Right ventricular architecture responsible for mechanical performance: Unifying role of ventricular septum Gerald Buckberg, MD, Julien I.E. Hoffman,

Slides:

Advertisements

Similar presentations

Uterine leiomyoma extension into right atrium: A case report

Advertisements

Lindsay S. Rogers, MD, Amy L. Peterson, MD, J

T.K. Susheel Kumar, MD, Christopher J. Knott-Craig, MD

Editorial Heart Failure Clinics

Left ventricular reconstruction: Early and late results

Novel mechanism of mitral regurgitation after lung transplantation in a patient with scleroderma and pulmonary hypertension Christian A. Bermudez, MD,

The STICH trial: Misguided conclusions

Ventricular and pulmonary vascular remodeling induced by pulmonary overflow in a chronic model of pretricuspid shunt Daniele Linardi, MD, Alessio Rungatscher,

Gerald Buckberg, MD, Aman Mahajan, MD, PhD, Saleh Saleh, MD, Julien I

Cardiac development after salvage partial left ventriculectomy in an infant with anomalous left coronary artery from the pulmonary artery Stephen Westaby,

Effects and mechanisms of left ventricular false tendons on functional mitral regurgitation in patients with severe cardiomyopathy Mehul R. Bhatt, MD,

Aortico-Left Ventricular Tunnel: Diagnosis Based on Two-Dimensional Echocardiography, Color Flow Doppler Imaging, and Magnetic Resonance Imaging RICHARD.

Matthew Williams, DO, Tomas Salerno, MD, Anthony L. Panos, MD

The practical clinical value of three-dimensional models of complex congenitally malformed hearts Eugénie Riesenkampff, MD, Urte Rietdorf, MSc, Ivo Wolf,

Cardiac pheochromocytoma

Roland Henaine, MD, Emilie Adam, MD, Kasra Azarnoush, MD, N

Spiral ventricular septation

Turning to the truth: Is mechanical aortic valve orientation important in transthoracic echocardiographic detection of prosthetic dysfunction and paravalvular.

Mechanical stress is associated with right ventricular response to pulmonary valve replacement in patients with repaired tetralogy of Fallot Dalin Tang,

Giant right atrial hemangioma: Correlation between magnetic resonance imaging and histopathologic evaluation Cristina Sánchez-Enrique, MD, David Vivas,

Altered left ventricular vortex ring formation by 4-dimensional flow magnetic resonance imaging after repair of atrioventricular septal defects Emmeline.

Cardiac lipoma arising from left ventricular papillary muscle: Resect or not? Young Sam Kim, MD, Kyung Hee Lee, MD, PhD, Suk Jin Choi, MD, PhD, Wan Ki.

Limitations to Chronic Right Ventricular Assist Device Support

Pulmonary artery banding for idiopathic dilative cardiomyopathy: A novel therapeutic strategy using an old surgical procedure Dietmar Schranz, MD, Alex.

Left ventricular inflow obstruction associated with persistent left superior vena cava and dilated coronary sinus Daniel J DiBardino, MD, Charles D Fraser,

Successful surgical management of ventricular fibromas in children

Spatial orientation of the ventricular muscle band: Physiologic contribution and surgical implications Francisco Torrent-Guasp, MDa, Manel Ballester,

Understanding right ventricular dysfunction and functional tricuspid regurgitation accompanying mitral valve disease Lina Maria Vargas Abello, MD, Allan.

Echocardiographic Assessment of Left Ventricular Systolic Function: An Overview of Contemporary Techniques, Including Speckle-Tracking Echocardiography

Morphologic spectrum of truncal valvar origin relative to the ventricular septum: Correlation with the size of ventricular septal defect Iki Adachi,

Tomaso Bottio, MD, PhD, Gino Gerosa, MD

Predicting recurrent mitral regurgitation after mitral valve repair: A difficult endeavor and a necessity Denis Bouchard, MD, Louis P. Perrault, MD,

Successful repair of a variant of mitral arcade

Evaluation of right ventricular function after cardiac surgery: The importance of tricuspid annular plane systolic excursion and right ventricular ejection.

Failing Systemic Right Ventricles With Persistent Pulmonary Hypertension: Candidates for Ventricular Assist Devices as Destination Therapy? Ophelie Loup,

Acute left ventricular failure after bilateral lung transplantation for idiopathic pulmonary arterial hypertension Tom Verbelen, MD, Sophie Van Cromphaut,

Hemoptysis as a rare presentation of cor triatriatum sinister

Early and late results of left ventricular reconstruction in thin-walled chambers: Is this our patient population? Gerald D. Buckberg, MD The Journal.

Factors affecting late survival after surgical remodeling of left ventricular aneurysms Hooshang Bolooki, MD, Eduardo DeMarchena, MD, Stephen M Mallon,

Congestive heart failure: Treat the disease, not the symptom

A novel surgical approach to close an acute ventricular septal defect using an occluder device Chanaka Rajakaruna, MRCS, Jonathan Hill, MA, MRCP, Eleanor.

Borderline hypoplasia of the left ventricle in neonates: Insights for decision-making from functional assessment with magnetic resonance imaging Lars.

Abdul Rahman Dakkak, MD, Angelo M. Dell'Aquila, MD, Juergen R

Anatomic repair of Ebstein's anomaly with isolated anterior leaflet downward displacement Qingyu Wu, MD, Guangyu Pan, MD, Hongyin Li, MD, Xiangchen Kong,

The elusive mass in the right atrium: A liver in the heart

Coronary blood supply of the inferior wall of the right ventricle in hearts with Ebstein malformation: relevance to vertical plication Iki Adachi, MD,

Helical myofiber orientation after myocardial infarction and left ventricular surgical restoration in sheep Joseph C. Walker, BS, Julius M. Guccione,

Mitral valve replacement for inflow obstruction of left ventricular assist device in a child with restrictive cardiomyopathy Hari Tunuguntla, MD, Susan.

Barlow disease: Simple and complex

Long-term cardiac remodeling after salvage partial left ventriculectomy in an infant with anomalous left coronary artery from the pulmonary artery Stephen.

Coronary artery thromboembolism as a result of left ventricular sump aneurysm after congenital heart surgery Timothy B. Cotts, MD, Felix J. Rogers, DO,

Minimally invasive off-pump implantation of HeartMate 3 left ventricular assist device Diyar Saeed, MD, PhD, Stephan Sixt, MD, PhD, Alexander Albert,

Transient right ventricular dysfunction caused by retractor during lower hemisternotomy mitral valve repair in a patient with pectus excavatum Homare.

Right ventricular failure from severe pulmonary hypertension after surgery for shone complex: Back to fetal physiology with reducting, atrioseptectomy,

The effects of the Cox maze procedure on atrial function

Chronic septal infarction confers right ventricular protection during mechanical left ventricular unloading James Mau, BSc, MB, BS, Stuart Menzie, MB,

Tricuspid Valve Prolapse Diagnosed by Cross-Sectional Echocardiography

Ductal stenting retrains the left ventricle in transposition of great arteries with intact ventricular septum Kothandam Sivakumar, MD, DM, Edwin Francis,

Yinsu Zhu, MD, Lijun Tang, MD, PhD, Yi Xu, MD

Physiologic left ventricular reconstruction: Shape, function, and time recaptured Gerald D. Buckberg, MD The Journal of Thoracic and Cardiovascular Surgery

Preserving the V-engine shape of the left ventricle with Melody mitral valve replacement in small children Patrick O. Myers, MD The Journal of Thoracic.

The university, creativity, and freedom

Sewing needles embedded in the cardiac interventricular septum and chest wall Stephanie L. Mick, MD, Ibrahim Abdullah, MD, Vakhtang Tchantchaleishvili,

Uterine leiomyoma extension into right atrium: A case report

Nonsurgical management of traumatic cardiac pseudoaneurysms

Ventricular assistant in restrictive cardiomyopathy: Making the right connection Robert D.B. Jaquiss, MD The Journal of Thoracic and Cardiovascular Surgery

Mechanical left ventricular unloading to prevent recurrent myocardial rupture Stephen Westaby, MS, PhD, Vipin Mehta, MD, Fidelma Flynn, MD, Neil Wilson,

Respect the aorta The Journal of Thoracic and Cardiovascular Surgery

Lipomatous septal hypertrophy

Giant right coronary artery aneurysm with a huge intramural thrombus

Presentation transcript:

Right ventricular architecture responsible for mechanical performance: Unifying role of ventricular septum Gerald Buckberg, MD, Julien I.E. Hoffman, MD The Journal of Thoracic and Cardiovascular Surgery Volume 148, Issue 6, Pages 3166-3171.e4 (December 2014) DOI: 10.1016/j.jtcvs.2014.05.044 Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 A, Cross-sectional view of both ventricles demonstrating the crescent shape of the right ventricle and conical form of the left ventricle. The obliquity of the septal muscle structure and its spiral arrangement is clear. Note the thickened septum and the wrap around basal loop. B, Longitudinal appearance of heart, showing the thin right ventricular free wall, trabecular right ventricular surface muscle, and (C) thickness of the biventricular septum. C, View of the intact heart demonstrating the transverse appearance of the right ventricular free wall and oblique fiber arrangement of the underlying anterior segment of the apical loop that covers the right ventricular septum and lower left ventricular free wall. D, Unfolding of the basal loop containing predominantly transverse fibers and the underlying helix that comprises the left and right ventricular septum. Note the oblique fibers of the right ventricular base adjacent to the pulmonary artery and the helical formation of the septum, such that the helical fibers cross each other at 60° of angulation when the heart is filled. LA, Left atrium; RA, right atrium; LV, left ventricle; RV, right ventricle. The Journal of Thoracic and Cardiovascular Surgery 2014 148, 3166-3171.e4DOI: (10.1016/j.jtcvs.2014.05.044) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Echocardiographic appearance of tricuspid annular plane systolic excursion. Note the predominant shortening during contraction, moving this plane from the base to apex. Longitudinal shortening predominates, because transverse shortening is minimal. TAPSE, Tricuspid annular plane systolic excursion. The Journal of Thoracic and Cardiovascular Surgery 2014 148, 3166-3171.e4DOI: (10.1016/j.jtcvs.2014.05.044) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 A, Ventricular myocardium separated into the right ventricle (RV), septum, and left ventricle (LV). Note the size of the biventricular septum muscle mass. B, Graph showing the weight of the respective segments of the LV, RV, and septum. The Journal of Thoracic and Cardiovascular Surgery 2014 148, 3166-3171.e4DOI: (10.1016/j.jtcvs.2014.05.044) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Left ventricular end-diastolic epi- and endocardial surface display of reconstructed magnetic resonance images before and 4 months after mitral insufficiency. Note the preferential bulging of the septum compared to the lateral wall during this period, as shown by Young and colleagues.11 The Journal of Thoracic and Cardiovascular Surgery 2014 148, 3166-3171.e4DOI: (10.1016/j.jtcvs.2014.05.044) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure E1 Fiber orientation relationship of the septum composed of oblique fibers that arise from the descending and ascending segments of the apical loop surrounded by the transverse muscle orientation of the basal loop that comprises the free right ventricular wall. Note the conical arrangement of the septum muscle and the basal loop wrap, forming the right ventricular cavity. The Journal of Thoracic and Cardiovascular Surgery 2014 148, 3166-3171.e4DOI: (10.1016/j.jtcvs.2014.05.044) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure E2 Diffusion tensor magnetic resonance image showing the helical inner or endocardial (clockwise) and outer or epicardial (counterclockwise) fiber orientation (purple and blue) and a central left ventricular free wall in the top chamber, which is white to reflect a more horizontal or very small angle pitch; these transverse fibers do not involve the septum. The Journal of Thoracic and Cardiovascular Surgery 2014 148, 3166-3171.e4DOI: (10.1016/j.jtcvs.2014.05.044) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure E3 Relationship between fiber orientation and ejection fraction. Note the 30% ejection fraction that occurs when a transverse or circumferential horizontal arrangement is present compared with the 60% ejection fraction when a spiral or helical relationship is present. MRI, Magnetic resonance imaging. Reprinted with permission from Zhukov and Barr.E1 The Journal of Thoracic and Cardiovascular Surgery 2014 148, 3166-3171.e4DOI: (10.1016/j.jtcvs.2014.05.044) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure E4 Right ventricular (RV) dysplasia observed by (A) magnetic resonance image displaying whitish RV free wall, with anterior and inferior aneurysm, and normal septum; (B) cross-section of heart specimen showing free wall aneurysm; and (C) histologic specimen showing free wall thinning, fibro fatty replacement, and normal septum. Reprinted with permission from Basso and colleagues.18 The Journal of Thoracic and Cardiovascular Surgery 2014 148, 3166-3171.e4DOI: (10.1016/j.jtcvs.2014.05.044) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure E5 Echocardiographic view of a failing left ventricle, left, before and, right, after left ventricular decompression, as described by Robert Kormos (personal communication). Left, The thin stretched akinetic septum has been pushed or bowed into the right ventricular chamber by the distended left ventricle (LV). Right, Note how the thickened septum after near total left ventricular decompression has become bowed into the left side by the distended right ventricle (RV). LVAD, Left ventricular assist device. The Journal of Thoracic and Cardiovascular Surgery 2014 148, 3166-3171.e4DOI: (10.1016/j.jtcvs.2014.05.044) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions