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PubMedDate not supplied

Evaluation of right-ventricular function by Doppler echocardiography in patients with chronic respiratory failure.

In patients with chronic respiratory failure, right-ventricular function was non-invasively evaluated by Doppler echocardiography. A total of 31 patients (16 men, 15 women; mean age 65.8 +/- 7.12 years) with pulmonary tuberculosis sequelae who had received home oxygen therapy during the preceding 6 or more months, were studied. Right-ventricular inflow and outflow waveforms were recorded, and right-ventricular function was evaluated using a new Doppler index combining systolic and diastolic function. On continuous wave Doppler echocardiography, estimated systolic pulmonary arterial pressure was calculated from the gradient between the right atrium and right ventricle. There was no correlation between the new Doppler index and systolic pulmonary arterial pressure, and some patients showed high index values despite low systolic pulmonary arterial pressure. The new Doppler index facilitated evaluation of ventricular function irrespective of right-ventricular afterload.

Aged↗
PubMed1988

Influence of acute preoperative hemodilution on right ventricular function.

In a randomized study, the effects of acute, preoperative hemodilution (HD) (12 mL/kg) on right ventricular function were investigated in coronary artery surgery patients with reduced left ventricular function (ejection fraction < 50%) and significant stenosis of the right coronary artery (RCA). Blood was replaced either by hydroxyethyl starch (HES) solution (ratio 1:1; HD-HES; n = 15) or by Ringer's lactate, (RL) (ratio 2.5:1; HD-RL; n = 15). Fifteen comparable patients without HD served as a control group. Besides commonly measured pressure parameters, right ventricular end-diastolic volume (RVEDV), right ventricular end-systolic volume (RVESV), and right ventricular ejection fraction (RVEF) were measured using a computerized thermodilution technique before and after HD, as well as after extracorporeal circulation (ECC). Right ventricular systolic function, expressed as RVEF, was not changed significantly by HD in any group. Furthermore, right ventricular function of the hemodiluted patients was not impaired by the subsequent ECC procedure. None of the traditionally measured parameters could be correlated significantly to the right ventricular thermodilution variables. It is concluded that moderate HD does not change right ventricular function even when the RCA is significantly stenosed.

Aged↗
PubMed1994

Determinants of the rate of right ventricular pressure rise by Doppler echocardiography: potential value in the assessment of right ventricular function.

Tricuspid regurgitation (TR) is common and the rate of right ventricular (RV) pressure rise in early systole can be obtained from the TR velocity profile. Right ventricular function has important implications in patients with valvular heart disease. Fifty five patients with mild or moderate TR and a wide range of pulmonary artery (PA) pressures were studied. The RV dP/dt was obtained as the ratio of the calculated rise in RV pressure from 0.5 m/s to 1.5 m/s of the TR velocity signal (8 mmHg based on simplified Bernoulli equation) to the time taken for this change. The RV dP/dt correlated positively with PA systolic pressure (r = 0.73, p < 0.001), tricuspid anular plane systolic excursion which is an echocardiographic index of RV ejection systolic function (r = 0.45, p < 0.001) and left ventricular (LV) fractional shortening (r = 0.40, p < 0.01). Multivariate analysis showed that all these three parameters independently influenced RV dP/dt (multivariate R = 0.83) accounting for 69% of its variability. In conclusion, it is suggested that right ventricular dP/dt is easily obtainable from Doppler TR velocity signal. It is influenced independently in a positive manner by PA systolic pressure and RV and LV systolic function. Despite its predominant dependence on PA systolic pressure, it may give useful insight into RV systolic function for a given level of PA pressure. It may also be useful for longitudinal follow up of the RV function in patients with heart disease.

Adult↗
PubMedDate not supplied

Right ventricular function in congenital heart disease: pressure and volume overload lesions.

The right ventricle is often subject to both pressure and volume overload in congenital heart disease. Evaluating right ventricular function in both the native lesion and after surgery in light of these loading conditions, presents a unique challenge for investigators studying these misshapen hearts. The purpose of this article is to briefly delineate what is generally known about right ventricular function in congenital heart disease and to touch on some noninvasive imaging modalities which have helped shed some light on this matter.

Animals↗
PubMed1998

Evaluation of Right Ventricular Function During CABG: Transesophageal Echocardiographic Assessment of Hepatic Venous Flow Versus Conventional Right Ventricular Performance Indices.

The vulnerability of right ventricle (RV) to ischemic insult during cardiac surgery is being increasingly recognized. This study aims to evaluate right ventricular function by measuring hepatic venous flow (HVF) patterns using intraoperative transesophageal echocardiography (TEE), and to compare HVF with other conventional two-dimensional echocardiographic and hemodynamic indices of RV performance. Patients undergoing coronary artery bypass grafting (CABG) were studied intraoperatively using a multiplane dual frequency 5/3.7-MHz phased array transducer, a pulmonary artery catheter, and an arterial catheter. Peak velocities and time velocity integrals of HVF pattern were studied. Peak systolic-diastolic ratio (S/D) of biphasic HVF and reverse flow ratio (% reverse flow/forward flow = % RF/FF) were also examined. Two-dimensional echocardiographic measurements included: (1) transverse plane long-axis (LA) and short-axis (SA) planimetered areas expressed as ratios; LA maximum major and minor-axis shortening fractions; (2) tricuspid annular plane systolic excursion (TAPSE) ratio. All data were obtained after induction of anesthesia (stage 1), after sternotomy (stage 2), aftercardiopulmonary bypass (CPB) (stage 3), and after sternal closure (stage 4). Pre-CPB all 35 patients had biphasic HVF by Doppler. In 31 patients peak S/D ratio was >1. After CPB, there was significant reduction in systolic forward flow (S wave), along with an increase in late systolic reverse flow (V wave) and an increase in % RF/FF. At this stage TAPSE ratio decreased (pre CPB 0.33 +/- 0.12 vs post CPB 0.30 +/- 0.11). There was simultaneous decrease in 2-D long-axis LA (pre CPB 0.52 +/- 0.11 vs post CPB 0.31 +/- 0.01) and max major axis LA (pre CPB 0.38 +/- 0.06 vs post CPB 0.31 +/- 0.11). Max major axis LA correlated significantly with changes in right atrial pressure (P < 0.05). Tricuspid annular motion diminished significantly at sternal closure. Hepatic systolic forward flow and TAPSE ratio can be an indirect measure of RV systolic functions in correlation with maximum major axis LA changes. Evaluation of HVF provides unique insight into right ventricular dynamics. It is an easy, safe, and sensitive method for assessing RV functions intraoperatively.

Journal Article↗
PubMed1993

Effects of chronic right ventricular pressure overload on left ventricular diastolic function.

Right ventricular (RV) function influences left ventricular (LV) diastolic filling in various clinical and experimental models. The influence of RV systolic function on LV diastolic performance was examined in patients with severe RV pressure overload. Eighty-two patients with pulmonary vascular or parenchymal disease who were referred for heart-lung or lung transplant evaluation were studied. All patients had radionuclide angiography from which RV ejection fraction and LV peak filling rate were measured. Most patients (n = 51) had right-sided cardiac catheterization. In 24 patients (group 1), RV ejection fraction was < 30%, whereas in 58 (group 2), it was > 30%. Mean pulmonary artery pressure was greater in group 1 than in 2 (57 +/- 16 vs 34 +/- 20 mm Hg; p < 0.0001). Pulmonary artery wedge pressure was also greater in group 1 than in 2 (14 +/- 9 vs 7 +/- 2 mm Hg; p < 0.0001), whereas peak filling rate was decreased (2.16 +/- 0.88 vs 2.97 +/- 0.79 end-diastolic volumes/s; p < 0.0001). LV ejection fraction was normal in all patients. There was an inverse relation between RV ejection fraction and pulmonary artery wedge pressure (r = 0.45; p < 0.001; SEE 5.3). There was a direct relation between RV ejection fraction and LV peak filling rate (r = 0.49; p < 0.0001; SEE 1.34). In patients with RV pressure overload, RV systolic function is related to LV diastolic performance. This effect is most likely mediated by ventricular interdependence.

Adolescent↗
PubMed1993

[The effect of continuous positive pressure in the nasal airway on the right ventricular function in obstructive apnea sleep syndrome].

BACKGROUND: The aim of this study was to evaluate the right ventricular function in the obstructive apnea sleep syndrome (OSAS) and to determine the effect of the continuous use of a continuous positive pressure nasal device on the airway (CPSPn) produces on this aspect of the disease. METHODS: Forty patients were diagnosed of OSAS by study of spontaneous night sleep. A functional respiratory study was performed in all the patients as was a calculation of the index of body mass (IBM) and isotopic ventriculography for the calculation of the right and left ventricular ejection fractions (RVEF and LVEF). Twenty-six patients were followed after 8.4 +/- 3.3 months of home treatment with CPAPn in which these studies were repeated. RESULTS: Twenty-four of the 40 patients (60%) had RVEF lower than 0.45. These 24 patients had paO2 in vigil state (69.9 +/- 13.6 mmHg) than those with a normal RVEF (80.1 +/- 8.7 mmHg) (p < 0.05). After treatment with CPAPn an elevation was observed in the RVEF in the group which was followed. This increase was significant in the subgroup sharing low RVEF (n = 16) prior to starting treatment upon passing from 0.39 (+/- 0.02) to 0.45 (+/- 0.04) (p < 0.001). CONCLUSIONS: Right ventricular dysfunction in frequent in patients with the obstructive apnea sleep syndrome and is more frequent in patients maintaining hypoxemia in vigil. The continual use of continuous positive pressure in the nasal airway produces improvement in right ventricular function particularly in those in whom this was most disturbed.

Adult↗
PubMed1997

Right ventricular function before and after percutaneous balloon mitral valvuloplasty.

Aim of this study was to evaluate right ventricular performance in patients with mitral stenosis and its modification by balloon valvuloplasty. Right ventricular volumes of 24 patients with postrheumatic mitral stenosis were determined by thermodilution 1 or 2 days before and 1 or 2 days after valvuloplasty. Right ventricular ejection fraction at rest was 43 (36-47)% (median and interquartile range). Right ventricular end-diastolic volume was 100 (86-119) ml/m2. Supine bicycle exercise (50 Watt) reduced right ventricular ejection fraction to 30 (29-37)% (P < 0.0001) and increased right ventricular end-diastolic volume to 124 (112-141) ml/m2 (P < 0.0001). At rest, right ventricular ejection fraction correlated inversely with pulmonary vascular resistance (r = -0.64, P < 0.0001), while no significant correlation with mitral valve area was found. Valvuloplasty increased right ventricular ejection fraction at rest to 48 (44-50)% (P < 0.005), and during exercise to 42 (38-45)% (P < 0.0001). This improvement of right ventricular ejection fraction correlated inversely with the value of this parameter before valvuloplasty (r = -0.88, P < 0.0001) and with the gain in stroke volume (r = 0.57, P < 0.01). The right ventricular function curve, disturbed before commissurotomy, was reestablished by the procedure. In conclusion, at the here investigated stage of mitral stenosis right ventricular function is reversibly impaired. This is predominantly caused by the hemodynamic consequences of the valvular defect and not by an impairment of right ventricular myocardial function.

Adult↗
PubMed1990

Depression and recovery of right ventricular function after cardiopulmonary bypass.

Transient left ventricular dysfunction is commonly described in association with cardiopulmonary bypass (CPB). We evaluated changes in right ventricular (RV) function after elective cardiac surgery in 24 patients with normal preoperative cardiac function. In all, irrespective of distribution of coronary artery disease or use of pharmacologic support, a transient depression of RV systolic function with respect to both preinduction and initial postoperative (Postop) values occurred 262 +/- 116 min post-CPB as represented by a decrease in RV stroke volume index (25.0 +/- 1.7 vs. 33.4 +/- 1.9 ml/m2 Postop) and RV ejection fraction (31.0 +/- 2.2 vs. 45.6 +/- 2.5% Postop), and an increase in RV end-systolic and end-diastolic volume indices. This depression responded readily to pharmacologic therapy within 2 h, resolved within 24 h, and had no adverse consequences in these otherwise healthy patients. Further studies are needed to identify the cause of this phenomenon and its importance in patients with preexisting cardiac dysfunction.

Aged↗
PubMed1992

RETRACTED: Right ventricular function in patients with aortic stenosis undergoing aortic valve replacement.

The effects of aortic stenosis (AS) on right ventricular function during cardiac surgery are not fully understood. Forty patients undergoing aortic valve replacement with either a systolic transvalvular gradient of less than 100 mm Hg (82.1 +/- 5.5 mm Hg; group 1, n = 20) or greater than 120 mm Hg (131.1 +/- 6.9 mm Hg, group 2, n = 20) were investigated with regard to right ventricular function in the perioperative period. Right ventricular ejection fraction (RVEF), right ventricular end-systolic volume (RVESV), and right ventricular end-diastolic volume (RVEDV) were measured by means of the thermodilution technique. Before cardiopulmonary bypass (CPB), RVEF was significantly lower in group 2 patients (34% +/- 6%) than in group 1 (45% +/- 5%). After CPB, RVEF increased significantly in group 2 (28% +/- 4% to 49% +/- 5%), and no further differences were noted between the groups. In the patients with a higher systolic transvalvular gradient, RVEDV and RVESV were lower at the start of surgery, but increased after opening the pericardium. Cardiac index was also lower in these patients. Pericardiotomy resulted in a decrease in right ventricular end-systolic pressure (RVESP) only in the patients of group 2. In these patients more epinephrine was necessary to maintain stable hemodynamics during the post-bypass period. It is concluded that patients with AS are at risk of reduced right ventricular function when the systolic transvalvular pressure gradient is more than 120 mmHg. Knowledge of the complex interaction between the two sides of the heart may enable anesthesiologists to optimize management during the perioperative period.

Aged↗
PubMedDate not supplied

Right ventricular function and failure: a review.

The importance of right ventricular (RV) function in maintaining global cardiac performance is the focus of this discussion. The physiological determinants of normal right ventricular function will be discussed, with particular emphasis on the afterload and contractility characteristics of the right ventricle. Numerous clinical conditions have been shown to affect RV performance. These conditions include positive-pressure ventilation, ischemia, pulmonary hypertension, and cardiac surgery. Present methods for the perioperative evaluation of RV function include angiography, radionuclide techniques, thermodilution techniques, echocardiography, and magnetic resonance imaging. Traditional modalities for the treatment of RV dysfunction consist of pharmacological interventions (i.e., vasodilators and inotropes) and/or mechanical assist devices. Newer pharmacological strategies for the treatment of RV failure and associated pulmonary hypertension include the phosphodiesterase fraction III inhibitors and the prostaglandins, specifically PGE1. In summary, the accurate evaluation of perioperative RV performance combined with new treatment options will ensure maximal preservation of RV performance.

Angiography↗
PubMed2006

Do calcium sensitizers affect right ventricular functions in patients with chronic heart failure?

Calcium sensitizers also improve cardiac function by increasing the contraction of the myocardium without significantly increasing intracellular calcium levels. Although right ventricular function is an important role for better cardiac global function, there is no study about effects of levosimendan on right ventricular function measured by tissue Doppler imaging. The aim of the present study was to evaluate changes of myocardial properties in patients with idiopathic dilated cardiomyopathy using tissue Doppler imaging after levosimendan infusion. This tissue Doppler study shows that levosimendan also affects myocardial especially systolic waves of right ventricle and those of left ventricle.

Adult↗
PubMed2005

Intraatrial repair of transposition of the great arteries: use of MR imaging after exercise to evaluate regional systemic right ventricular function.

PURPOSE: To prospectively assess regional systemic right ventricular (RV) function at rest and in response to exercise by using magnetic resonance (MR) imaging in patients who have undergone surgical correction at the atrial level for transposition of the great arteries (TGA). MATERIALS AND METHODS: Informed consent was obtained, and the medical review board approved this study. In 25 adult patients (mean age, 25.8 years +/- 4.7 [standard deviation]; 13 men) who had undergone correction for TGA (23.4 years +/- 4.9 after surgery) and 11 healthy volunteers (mean age, 27.4 years +/- 2.7; six men), systemic ventricular function was assessed with MR imaging (turbo field echo-planar imaging) at rest and during supine bicycle exercise. Regional wall thickness and wall thickening of the systemic RV were assessed and compared with those of the left ventricle in healthy volunteers by two investigators working together. Regional wall parameters were calculated by using the three-dimensional centerline method. Independent-samples t test and paired-samples t test were used for statistical analysis. RESULTS: Ejection fraction of the systemic RV did not increase after exercise (56% +/- 8 at rest to 55% +/- 7 after exercise, P = .196). Mean RV wall thickening was impaired in patients with TGA at all levels both at rest and in response to exercise (P < .05). Moreover, the free wall and the anterior wall of the systemic RV had a smaller end-systolic thickness and a diminished thickening at rest and after exercise compared with findings in the normal left ventricle (P < .05). CONCLUSION: The systemic RV of patients after intraatrial correction for TGA reveals regional functional disturbances at rest and in response to exercise.

Adult↗
PubMed1985

Right ventricular function at rest and during exercise in aortic and mitral valve disease.

Right ventricular function at rest and during exercise was examined in a group of patients with symptomatic aortic or mitral valve disease, or both. The right ventricular ejection fraction was less than 45% in 22 of 36 patients at rest and in 12 of 17 subjects at symptom-limited, supine bicycle exercise. The right ventricular ejection fraction failed to increase more than 5% with exercise in 17 of 17 patients. The central venous pressure was greater than 5 mm Hg in 18 of 36 patients at rest and in 13 of 17 patients at maximal exercise. There was a significant inverse relation between rest right ventricular ejection fraction and mean pulmonary artery pressure (r = -0.47, p less than 0.05) and between rest right ventricular ejection fraction and mean central venous pressure (r = -0.39, p less than 0.05). There was no significant relation between the exercise values of these variables. In individual patients, the changes in right ventricular ejection fraction and pulmonary artery pressure with graded exercise were nonlinear. It is concluded that right ventricular function is not a simple function of pulmonary artery pressure at rest or during exercise in aortic and mitral valve disease. Less than one-quarter of the variation in right ventricular ejection fraction at rest can be explained by the variation in pulmonary artery pressure, and the finding of a normal (greater than 45%) right ventricular ejection fraction does not reliably exclude the possibility of pulmonary hypertension in a patient with valvular heart disease.

Adult↗