIONS: Ischemic cardiomyopathy has a poor prognosis if the end-systolic volume index exceeds 100 mL/m2. Various procedures exist to reduce left ventricular volume. Extensive ventricular resections improve ventricular function, but have a high mortality. This led us to use other methods of ventricular volume reduction such as more conservative resections combined with left ventricular reconstructions or ventricular volume reduction with endocavitary patches. Mortality was reduced significantly by this approach. The patients that survived have remained Class I-II in a follow-up that extends up to 30 months. Surgical therapy of Class III-IV ischemic cardiomyopathy is feasible, but aggressive ventricular resections have a high mortality. We advocate a more reconstructive approach with limited or no ventricular resection.

Aged↗
PubMed1989

Absence of left ventricular volume loading in infants with coarctation of the aorta and a large ventricular septal defect.

Clinical characteristics and angiographic ventricular volume data were obtained in 25 infants aged 1 to 66 days who presented with coarctation of the aorta, ventricular septal defect and congestive heart failure to determine if left ventricular volume loading was present and if there were hemodynamic or volumetric variables that were predictive of operative mortality in this group. Pulmonary to systemic flow ratio averaged 2.8 +/- 0.8 and right ventricular/left ventricular peak pressure ratio was 0.96 +/- 0.12. Left ventricular end-diastolic volume averaged 116 +/- 49% of normal and was less than the investigators' lower limit of normal in 5 (20%) of 25 patients. In contrast, right ventricular end-diastolic volume, measured in eight patients, averaged 173 +/- 47% of normal and was greater than the investigators' upper limit of normal in seven (88%) of eight. Left ventricular ejection fraction averaged 0.47 +/- 0.17 and was below normal (less than 0.55) in 14 (58%) of 24 patients. Preoperative volume and ejection fraction data did not differ in infants with coarctation plus ventricular septal defect and a similar group of 19 infants with isolated coarctation. Abnormal left ventricular operative volume distensibility was inferred by normal or decreased left ventricular end-diastolic volume and increased left ventricular end-diastolic pressure (greater than 12 mm Hg) in 12 (55%) of 24 patients. Early plus late mortality was related to left ventricular size: 3 of 5 patients with a small left ventricular end-diastolic volume died, compared with only 4 of 20 with a normal or increased volume (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Abnormalities, Multiple↗
PubMed1977

Pre and postoperative ventricular function in infants and children with right ventricular volume overload.

Hemodynamic and ventricular volume parameters were evaluated in 21 patients (24 studies) with total anomalous pulmonary venous return (TAPVR), 11 patients with secundum atrial septal defect (ASD), and eight patients who had complete correction of TAPVR or ASD. Right and left ventricular (RV and LV) volume parameters were calculated according to Simpson's rule and the area length methods, respectively. In infants with TAPVR, RV end-diastolic volume was larger than normal, but RV ejection fraction was significantly less than normal. LV end-diastolic volume and LV ejection fraction were all less than normal in infants with or without pulmonary hypertension, and the values did not correlate with the cardiorespiratory symptoms. In children with TAPVR or ASD, RV end-diastolic volume and output were higher than normal preoperatively and decreased to normal or near normal values postoperatively. The data suggest that pulmonary venous obstruction and/or RV failure are responsible for cardiorespiratory symptoms in infants with TAPVR and early surgical intervention is recommended in these patients.

Blood Volume↗
PubMed1997

Echocardiographic Assessment of Right Ventricular Volume and Function.

Echocardiographic evaluation of right ventricular volume and function has become a subject of growing interest with the increasing awareness of the important role of the right ventricle in the entire circulation. However, the anatomically complex and load-dependent shaped right ventricle shape is difficult to describe by a simple geometric figure and its volume and function are, therefore, difficult to assess in a simple manner. A number of echocardiographic methods for evaluating right ventricular volume and function have emerged; to date, however, their quantification remains a clinical challenge. The major goal is to develop a reproducible method that will allow for quantitative comparisons between patients or serially within a given patient. This discussion examines the available methods with specific attention to their reliability and limitations. Visual inspection or measurement of single plane indices is limited by their lack of standardization and failure to describe the entire right ventricle. Simpson's rule requires computer calculations and assumes an elliptic symmetry present in the left, but not the right ventricle. Application of the area-length method to the subcostal outflow tract and apical four-chamber views is a particularly practical current approach. Three-dimensional echo reconstruction, which eliminates the need for geometric assumptions and individual standardized views, although only in its infancy, promises to be the most accurate method for right ventricular volume calculation and in the future should emerge as the standard for research and many clinical applications.

Journal Article↗
PubMed1989

[Right ventricular volumes and ejection fraction estimated by two-dimensional echocardiography].

UNLABELLED: The right ventricular volumes and ejection fraction (RVEF) obtained from two-dimensional echocardiography and from right ventricular angiography were compared in 20 patients with congenital heart disease. Single plane area-length method of apical four-chamber view was used to estimate echocardiographic right ventricular volumes and single plane right anterior oblique projection was used to calculate angiographic right ventricular volumes. The results showed that right ventricular volumes estimated by echocardiography correlated highly with that calculated by angiography, the correlation coefficients of end-diastolic volume, end-systolic volume and stroke volume were 0.983, 0.976, 0.973 respectively. Echocardiographic RVEF also correlated strongly with angiographic RVEF (r = 0.992, P less than 0.001), and there were no significant difference between the two methods (P greater than 0.05). CONCLUSION: two-dimensional echocardiography can be used to accurately estimate right ventricular volumes and ejection fraction.

Adolescent↗
PubMedDate not supplied

[Quantification of ventricular volume. Comparative study of 2 angiographic methods].

The left ventricular volumes and the ejection fraction were measured in 78 patients who had different cardiopathies, in more than 50% the diagnosis of ischaemic heart disease of coronary origin was made. Every cineangiocardiogram was carefully observed to find those who had normal and abnormal ventricular contraction. The ventricular volumes were calculated by the Green method and afterwards the results were compared with the values obtained by the Sandler and Dodge method. A very good correlation was found between the two methods and we got the conclusion that although it is preferable to calculate ventricular volumes and the ejection fraction with biplane method or with Saudler and Dodge's monoplane, the results of the present work permit the use of Green's method in calculating ventricular volumes and obtaining confident results, independently of the ventricular contraction type with the exception of those who have large ventricular aneurisms.

Angiocardiography↗
PubMed1997

Right and left ventricular volume and ejection fraction by tomographic gated blood-pool scintigraphy.

UNLABELLED: Tomographic techniques separate overlying structures, permitting measurements of absolute ventricular volumes. The purpose of this study was to determine absolute right and left ventricular volume and ejection fraction measurements with tomographic gated equilibrium blood-pool scintigraphy (TMUGA) compared to MRI and conventional planar scintigraphy. METHODS: Eighteen patients were studied. Ventricular volumes for TMUGA and MRI were calculated by modified Simpson's rule. TMUGA regions were defined by constraints including phase analysis, intensity threshold and visual inspection. MRI studies were acquired with a fast gradient-echo, ECG-gated, breath-hold technique and boundaries were defined by a semiautomated contour method. Conventional gated first-pass radionuclide angiography (FP) and planar gated equilibrium blood-pool scintigraphy (PMUGA) were performed for RV EF and LV EF, respectively. RESULTS: TMUGA absolute right ventricular volumes showed excellent-correlation with MRI for both right ventricular volumes (r = 0.91, slope = 0.90, s.e.e. = 15.7) and left ventricular volumes (r = 0.96, slope = 0.88, s.e.e. = 18.2). For left ventricular ejection fraction, TMUGA also showed excellent correlation with MRI (r = 0.94, slope = 1.10, s.e.e. = 9.0) and planar MUGA (r = 0.97, slope = 1.23, s.e.e. = 6.2). For right ventricular ejection fraction, TMUGA showed good correlation with both MRI (r = 0.88, slope = 0.79, s.e.e. = 6.0) and first-pass planar scintigraphy (r = 0.86, slope = 1.2, s.e.e. = 7.9). CONCLUSION: Tomographic gated blood-pool scintigraphy absolute right and left ventricular volumes and ejection fractions show good correlation with accepted techniques. Further studies are necessary to define the reproducibility of this method.

Cardiac Volume↗
PubMed1986

Right ventricular volume determination in isolated human hearts.

For right ventricular volume determination a new method was developed that took into account right ventricular imaging by apical two-dimensional echocardiography in the four- and two-chamber views. Right ventricular volume was calculated by subtraction of the partial volume of the left ventricle and interventricular septum from the total heart volume of the right and left ventricles including the interventricular septum. Accuracy of the subtraction method was evaluated in isolated human hearts by two-dimensional echocardiography and radiography. Regression analysis indicated that for both the echocardiographic and radiologic procedures, the subtraction method gave the best correlation with the right ventricular filling volume. The correlation coefficients obtained using the echocardiographic procedure were 0.964, 0.848, and 0.851 for the subtraction method, pyramid method, and Simpson's rule method, respectively. For the radiographic procedure, these values were 0.946, 0.860, and 0.872. Percentage difference calculations indicated that the subtraction method systematically underestimated (-7.4%) the filling volume in the echocardiographic procedure, but this was not seen with the radiologic procedures. The random error associated with the subtraction method was only half (10.5%, 13.9%) of that seen with the other two methods in both the echocardiographic and radiological procedures. These results indicate that right ventricular volume determination by the subtraction method seems to be suitable for apical two-dimensional echocardiography and is more accurate than the pyramid method and Simpson's rule method.

Echocardiography↗