Restrictive Right Ventricular Physiology

Lam, Yat‐Yin; Kaya, Mehmet; Göktekín, Ömer; Li, Wei; Henein, Michael Y.

doi:10.1016/j.jacc.2007.06.042

Cited by 33 publications

(6 citation statements)

References 25 publications

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“…The reduction in right ventricular diastolic compliance is reflected as antegrade forward flow through the superior vena cava. Due to this restriction the right ventricle acts as a passive conduit between the systemic venous inflow and pulmonary artery inflow during atrial systole [10].…”

Section: Discussionmentioning

confidence: 99%

Etiology of right ventricular restrictive physiology early after repair of tetralogy of Fallot in pediatric patients

Bhushan

Huang

et al. 2019

J Cardiothorac Surg

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Background Right ventricular restrictive physiology (RVRP) is a common finding after repair of Tetralogy of Fallot (TOF). The characteristic feature of RVRP is the presence of a direct end-diastolic flow (EDFF) during atrial contraction in the main pulmonary artery. This end-diastolic forward flow is caused by increased right ventricular end-diastolic pressure due to right ventricular myocardial stiffness and decreased right ventricular compliance. Objective Our main objective is to found out the etiology of RVRP in pediatrics patients who underwent for complete repair of Tetralogy of Fallot (TOF). Methods A total of 50 TOF patients have registered for this study in our hospital from January 2017 to September 2018. The patients were divided in two groups, group A with restrictive physiology and group B without restrictive physiology. The patients selected for this study includes TOF patients, TOF patients with atrial septal defect (ASD), and TOF patients with patent ductus arteriosus (PDA). Ventricular hypertrophy and right heart enlargement were evaluated by electrocardiogram and echocardiography. The other parameters we used to compare between these two groups were sex, age, weight, cardio pulmonary bypass (CPB) time, aortic cross clamping time, transannular patch, SP0 2 , RV/LV pressure, ventricular hypertrophy, right heart (RH) enlargement, tricuspid annular plane systolic excursion (TAPSE), pulmonary artery systolic pressure (PASP), TAPSE/PASP ratio, pulmonary annular diameter, intubation time, PICU stay and hematocrit (HCT). Results RVRP was identified in 28 patients (58%). Lower SP0 2 (mean: 84.3 ± 7.9%) with p -value 0.015, transannular patch repair ( n = 22, 78.5%) with p-value< 0.001, longer cardiopulmonary bypass (CPB) time (mean: 117.6 ± 23 min) with p-value< 0.001, longer aortic cross clamping time (mean: 91.4 ± 20.26 min) with p-value< 0.001, lower TAPSE, lower PASP,lower TAPSE/PASP ratio and presence of hypertrophy (p-value < 0.001) were identified as etiology for restrictive physiology. It was also found that 77% TOF patients with ASD have a higher risk of RVRP in our study. Conclusions In TOF patient’s etiology for right ventricular restrictive physiology are associated with lower SP0 2, transannular patch repair, longer CPB and longer aortic cross clamping time, hypertrophy, lower TAPSE, lower PASP and lower TAPSE/PASP ratio.

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Section: Discussionmentioning

confidence: 99%

Etiology of right ventricular restrictive physiology early after repair of tetralogy of Fallot in pediatric patients

Bhushan

Huang

et al. 2019

J Cardiothorac Surg

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“…Several technologies have been used for PS: 1) transthoracic echocardiography only showed pulmonary artery longitudinal section and simultaneously displayed two pulmonary valve leaflets due to acoustic window. As a result, it fails to recognize the number of valve leaflets accurately and the full view of pulmonary valves can be observed in a minority of valve annulus transverse sections ( 23 , 24 ); 2) Real-time three-dimensional echocardiography can determine the number of pulmonary valves in a half of PS patients through reconstruction of volume data acquired ( 25 ). However, this technique has some shortcomings, such as low display rate, poor spatial resolution, heavily depending on techniques and other several interference factors; 3) hemodynamic change, explicit PS location and severity of PS cases, can be detected by right ventricular angiography, but it cannot directly display the number and morphology of stenotic pulmonary valve.…”

Section: Discussionmentioning

confidence: 99%

Dual-Source Computed Tomography Evaluation of Children with Congenital Pulmonary Valve Stenosis

Sun

Huang

et al. 2016

Iran J Radiol

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BackgroundDespite dual-source computed tomography (DSCT) technology has been performed well on adults or infants with heart disease, specific knowledge about children with congenital pulmonary valve stenosis (PS) remained to be established.ObjectivesThis original research aimed to establish a professional approach of DSCT performing technology on children and to assess the image quality performed by DSCT to establish a diagnostic evaluation for children with PS.Patients and MethodsNinety-eight children with congenital PS referred to affiliated hospital of Jining medical college were recruited from October 2013 to March 2015. Participants were divided into four groups according to different ages (0 - 1, 1 - 3, 3 - 7, 7 - 14), or three groups according to different heart rates (< 90, 90 - 110, > 110). Image quality of pulmonary valves was assessed based on a four-point grading scale (1 - 4 points). Those cases achieving a score of ≥ 3 points were selected for further investigation, which played a critical role in our analysis. Correlation analysis was used to identify the effects of age and heart rate on image quality. Additionally, the results evaluated by DSCT were compared with those evaluated from the operation, further confirming the accuracy of DSCT.ResultsSeventy-two cases (73.4%) achieved a score of ≥ 3 points based on pulmonary valve imaging, which were available for further diagnosis. There was a statistically significant difference (P < 0.05) between the four groups except 0 - 1 group and 1 - 3 group, 3 - 7 group and 7 - 14 group, and the image quality of elder group was higher than younger group. Image score was gradually decreased with increased heart rate (F = 19.05, P < 0.01). Heart rate was negatively correlated with pulmonary valve scores (r = -0.391, P < 0.001), while there was no correlation between age and scores (r = 0.185, P = 0.070). The number, shape, commissure, and opening status of pulmonary valves evaluated by DSCT were the same as the results of operation.ConclusionHeart rate serves a pivotal role in imaging quality of DSCT. DSCT provides a functional evaluation of children with congenital PS and consequently contributes to a theoretical basis for corresponding treatment protocols.

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“…In the setting of restrictive physiology, atrial contraction in late diastole forces blood into a poorly compliant RV resulting in premature opening of the pulmonic valve with antegrade flow on spectral and colour Doppler 1 2. Restrictive RV physiology is common in patients with congenital RV outflow tract obstruction, seen in conditions such as Tetralogy of Fallot and pulmonary atresia, sometimes even after timely repair 3. Delayed repair of the obstruction may result in myocardial fibrosis and restrictive physiology, which is associated with poor clinical outcomes in some, but not all, studies 4.…”

Section: Answer: C Right Atrial Pressure >10 Mm Hgmentioning

confidence: 99%

Exertional dyspnoea in a 28-year-old woman

Carlson

Steinberg

Krieger

2017

Heart

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Restrictive Right Ventricular Physiology

Abstract: Restrictive RV physiology is common in PVS patients. Its presence is related to a worse deterioration in RV long-axis function and decreased exercise tolerance in patients.

Cited by 33 publications

References 25 publications

Etiology of right ventricular restrictive physiology early after repair of tetralogy of Fallot in pediatric patients

Etiology of right ventricular restrictive physiology early after repair of tetralogy of Fallot in pediatric patients

Dual-Source Computed Tomography Evaluation of Children with Congenital Pulmonary Valve Stenosis

Exertional dyspnoea in a 28-year-old woman

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