Analysis of right ventricular function during bypass of the left side of the heart by afterload alterations in both normal and failing hearts Chang-Hee.

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Presentation transcript:

Analysis of right ventricular function during bypass of the left side of the heart by afterload alterations in both normal and failing hearts Chang-Hee Park, MD, Kazunobu Nishimura, MD, PhD, Mitsuru Kitano, MD, Katsuhiko Matsuda, MD, PhD, Yoshifumi Okamoto, MD, PhD, Toshihiko Ban, MD, PhD The Journal of Thoracic and Cardiovascular Surgery Volume 111, Issue 5, Pages 1092-1102 (May 1996) DOI: 10.1016/S0022-5223(96)70386-0 Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 1 Schematic diagram of experimental preparation. See text for details. Ao, Aorta; PA, pulmonary artery; RA, right atrium; LSA, left subclavian artery; LAA, left atrial appendage; LV apex, left ventricular apex; LVP, left ventricular pressure; RVP, RV pressure. The Journal of Thoracic and Cardiovascular Surgery 1996 111, 1092-1102DOI: (10.1016/S0022-5223(96)70386-0) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 2 Percent change of hemodynamic variables after failing heart models were induced. PA flow, Pulmonary artery flow; LVP, left ventricular pressure; RVEDP, RV end-diastolic pressure; EF, ejection fraction. *p < 0.05 by Wilcoxon signed-rank test compared with value in normal hearts. # p < 0.05 by paired t test compared with value in normal hearts. The Journal of Thoracic and Cardiovascular Surgery 1996 111, 1092-1102DOI: (10.1016/S0022-5223(96)70386-0) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 3 Representative RV pressure-volume loops obtained in normal hearts. A, Representative RV pressure- volume loops obtained during bilateral intrapulmonary balloon inflation without LHB. Line shows slope of RV ESPVR. B, RV pressure-volume loops obtained with 100% assist of LHB in normal hearts. Line shows slope of RV ESPVR. Broken line shows slope of RV ESPVR without LHB. One hundred percent assist of LHB resulted in parallel rightward shift of RV ESPVR in normal hearts. The Journal of Thoracic and Cardiovascular Surgery 1996 111, 1092-1102DOI: (10.1016/S0022-5223(96)70386-0) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 3 Representative RV pressure-volume loops obtained in normal hearts. A, Representative RV pressure- volume loops obtained during bilateral intrapulmonary balloon inflation without LHB. Line shows slope of RV ESPVR. B, RV pressure-volume loops obtained with 100% assist of LHB in normal hearts. Line shows slope of RV ESPVR. Broken line shows slope of RV ESPVR without LHB. One hundred percent assist of LHB resulted in parallel rightward shift of RV ESPVR in normal hearts. The Journal of Thoracic and Cardiovascular Surgery 1996 111, 1092-1102DOI: (10.1016/S0022-5223(96)70386-0) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 4 Representative RV pressure-volume loops obtained in failing hearts. A, Pressure-volume loops without LHB. Line shows slope of RV ESPVR. B, Pressure-volume loops with 70% assist of LHB. Line shows slope of RV ESPVR with 70% LHB and broken line shows slope of RV ESPVR without LHB. C, Pressure-volume loops with 100% assist of LHB. Line shows slope of RV ESPVR with 100% LHB and broken line shows slope of RV ESPVR without LHB. Consequently, RV ESPVR decreased with increase in assist ratio of LHB in failing hearts. The Journal of Thoracic and Cardiovascular Surgery 1996 111, 1092-1102DOI: (10.1016/S0022-5223(96)70386-0) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 4 Representative RV pressure-volume loops obtained in failing hearts. A, Pressure-volume loops without LHB. Line shows slope of RV ESPVR. B, Pressure-volume loops with 70% assist of LHB. Line shows slope of RV ESPVR with 70% LHB and broken line shows slope of RV ESPVR without LHB. C, Pressure-volume loops with 100% assist of LHB. Line shows slope of RV ESPVR with 100% LHB and broken line shows slope of RV ESPVR without LHB. Consequently, RV ESPVR decreased with increase in assist ratio of LHB in failing hearts. The Journal of Thoracic and Cardiovascular Surgery 1996 111, 1092-1102DOI: (10.1016/S0022-5223(96)70386-0) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 4 Representative RV pressure-volume loops obtained in failing hearts. A, Pressure-volume loops without LHB. Line shows slope of RV ESPVR. B, Pressure-volume loops with 70% assist of LHB. Line shows slope of RV ESPVR with 70% LHB and broken line shows slope of RV ESPVR without LHB. C, Pressure-volume loops with 100% assist of LHB. Line shows slope of RV ESPVR with 100% LHB and broken line shows slope of RV ESPVR without LHB. Consequently, RV ESPVR decreased with increase in assist ratio of LHB in failing hearts. The Journal of Thoracic and Cardiovascular Surgery 1996 111, 1092-1102DOI: (10.1016/S0022-5223(96)70386-0) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 5 Change in slope of PRVP-RVSV relationship with increases in assist ratio of LHB in both normal and failing hearts. *p < 0.05 by Wilcoxon signed-rank test compared with values without LHB. The Journal of Thoracic and Cardiovascular Surgery 1996 111, 1092-1102DOI: (10.1016/S0022-5223(96)70386-0) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 6 Representative PRVP-RVSV relationship in normal hearts. RVSV was almost constant in normal hearts when afterload was increased regardless of assist ratio of LHB. Moreover, RVSV was maintained at higher level during LHB compared with that without LHB. The Journal of Thoracic and Cardiovascular Surgery 1996 111, 1092-1102DOI: (10.1016/S0022-5223(96)70386-0) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 7 A, Representative PRVP-RVSV relationship in failing hearts. Correlation between PRVP and RVSV was inversely linear with significant regression. Slope of correlation became steeper during 100% LHB compared with that without LHB. Intersection of two slopes (that is, “critical point”) was noted. B, Reducing LHB assist ratio to 70% caused slope of PRVP-RVSV correlation to become more gentle, and thereby “critical point” shifted rightward, indicating higher afterload. The Journal of Thoracic and Cardiovascular Surgery 1996 111, 1092-1102DOI: (10.1016/S0022-5223(96)70386-0) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 7 A, Representative PRVP-RVSV relationship in failing hearts. Correlation between PRVP and RVSV was inversely linear with significant regression. Slope of correlation became steeper during 100% LHB compared with that without LHB. Intersection of two slopes (that is, “critical point”) was noted. B, Reducing LHB assist ratio to 70% caused slope of PRVP-RVSV correlation to become more gentle, and thereby “critical point” shifted rightward, indicating higher afterload. The Journal of Thoracic and Cardiovascular Surgery 1996 111, 1092-1102DOI: (10.1016/S0022-5223(96)70386-0) Copyright © 1996 Mosby, Inc. Terms and Conditions