Contraction Pattern of the Systemic Right Ventricle

Pettersen, Eirik; Helle-Valle, Thomas; Edvardsen, Thor; Lindberg, Harald; Smith, Hans‐Jørgen; Smevik, Bjarne; Smiseth, Otto A.; Andersen, Kai

doi:10.1016/j.jacc.2007.02.062

Cited by 260 publications

(72 citation statements)

References 21 publications

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“…In addition to TV competence, the ultimate fate of RV function in CCTGA was influenced by several factors, including adaptability to the systemic afterload,31 myocardial perfusion,32, 33, 34, 35 and arrhythmias 36. Significant individual differences have been noticed in the long‐term outcomes of these patients.…”

Section: Discussionmentioning

confidence: 99%

Long‐Term Outcomes of Tricuspid Valve Surgery in Patients With Congenitally Corrected Transposition of the Great Arteries

Deng

Tang

et al. 2018

JAHA

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BackgroundValvuloplasty is generally considered unsuccessful in patients with congenitally corrected transposition of the great arteries. Optimal timing of tricuspid valve surgery in these patients is crucial.Methods and ResultsWe retrospectively reviewed 57 patients with congenitally corrected transposition of the great arteries undergoing tricuspid valve surgery at our institution. Eleven patients had tricuspid valve plasty and 46 had tricuspid valve replacement. Mean duration of follow‐up was 7.4±5.5 years in the group of tricuspid valve plasty and 5.6±3.6 years in the group of tricuspid valve replacement, respectively (P=0.33). For the total of 57 patients, estimates of 1‐, 5‐, and 10‐year survival or freedom from transplantation were 96.4%, 91.6%, and 75.6%, respectively. Late right ventricular ejection fraction of most patients (90%) remained preserved (≥40%) during the follow‐up. In a highly selected group of tricuspid valve plasty recipients, although long‐term survival and right ventricular function were similar compared with tricuspid valve replacement, recurrent tricuspid regurgitation was observed in 60% of these patients. Multivariate Cox regression analysis identified preoperative right ventricular end‐diastolic dimension (1‐cm increment; harzard ratio, 3.22; P=0.02) as an independent predictor of postoperative mortality or need for transplantation. Patients undergoing surgery with a right ventricular end‐diastolic dimension ≥60 mm had a significant lower survival rate compared with those with a right ventricular end‐diastolic dimension <60 mm (P=0.003).ConclusionsTricuspid valve surgery in patients with congenitally corrected transposition of the great arteries could yield satisfactory long‐term outcomes. Recurrent tricuspid regurgitation was frequently observed in tricuspid valve plasty recipients. Preoperative right ventricular end‐diastolic dimension was a risk factor for late mortality and surgery should be performed before cardiac enlargement and dysfunction for best outcomes.

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Section: Discussionmentioning

confidence: 99%

Long‐Term Outcomes of Tricuspid Valve Surgery in Patients With Congenitally Corrected Transposition of the Great Arteries

Deng

Tang

et al. 2018

JAHA

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“…Interestingly, in the systemic RV [100], it has been reported a shift in the ventricular free wall from longitudinal to circumferential shortening when compared with the normal RV but without any change in septal shortening. The systemic RV is more similar to the normal LV, which has a well-developed middle circumferential layer.…”

Section: Strain Rate Imaging (Sri or 1d-strain)mentioning

confidence: 99%

“…The assessment of RV longitudinal strain from the apical views (Figs. 3, 4) is feasible in the clinical setting [98][99][100]. In normal subjects, RV longitudinal velocities show a baso-apical gradient with higher velocities at the base and appeared consistently higher when compared to the LV [98].…”

Section: Strain Rate Imaging (Sri or 1d-strain)mentioning

confidence: 99%

Do we have two hearts? New insights in right ventricular function supported by myocardial imaging echocardiography

Vitarelli

Terzano

2009

Heart Fail Rev

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RV performance is difficult to evaluate, given its geometry, interrelationship with the left ventricle, and sensitivity to alterations in pulmonary pressure. This article focuses on some of the challenges related to the assessment of RV function in the setting of the RV's unique anatomic, physiologic, conventional and newer echocardiographic aspects, and therapeutic implications. The majority of proposed methods of echocardiographic assessment of RV function are based on volumetric approximations of the RV. Such approaches have inherent limitations, first as volume-related measures such as EF are load dependent, second because of the complex geometry of the RV. The issue of RV geometry is usually overcome using geometry-independent parameters such as tricuspid annular excursion and the Tei index. The recent introduction of real-time three-dimensional echocardiography and myocardial imaging echocardiography (tissue Doppler imaging, 1D-strain and 2D-strain echocardiography) implied a great progress in echocardiography. Tissue Doppler imaging allows the quantitative assessment of RV systolic and diastolic function by means of measurement of myocardial velocities. Strain measurements have been shown to correlate well with sonomicrometry segment length measurements both in the inflow and outflow tract of the RV and under different loading conditions. Other findings have been reported in chronic and acute clinical settings. Standard and novel echocardiographic methods of assessment of RV size and performance can help clinicians in the treatment of acute and chronic RV failure and contribute to a better understanding of the peculiar chamber-related functional mechanisms in the context of ventricular interdependent independency.

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“…The normal right ventricular free wall also exhibits torsion, but of a lesser magnitude [29]. In patients who underwent Mustard or Senning repair for transposition of great arteries, the systemic right ventricle exhibited greater circumferential than longitudinal strain, in contrast to the normal right ventricle that has greater longitudinal than circumferential strain.…”

Section: Torsionmentioning

confidence: 99%

Architecture of the left ventricle: insights for optimal surgical ventricular restoration

Adhyapak

Parachuri

2009

Heart Fail Rev

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The normal left ventricular shape has been defined as prolate ellipsoid. This shape is an adaptation to evolution. A knowledge of its unique macro and micro architecture forms the cornerstone in the understanding of its complex function. The left ventricle has a unique architecture with three different myofiber orientations, the longitudinal, circumferential and oblique fibers. The oblique orientation of fibers is essential for effective clockwise and anticlockwise torsional movements during systole and diastole, for optimal ventricular ejection and filling. The orientation and fiber angle decide the shape of the ventricle. An ellipsoid shape is vital for optimal function. Pathological disease states such as ischemic heart disease, valvular heart disease and cardiomyopathies cause a loss of obliquity of the myofibers. The myofibers become more horizontal resulting in ventricular dilatation and increased sphericity. The change from ellipsoid to globular shape with disease heralds the onset of left ventricular dysfunction and initiates the cascade of heart failure. Several strategies have been successful in reverting ventricular dilatation and sphericity to a more ellipsoid geometry. Pharmacological therapies like beta blockade and angiotensin converting enzyme inhibition have proven beneficial in early stages of heart failure with pathological remodeling. However, these agents in isolation are limited in reversing pathological remodeling in advanced heart failure. In some cases of advanced heart failure due to postinfarction left ventricular aneurysms, ventricular volume reduction with restoration surgeries have a role in restoring ventricular geometry with beneficial clinical outcomes. Surgical ventricular restoration has progressively evolved from the 1950s. Initially, aneurysmal resection and linear repair was done. This was gradually replaced by endoventricular patch plasty, which had better results. The resulting left ventricle was smaller in size but still continued to have a spherical configuration. Exclusion of the infarct area with a smaller longitudinal patch results in realignment of the non-diseased ventricular fibers with a resulting ellipsoid shape. This ellipsoid shape ensures clinical benefits. The geometry of the endoventricular patch thus holds the key to optimal ventricular shape in these patients. The technique to optimally restore a diseased ventricle to normal continues to evolve. This requires insights into the normal architecture and function, and the pathophysiologic effects of disease.

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Contraction Pattern of the Systemic Right Ventricle

Cited by 260 publications

References 21 publications

Long‐Term Outcomes of Tricuspid Valve Surgery in Patients With Congenitally Corrected Transposition of the Great Arteries

Long‐Term Outcomes of Tricuspid Valve Surgery in Patients With Congenitally Corrected Transposition of the Great Arteries

Do we have two hearts? New insights in right ventricular function supported by myocardial imaging echocardiography

Architecture of the left ventricle: insights for optimal surgical ventricular restoration

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