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Sample records for arrhythmogenic right ventricular dysplasia

  1. Arrhythmogenic Right Ventricular Dysplasia

    Science.gov (United States)

    MENU Return to Web version Arrhythmogenic Right Ventricular Dysplasia Overview What is arrhythmogenic right ventricular dysplasia? Arrhythmogenic right ventricular dysplasia (say: “uh-rith-mo-jen-ic right ven-trick- ...

  2. Arrhythmogenic right ventricular dysplasia

    OpenAIRE

    Bockeria O.L.; Lе T.G.

    2015-01-01

    Arrhythmogenic right ventricular dysplasia is a hereditary cardiomyopathy characterized by structural and functional disorders in the right ventricle, which results in ventricular arrhythmias. Arrhythmogenic right ventricular dysplasia is one of the important causes of sudden cardiac death in young people and athletes. Structural disorders in arrhythmogenic right ventricular dysplasia are associated with fibrosis and fatty infiltration of the right ventricular myocardium. These changes lead t...

  3. Arrhythmogenic right ventricular dysplasia

    Directory of Open Access Journals (Sweden)

    Bockeria O.L.

    2015-06-01

    Full Text Available Arrhythmogenic right ventricular dysplasia is a hereditary cardiomyopathy characterized by structural and functional disorders in the right ventricle, which results in ventricular arrhythmias. Arrhythmogenic right ventricular dysplasia is one of the important causes of sudden cardiac death in young people and athletes. Structural disorders in arrhythmogenic right ventricular dysplasia are associated with fibrosis and fatty infiltration of the right ventricular myocardium. These changes lead to progressive dilatation and dysfunction of the right ventricle, as well as the occurrence of life-threatening ventricular arrhythmias.In 2010 The Task Force corrected the diagnostic criteria of the condition, which include large and small criteria from 6 different categories to make the diagnosis more accurate. ECG, EchoCG, MRI of the heart as well as myocardial biopsy play an important role in the diagnosis of the disease. Prognosis of the disease often depends on the timely prevention of sudden cardiac death – the implantation ofa cardioverter-defibrillator and optimal drug therapy of the symptomatic heart failure.

  4. Arrhythmogenic right ventricular dysplasia

    International Nuclear Information System (INIS)

    The arrhythmogenic right ventricular dysplasia is a condition predominantly well defined with arrhythmic events. We analyze three cases diagnosed by the group. These cases were presented as ventricular tachycardia with a morphology of left bundle branch block, presenting one of them aborted sudden death in evolution. The baseline electrocardiogram and signal averaging were abnormal in two of the three cases, like the echocardiogram. The electrophysiological study was able to induce in the three patients with sustained monomorphic ventricular tachycardia morphology of left bundle branch block. The definitive diagnosis was made by right ventriculography in two cases and magnetic resonance imaging in the other. Treatment included antiarrhythmic drugs in the three cases and the placement of an automatic defibrillator which survived a sudden death (Author)

  5. Arrhythmogenic right ventricular dysplasia: A case report

    Directory of Open Access Journals (Sweden)

    Tessa Negrín Valdés

    2015-10-01

    Full Text Available Arrhythmogenic right ventricular dysplasia is a heart muscle disease that predominantly affects the right ventricle, bringing about the replacement of normal myocardium with fatty or fibrofatty tissue and causing sudden death in young individuals. Ventricular tachycardia is an important clinical manifestation, although there are reports of right or global heart failure. The diagnosis is confirmed by echocardiography and magnetic resonance imaging. The case of a 65-year-old former smoker, with hypertension and ischemic heart disease, a history of effort syncope symptoms and proven non-sustained ventricular tachycardia, with morphology of left bundle branch block, is reported. Relevant diagnostic studies were performed, and echocardiographic elements which were compatible with arrhythmogenic right ventricular dysplasia were found. Therefore, an implantable cardioverter defibrillator was implanted, after which the patient has had a favorable outcome.

  6. New ECG Criteria in Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy

    NARCIS (Netherlands)

    M.G.P.J. Cox; J.J. van der Smagt; A.A.M. Wilde; A.C.P. Wiesfeld; D.E. Atsma; M.R. Nelen; L.M. Rodriguez; P. Loh; M.J. Cramer; P.A. Doevendans; J.P. van Tintelen; J.M.T. de Bakker; R.N.W. Hauer

    2009-01-01

    Background-Desmosomal changes, electric uncoupling, and surviving myocardial bundles in fibrofatty tissue characterize arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C). Resultant activation delay is pivotal for reentry and thereby ventricular tachycardia (VT). Current task force cr

  7. Arrhythmogenic right ventricular cardiomyopathy/dysplasia.

    Science.gov (United States)

    Thiene, Gaetano; Corrado, Domenico; Basso, Cristina

    2007-01-01

    Arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) is a heart muscle disease clinically characterized by life-threatening ventricular arrhythmias. Its prevalence has been estimated to vary from 1:2,500 to 1:5,000. ARVC/D is a major cause of sudden death in the young and athletes. The pathology consists of a genetically determined dystrophy of the right ventricular myocardium with fibro-fatty replacement to such an extent that it leads to right ventricular aneurysms. The clinical picture may include: a subclinical phase without symptoms and with ventricular fibrillation being the first presentation; an electrical disorder with palpitations and syncope, due to tachyarrhythmias of right ventricular origin; right ventricular or biventricular pump failure, so severe as to require transplantation. The causative genes encode proteins of mechanical cell junctions (plakoglobin, plakophilin, desmoglein, desmocollin, desmoplakin) and account for intercalated disk remodeling. Familiar occurrence with an autosomal dominant pattern of inheritance and variable penetrance has been proven. Recessive variants associated with palmoplantar keratoderma and woolly hair have been also reported. Clinical diagnosis may be achieved by demonstrating functional and structural alterations of the right ventricle, depolarization and repolarization abnormalities, arrhythmias with the left bundle branch block morphology and fibro-fatty replacement through endomyocardial biopsy. Two dimensional echo, angiography and magnetic resonance are the imaging tools for visualizing structural-functional abnormalities. Electroanatomic mapping is able to detect areas of low voltage corresponding to myocardial atrophy with fibro-fatty replacement. The main differential diagnoses are idiopathic right ventricular outflow tract tachycardia, myocarditis, dialted cardiomyopathy and sarcoidosis. Only palliative therapy is available and consists of antiarrhythmic drugs, catheter ablation and

  8. Arrhythmogenic right ventricular cardiomyopathy/dysplasia

    Directory of Open Access Journals (Sweden)

    Basso Cristina

    2007-11-01

    Full Text Available Abstract Arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D is a heart muscle disease clinically characterized by life-threatening ventricular arrhythmias. Its prevalence has been estimated to vary from 1:2,500 to 1:5,000. ARVC/D is a major cause of sudden death in the young and athletes. The pathology consists of a genetically determined dystrophy of the right ventricular myocardium with fibro-fatty replacement to such an extent that it leads to right ventricular aneurysms. The clinical picture may include: a subclinical phase without symptoms and with ventricular fibrillation being the first presentation; an electrical disorder with palpitations and syncope, due to tachyarrhythmias of right ventricular origin; right ventricular or biventricular pump failure, so severe as to require transplantation. The causative genes encode proteins of mechanical cell junctions (plakoglobin, plakophilin, desmoglein, desmocollin, desmoplakin and account for intercalated disk remodeling. Familiar occurrence with an autosomal dominant pattern of inheritance and variable penetrance has been proven. Recessive variants associated with palmoplantar keratoderma and woolly hair have been also reported. Clinical diagnosis may be achieved by demonstrating functional and structural alterations of the right ventricle, depolarization and repolarization abnormalities, arrhythmias with the left bundle branch block morphology and fibro-fatty replacement through endomyocardial biopsy. Two dimensional echo, angiography and magnetic resonance are the imaging tools for visualizing structural-functional abnormalities. Electroanatomic mapping is able to detect areas of low voltage corresponding to myocardial atrophy with fibro-fatty replacement. The main differential diagnoses are idiopathic right ventricular outflow tract tachycardia, myocarditis, dialted cardiomyopathy and sarcoidosis. Only palliative therapy is available and consists of antiarrhythmic drugs

  9. Arrhythmogenic Right Ventricular Dysplasia in Neuromuscular Disorders

    Science.gov (United States)

    Finsterer, Josef; Stöllberger, Claudia

    2016-01-01

    OBJECTIVES Arrhythmogenic right ventricular dysplasia (ARVD) is a rare, genetic disorder predominantly affecting the right ventricle. There is increasing evidence that in some cases, ARVD is due to mutations in genes, which have also been implicated in primary myopathies. This review gives an overview about myopathy-associated ARVD and how these patients can be managed. METHODS A literature review was done using appropriate search terms. RESULTS The myopathy, which is most frequently associated with ARVD, is the myofibrillar myopathy due to desmin mutations. Only in a single patient, ARVD was described in myotonic dystrophy type 1. However, there are a number of genes causing either myopathy or ARVD. These genes include lamin A/C, ZASP/cypher, transmembrane protein-43, titin, and the ryanodine receptor-2 gene. Diagnosis and treatment are identical for myopathy-associated ARVD and nonmyopathy-associated ARVD. CONCLUSIONS Patients with primary myopathy due to mutations in the desmin, dystrophia myotonica protein kinase, lamin A/C, ZASP/cypher, transmembrane protein-43, titin, or the ryanodine receptor-2 gene should be screened for ARVD. Patients carrying a pathogenic variant in any of these genes should undergo annual cardiological investigations for cardiac function and arrhythmias. PMID:27790050

  10. QT dispersion in patients with arrhythmogenic right ventricular dysplasia

    DEFF Research Database (Denmark)

    Benn, Marianne; Hansen, P S; Pedersen, A K

    1999-01-01

    , of electrical instability. The present study was conducted to assess the occurrence of QT dispersion and its modulation during treatment with sotalol. Methods Twenty-five patients with the diagnosis of arrhythmogenic right ventricular dysplasia were studied retrospectively. Fourteen patients were considered low...

  11. Arrhythmogenic right ventricular cardiomyopathy/dysplasia: an updated imaging approach.

    Science.gov (United States)

    Zimmerman, Stefan L

    2015-02-01

    Arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) is a rare inherited cardiomyopathy characterized by fibrofatty replacement of the right ventricular myocardium and risk of sudden death from ventricular tachyarrhythmias. Cardiac magnetic resonance (MR) imaging plays an important role in the diagnostic evaluation of patients and family members suspected of having ARVC/D. This article discusses the epidemiology and pathophysiology of ARVC/D, reviews typical MR imaging findings and diagnostic criteria, and summarizes potential pitfalls in the MR imaging evaluation of patients suspected of having ARVC/D.

  12. A Genetic Variants Database for Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy

    NARCIS (Netherlands)

    van der Zwaag, Paul A.; Jongbloed, Jan D. H.; van den Berg, Maarten P.; van der Smagt, Jasper J.; Jongbloed, Roselie; Bikker, Hennie; Hofstra, Robert M. W.; van Tintelen, J. Peter

    2009-01-01

    Arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) is a hereditary cardiomyopathy characterized by fibrofatty replacement of cardiomyocytes, ventricular tachyarrhythmias and sudden death. ARVD/C is mainly caused by mutations in genes encoding desmosomal proteins. However, the pathoge

  13. Right ventricular cardiomyopathy meeting the arrhythmogenic right ventricular dysplasia revised criteria? Do not forget sarcoidosis

    Energy Technology Data Exchange (ETDEWEB)

    Vasaturo, Sabina; Ploeg, David E.; Zeppenfeld, Katja; Veselic-Charvat, Maud [Leiden University Medical Center, Leiden (Netherlands); Buitrago, Guadalupe [Dept. of Radiology, Hospital General Universitario Gregorio Maranon, Madrid (Spain)

    2015-06-15

    A 53-year-old woman was referred for ventricular fibrillation with resuscitation. A CT-angiography showed signs of a right ventricular enlargement without obvious cause. A cardiac MRI demonstrated a dilated and hypokinetic right ventricle with extensive late gadolinium enhancement. Arrhythmogenic right ventricular dysplasia (ARVD) was suspected according to the {sup r}evised ARVD task force criteria{sup .} An endomyocardial biopsy was inconclusive. The patient developed purulent pericarditis after epicardial ablation therapy and died of toxic shock syndrome. The post-mortem pathologic examination demonstrated sarcoidosis involving the heart, lungs, and thyroid gland.

  14. Prophylactic implantable defibrillator in patients with arrhythmogenic right ventricular cardiomyopathy/dysplasia and no prior ventricular fibrillation or sustained ventricular tachycardia.

    LENUS (Irish Health Repository)

    Corrado, Domenico

    2010-09-21

    The role of implantable cardioverter-defibrillator (ICD) in patients with arrhythmogenic right ventricular cardiomyopathy\\/dysplasia and no prior ventricular fibrillation (VF) or sustained ventricular tachycardia is an unsolved issue.

  15. Role of cardiovascular magnetic resonance imaging in arrhythmogenic right ventricular dysplasia

    OpenAIRE

    Bluemke David A; Calkins Hugh; Tandri Harikrishna; Jain Aditya

    2008-01-01

    Abstract Arrhythmogenic right ventricular dysplasia (ARVD) is a genetic cardiomyopathy characterized clinically by ventricular arrhythmias and progressive right ventricular (RV) dysfunction. The histopathologic hallmark is fibro-fatty replacement of RV myocardium. It is inherited in an autosomal pattern with variable penetrance. ARVD is unique in that it most commonly presents in young, otherwise healthy and highly athletic individuals. The cause of ARVD is not well-known but recent evidence ...

  16. Arrhythmogenic right ventricular dysplasia/cardiomyopathy diagnostic task force criteria: impact of new task force criteria

    NARCIS (Netherlands)

    M.G.P.J. Cox; J.J. van der Smagt; M. Noorman; A.C. Wiesfeld; P.G.A. Volders; I.M. van Langen; D.E. Atsma; D. Dooijes; A.C. Houweling; P. Loh; L. Jordaens; Y. Arens; M.J. Cramer; P.A. Doevendans; J.P. van Tintelen; A.A.M. Wilde; R.N.W. Hauer

    2010-01-01

    BACKGROUND: Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy (ARVD/C) Diagnostic Task Force Criteria (TFC) proposed in 1994 are highly specific but lack sensitivity. A new international task force modified criteria to improve diagnostic yield. A comparison of diagnosis by 1994 TFC versus ne

  17. Activation delay and VT parameters in arrhythmogenic right ventricular dysplasia/cardiomyopathy : Toward improvement of diagnostic ECG criteria

    NARCIS (Netherlands)

    Cox, Moniek G. P. J.; Nelen, Marcel R.; Wilde, Arthur A. M.; Wiesfeld, Ans C.; Van Der Smagt, Jasper; Loh, Peter; Cramer, Maarten J.; Doevendans, Pieter A.; Van Tintelen, J. Peter; De Bakker, Jacques M. T.; Hauer, Richard N. W.

    2008-01-01

    Activation Delay and VT Parameters. Introduction: Desmosomal changes, electrical uncoupling, and surviving myocardial bundles embedded in fibrofatty tissue are hallmarks of activation delay in arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C). Currently, generally accepted task forc

  18. Diagnosis of Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia:Proposed Modification of the Task Force Criteria

    Institute of Scientific and Technical Information of China (English)

    童鸿

    2011-01-01

    @@ The original 1994 International Task Force criteria for the clinical diagnosis of arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC / D) were based on structural,histological,ECG,arrhythmic,and familial features of the disease (Table 1).Abnormalities were subdivided into major and minor categories according to the specificity of their association with ARVC / D.Right precordial T-wave inversion,though well recognized in ARVC / D,was considered a minor criterion because of its presence in other conditions,including anterior ischemia and right ventricular (RV) hypertrophy.Arrhythmias of RV origin,another cardinal feature of ARVC / D,was designated a minor criterion because of its occurrence in other diseases,particularly idiopathic RV outflow tract tachycardia.

  19. Advances in the Diagnosis and Management of Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy.

    Science.gov (United States)

    Orgeron, Gabriela M; Calkins, Hugh

    2016-06-01

    Arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) is an inherited cardiomyopathy characterized by ventricular arrhythmias, right ventricular dysfunction, and sudden cardiac death. Since the first description of ARVD/C in 1982, there have been major advances in the diagnosis and management of the disease. For instance, the discovery of desmosomal abnormalities as a genetic basis for ARVD/C; the importance of proband status and ventricular ectopy for risk stratification of patients at risk for sudden cardiac death; and the critical role that exercise plays in the development and progression of ARVD/C, just to name a few. From a treatment perspective, the placement of implantable cardioverter defibrillators in those at risk for sudden cardiac death and ablation techniques have also evolved over time. In 2010, an update of the 1994 Task Force Diagnostic criteria for ARVD/C was published with the hope to increase diagnostic sensitivity. This update incorporates new knowledge and technology to assess structural cardiac abnormalities and is the standard for diagnosis today. PMID:27108363

  20. Mean Platelet Volume in Patients with Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia

    Directory of Open Access Journals (Sweden)

    İbrahim Altun

    2015-12-01

    Full Text Available Aim: Arrhythmogenic right ventricular cardiomyopathy or dysplasia (ARVC/D is characterized by the gradual replacement of the right ventricular myocardium with fibrous and adipose tissue and can cause ventricular tachyarrhythmia in young patients. Mean platelet volume (MPV is reported to be an easily measurable marker reflecting platelet activation and plays an important role in the pathophysiology of cardiovascular disorders. In this study, we aimed to assess MPV in patients with ARVC/D. Methods: Twenty-nine patients (23 men, age: 38.0±13.1 years with ARVC/D and forty-one healthy subjects (30 men, age: 39.3±11.8 years were studied. Plasma MPV was measured in ARVC/D patients and control subjects. Results: The MPV was higher in patients with ARVC/D when compared with the control group (9.87±1.0 vs. 8.2±1.1 fl, p<0.01. To investigate any possible connection between MPV and clinical presentation of ARVC/D, ARVC/D patients were separated into two groups according to the presence of syncope and sudden cardiac death (SCD. MPV was higher in ARVC/D patients with SCD compared to those without cardiac arrest, but the difference was not statistically significant. Conclusion: Our results suggest that patients with ARVC/D have increased platelet activation.

  1. A new locus for arrhythmogenic right ventricular dysplasia on the long arm of chromosome 14

    Energy Technology Data Exchange (ETDEWEB)

    Severini, G.M.; Krajinovic, M.; Falaschi, A. [AREA Science Park, Trieste (Italy)] [and others

    1996-01-15

    Familial arrhythmogenic right ventricular cardiomyopathy or dysplasia (ARVD) is an idiopathic heart muscle disease with an autosomal-dominant pattern of transmission, characterized by fibro-fatty replacement of the right ventricular myocardium and ventricular arrhythmias. Recently, linkage to the chromosome 14q23-q24 (locus D14S42) has been reported in two families. In the present study, three unrelated families with ARVD were investigated. According to strict diagnostic criteria, 13 of 37 members were considered to be affected. Linkage to the D14S42 locus was excluded. On the other hand, linkage was found in the region 14q12-q22 in all three families (cumulative two-point lod score is 3.26 for D14S252), with no recombination between the detected locus and the disease gene. With multipoint linkage analysis, a maximal cumulative lod score of 4.7 was obtained in the region between loci D14S252 and D14S257. These data indicate that a novel gene causing familial ARVD (provisionally named ARVD2) maps to the long arm of chromosome 14, thus supporting the hypothesis of genetic heterogeneity in this disease. 33 refs., 4 figs., 3 tabs.

  2. Genetics Home Reference: arrhythmogenic right ventricular cardiomyopathy

    Science.gov (United States)

    ... Genetics Home Health Conditions ARVC arrhythmogenic right ventricular cardiomyopathy Enable Javascript to view the expand/collapse boxes. ... Open All Close All Description Arrhythmogenic right ventricular cardiomyopathy ( ARVC ) is a form of heart disease that ...

  3. Desmosomal cadherins are decreased in explanted arrhythmogenic right ventricular dysplasia/cardiomyopathy patient hearts.

    Directory of Open Access Journals (Sweden)

    Alexia Vite

    Full Text Available AIMS: Arrhythmogenic right ventricular Dysplasia/cardiomyopathy (ARVD/C is an autosomal dominant inherited cardiomyopathy associated with ventricular arrhythmia, heart failure and sudden death. Genetic studies have demonstrated the central role of desmosomal proteins in this disease, where 50% of patients harbor a mutation in a desmosmal gene. However, clinical diagnosis of the disease remains difficult and molecular mechanisms appears heterogeneous and poorly understood. The aim of this study was to characterize the expression profile of desmosomal proteins in explanted ARVD/C heart samples, in order to identify common features of the disease. METHODS AND RESULTS: We examined plakophilin-2, desmoglein-2, desmocollin-2, plakoglobin and β-catenin protein expression levels from seven independent ARVD/C heart samples compared to two ischemic, five dilated cardiomyopathy and one healthy heart sample as controls. Ventricular and septum sections were examined by immunoblot analysis of total heart protein extracts and by immunostaining. Immunoblots indicated significant decreases in desmoglein-2 and desmocollin-2, independent of any known underlying mutations, whereas immune-histochemical analysis showed normal localization of all desmosomal proteins. Quantitative RT-PCR revealed normal DSG2 and DSC2 mRNA transcript levels, suggesting increased protein turn-over rather than transcriptional down regulation. CONCLUSION: Reduced cardiac desmoglein-2 and desmocollin-2 levels appear to be specifically associated with ARVD/C, independent of underlying mutations. These findings highlight a key role of desmosomal cadherins in the pathophysiology of ARVD/C. Whether these reductions could be considered as specific markers for ARVD/C requires replication analysis.

  4. Clinical and genetic characterization of families with arrhythmogenic right ventricular dysplasia/cardiomyopathy provides novel insights into patterns of disease expression.

    LENUS (Irish Health Repository)

    Sen-Chowdhry, Srijita

    2007-04-03

    According to clinical-pathological correlation studies, the natural history of arrhythmogenic right ventricular dysplasia\\/cardiomyopathy is purported to progress from localized to global right ventricular dysfunction, followed by left ventricular (LV) involvement and biventricular pump failure. The inevitable focus on sudden death victims and transplant recipients may, however, have created a skewed perspective of a genetic disease. We hypothesized that unbiased representation of the spectrum of disease expression in arrhythmogenic right ventricular dysplasia\\/cardiomyopathy would require in vivo assessment of families in a genetically heterogeneous population.

  5. Case study of right ventricle arrhythmogenic dysplasia within one family

    OpenAIRE

    Bockeria L.A.; Shatalov K. V.; Berseneva M. I.; Koloskova N. N.

    2012-01-01

    We present the clinical case of arrhythmogenic cardiomyopathy and the analysis of different manifestations of this disease within one family. Three brothers D. born in 1986, 1988 and 1998 were observed between 2009 and 2011. Echocardiography, magnetic resonance imaging, histologic study were used as the methods of examination. According to their results the arrhythmogenic right ventricular dysplasia was diagnosed. Elder child had manifestations of end-stage heart failure which required hea...

  6. MRI for arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C); MRT bei arrhythmogener rechtsventrikulaerer Dysplasie/Kardiomyopathie (ARVD/C)

    Energy Technology Data Exchange (ETDEWEB)

    Hunold, P. [Universitaetsklinikum Schleswig-Holstein, Campus Luebeck, Klinik fuer Radiologie und Nuklearmedizin, Luebeck (Germany)

    2013-01-15

    Arrhythmogenic right ventricular dysplasia/cardiomyopathy is a congenital disease that may present with sudden cardiac death as the first manifestation. Standards for the difficult clinical diagnosis are the so-called modified Task Force criteria that incorporate imaging-based, electrocardiographic and anamnestic information. Cardiac magnetic resonance imaging (MRI) is the standard technique for imaging of the right ventricle and can compliment the recent ARVD/C diagnosis criteria by providing exact information on right ventricular size and function. It is the most reliable modality available for the detection of right ventricular aneurysms and the quantification of ventricular size. Furthermore, MRI is able to identify areas of fatty or fibrous replacement within the right ventricular myocardium in a non-invasive way. However, a suspicion of ARVD/C cannot be confirmed or excluded based on MRI findings alone. In clinical routine cardiac MRI is an enormously important component in the ARVD/C diagnostic toolbox; however, MRI can only act as one part of the diagnostic puzzle and should exclusively be performed by experienced centers using specifically tailored protocols. (orig.) [German] Die arrhythmogene rechtsventrikulaere Dysplasie/Kardiomyopathie (ARVD/C) ist eine angeborene Erkrankung, deren Erstmanifestation haeufig der ploetzliche Herztod ist. Standard fuer die schwierige Diagnostik sind die sog. modifizierten Task-force-Kriterien, in die bildgebende, elektrokardiographische und anamnestische Befunde eingehen. Die MRT ist das Standardverfahren zur Darstellung des rechten Ventrikels. Zu den derzeit gueltigen ARVD/C-Diagnosekriterien kann die MRT exakte Informationen zu Groesse und Funktion des rechten Ventrikels liefern. Fuer die Identifizierung rechtsventrikulaerer Aneurysmata und zur Quantifizierung der Ventrikelgroesse ist die MRT die zuverlaessigste verfuegbare Methode. Darueber hinaus koennen Fibrose- und Fettareale innerhalb des rechtsventrikulaeren

  7. Arrhythmogenic right ventricular cardiomyopathy as a cause of sudden death in young people: Literature review

    OpenAIRE

    Mazić Sanja; Lazović Biljana; Đelić Marina

    2012-01-01

    Arrhythmogenic right ventricular cardiomyopathy/dysplasia is a progressive condition with right ventricular myocardium being replaced by fibro-fatty tissue. It is a hereditary disorder mostly caused by desmosome gene mutations. The prevalence of arrhythmogenic right ventricular cardiomyopathy is about 1/1000-5000. Clinical presentation is usually related to ventricular tachycardias, syncope or presyncopa, or ventricular fibrillation leading to cardiac arrest, mostly in young people and ...

  8. Magnetic resonance findings in arrhythmogenic dysplasia of right ventricle

    International Nuclear Information System (INIS)

    To compare the magnetic resonance (MR) findings in patients with arrhythmogenic dysplasia of right ventricle (ADRV) with the images of right ventricle (RV) presenting normal morphology. Three groups of patients were studied by MR: a) a group of 20 healthy volunteers; b) 22 patients with ADRV diagnosed by other methods; and c) 11 patients presenting right ventricular tachycardia (VT) with no evidence of ADRV. When compared with the other two groups, the patients with ADRV were found to have an enlarged right atrium and RV, one wall of RV abnormally thin, changes in the myocardial signal and significant left ventricular involvement. MR is a noninvasive method that is useful in the assessment of RV dilation, ventricular wall thinning, deformities and sacculations and in the detection of changes in the myocardial MR signal produced by the replacement. It aids in the localization, characterization and quantification of morphological changes in RV. (Author) 36 refs

  9. Arrhythmogenic right ventricular cardiomyopathy in two cats.

    Science.gov (United States)

    Harvey, A M; Battersby, I A; Faena, M; Fews, D; Darke, P G G; Ferasin, L

    2005-03-01

    Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a disease characterised by infiltration of the myocardium by adipose and fibrous tissue. The disease is an important cause of sudden death in humans, but has rarely been described in animals. This report describes ARVC in two cats with right-sided congestive heart failure. One cat had also experienced previous episodes of syncope. Standard six-lead and 24-hour (Holter) electrocardiogram recording revealed complete atrioventricular block and multiform ventricular ectopics in both cats, with the addition of ventricular tachycardia, ventricular bigeminy and R-on-T phenomenon in one of them. On echocardiography, the right ventricle and atrium were massively dilated and hypokinetic. The survival times of the cats were three days and 16 days following diagnosis. Histopathology in one case revealed fibro-fatty infiltration of the myocardium, predominantly affecting the right ventricular free wall. PMID:15789811

  10. Mouse Models in Arrhythmogenic Right Ventricular Cardiomyopathy

    OpenAIRE

    Lodder, Elisabeth M.; Rizzo, Stefania

    2012-01-01

    Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a heart muscle disorder characterized by fibro-fatty replacement of cardiomyocytes. The cardinal manifestations are arrhythmias, sudden cardiac death, and seldom heart failure. Mutations in genes encoding desmosomal proteins and their interaction partners have been implicated in the pathogenesis of ARVC and it is now widely accepted that ARVC is a disease caused by abnormal cell–cell adhesion. The mechanism(s) by which mutations in des...

  11. Mouse models in Arrhythmogenic Right Ventricular Cardiomyopathy

    OpenAIRE

    Lodder, Elisabeth M.; Stefania eRizzo

    2012-01-01

    Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a heart muscle disorder characterized by fibrofatty replacement of cardiomyocytes. The cardinal manifestations are arrhythmias, sudden cardiac death and seldom heart failure. Mutations in genes encoding desmosomal proteins and their interaction partners have been implicated in the pathogenesis of ARVC and it is now widely accepted that ARVC is a disease caused by abnormal cell-cell adhesion due to defects in desmosomes. The mechanism(s...

  12. Diagnosis of arrhythmogenic right ventricular cardiomyopathy

    OpenAIRE

    Peters, Matthew N.; Katz, Morgan J.; Alkadri, Mohi E.

    2012-01-01

    Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an infrequently diagnosed condition with a high incidence of sudden cardiac death. While the only option for cure is orthotopic cardiac transplantation, the use of an implantable cardiac defibrillator can be life saving. Accordingly, the prompt recognition of ARVC is crucial. Fortunately, a definitive diagnosis of ARVC can often be made by a combination of the clinical history and electrocardiogram alone, as illustrated by the present ...

  13. Usefulness of equilibrium radionuclide ventriculography in the diagnosis of arrhythmogenic right ventricular dysplasia and a report of cases of a familial occurrence

    Energy Technology Data Exchange (ETDEWEB)

    Hirooka, Yoshitaka; Urabe, Yoshitoshi; Imaizumi, Tsutomu; Takeshita, Akira; Tajimi, Tsukasa; Koyanagi, Samon; Nakamura, Motoomi

    1988-06-01

    Arrhythmogenic right ventricular dysplasia (ARVD) is a recently identified clinical entity and its diagnosis rests on documentation of ventricular tachycardia (VT) of right ventricular origin and morphologic changes of the right ventricle. However, the diagnosis of ARVD is difficult noninvasively and often requires angiography. The usefulness of equilibrium radionuclide ventriculography as a noninvasive method for the diagnosis of ARVD has not been fully evaluated. We performed equilibrium radionuclide ventriculography in 7 patients with ARVD, 10 normal subjects and 9 patients with dilated cardiomyopathy (DCM). The right ventricular ejection fraction (EF) in patients with ARVD (25 +- 8 %, mean +- SD) was lower (p < 0.001) than that in normal subjects (56 +- 7 %) but was not significantly different from that in patients with DCM (32 +- 10 %). The left ventricular EF in patients with ARVD (57 +- 12 %) was lower (p < 0.05) than that in normal subjects (70 +- 7 %), but higher (p < 0.001) than that in patients with DCM (27 +- 7 %). These findings suggest that ARVD is a specific from of DCM which predominantly affects the right ventricle and that equilibrium radionuclide ventriculography may be a useful noninvasive method for the diagnosis of this disorder. In addition, we present a family in which 3 of 6 siblings were affected by ARVD, suggesting that some genetic factors may be involved in the etiology of this disorder.

  14. Displasia arritmogénica del ventrículo derecho y enfermedad del nódulo sinusal Arrhythmogenic right ventricular dysplasia and sick sinus syndrome

    Directory of Open Access Journals (Sweden)

    Domingo C. Balderramo

    2004-10-01

    Full Text Available La displasia arritmogénica del ventrículo derecho (DAVD compromete principalmente al ventrículo derecho y debe ser considerada en pacientes jóvenes que presentan síncope, taquicardia ventricular o paro cardíaco y en adultos con insuficiencia cardíaca congestiva. Las alteraciones eléctricas auriculares debidas a DAVD han sido poco descriptas. Informamos el caso de un varón de 60 años con DAVD que durante la evolución presentó enfermedad del nódulo sinusal (tiempo de recuperación del nódulo sinusal de 6113 mseg. Las arritmias auriculares se podrían explicar por el reemplazo gradual de los miocitos auriculares por tejido adiposo.Arrhythmogenic right ventricular dysplasia (ARVD involves primarily the right ventricle, and should be considered in young patients presenting with syncope, ventricular tachycardia, cardiac arrest or in adults patients with congestive heart failure. Atrial electrical abnormalities due to ARVD have been rarely described. We report a case of ARVD in a 60-year-old man who developed sick sinus syndrome during evolution (sinus node recovery time of 6113 mseg. Atrial arrhythmias may be explained by gradual replacement of right atrium myocytes by adipose tissue.

  15. Management of arrhythmogenic right ventricular cardiomyopathy.

    Science.gov (United States)

    Silvano, Maria; Mastella, Giulio; Zorzi, Alessandro; Migliore, Federico; Pilichou, Kalliopi; Bauce, Barbara; Rigato, Ilaria; Perazzolo Marra, Martina; Iliceto, Sabino; Thiene, Gaetano; Basso, Cristina; Corrado, Domenico

    2016-08-01

    Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a genetically determined heart muscle disorder, predisposing to sudden cardiac death (SCD), particularly in young patients and athletes. Pathological features include loss of myocytes and fibrofatty replacement of right ventricular myocardium; a biventricular involvement is often observed. The diagnosis of ARVC (prevalence 1:5.000 in the general population) does not rely on a single gold standard test but is achieved using a scoring system, proposed in 2010 by an International Task Force, which encompasses familial and genetic factors, ECG abnormalities, arrhythmias, and structural/functional ventricular alterations. The main goal of treatment is the prevention of SCD. Implantable cardioverter defibrillator (ICD) is the only proven "lifesaving" therapy; however, it is associated with a significant morbidity due to device-related complications and inappropriate ICD interventions. Other treatment options such as life style changes, antiarrhythmic drugs, beta-blockers and catheter ablation may reduce the arrhythmic burden and alleviate symptoms, without evident impact on prevention of SCD. Selection of patient candidates to ICD implantation is the most challenging issue in the clinical management of ARVC. This article reviews the current perspective on management of ARVC, focusing on clinical manifestations, diagnostic criteria, risk stratification and therapeutic strategies of affected patients. PMID:27186923

  16. Arrhythmogenic right ventricular cardiomyopathy as a cause of sudden death in young people: Literature review

    Directory of Open Access Journals (Sweden)

    Mazić Sanja

    2012-01-01

    Full Text Available Arrhythmogenic right ventricular cardiomyopathy/dysplasia is a progressive condition with right ventricular myocardium being replaced by fibro-fatty tissue. It is a hereditary disorder mostly caused by desmosome gene mutations. The prevalence of arrhythmogenic right ventricular cardiomyopathy is about 1/1000-5000. Clinical presentation is usually related to ventricular tachycardias, syncope or presyncopa, or ventricular fibrillation leading to cardiac arrest, mostly in young people and athletes. It may be difficult to make the diagnosis of arrhythmogenic right ventricular cardiomyopathy due to several problems arising from the specificity of electrocardiograph abnormalities, different potential etiologies of ventricular arrhythmias with a left bundle branch morphology, the assessment of the right ventricular structure and function, and the interpretation of endomyocardial biopsy findings. Therefore, standardized diagnostic criteria have been proposed by the Study Group on arrhythmogenic right ventricular cardiomyopathy of the European Society of Cardiology. In order to make the diagnosis of arrhythmogenic right ventricular cardiomyopathy, a number of clinical tests are employed, including the electrocardiogram, echocardiography, myocardial perfusion scintigraphy, myocardial biopsy, right ventricular angiography, cardiac magnetic resonance imaging and genetic testing. The therapeutic options include beta blockers, antiarrhythmic drugs, catheter ablation, and implantable cardioverter defibrillator. The implantable cardioverter defibrillator is the most effective safe-guard against arrhythmic sudden death. Preparticipation screening for sport eligibility has been proven to be effective in detecting asymptomatic patients and sport disqualification has been lifesaving, substantially declining sudden death in young athletes.

  17. Genetic bases of arrhythmogenic right ventricular cardiomyopathy

    Directory of Open Access Journals (Sweden)

    Alessandra Rampazzo

    2010-05-01

    Full Text Available Arrhythmogenic right ventricular cardiomyopathy (ARVC is a heart muscle disease in which the pathological substrate is a fibro-fatty replacement of the right ventricular myocardium. The major clinical features are different types of arrhythmias with a left branch block pattern. ARVC shows autosomal dominant inheritance with incomplete penetrance. Recessive forms were also described, although in association with skin disorders. Ten genetic loci have been discovered so far and mutations were reported in five different genes. ARVD1 was associated with regulatory mutations of transforming growth factor beta-3 (TGFβ3, whereas ARVD2, characterized by effort-induced polymorphic arrhythmias, was associated with mutations in cardiac ryanodine receptor-2 (RYR2. All other mutations identified to date have been detected in genes encoding desmosomal proteins: plakoglobin (JUP which causes Naxos disease (a recessive form of ARVC associated with palmoplantar keratosis and woolly hair; desmoplakin (DSP which causes the autosomal dominant ARVD8 and plakophilin-2 (PKP2 involved in ARVD9. Desmosomes are important cell-to-cell adhesion junctions predominantly found in epidermis and heart; they are believed to couple cytoskeletal elements to plasma membrane in cell-to-cell or cell-to-substrate adhesions.

  18. Dynamic electrocardiographic changes in patients with arrhythmogenic right ventricular cardiomyopathy.

    LENUS (Irish Health Repository)

    Quarta, Giovanni

    2010-04-01

    Electrocardiographic (ECG) abnormalities of depolarisation and repolarisation contribute to the diagnostic criteria for arrhythmogenic right ventricular cardiomyopathy (ARVC). The development of diagnostic ECG features were investigated in a genotyped cohort with ARVC to provide more sensitive markers of early disease.

  19. Advanced quantitative echocardiography in arrhythmogenic right ventricular cardiomyopathy

    DEFF Research Database (Denmark)

    Kjaergaard, Jesper; Hastrup Svendsen, Jesper; Sogaard, Peter;

    2007-01-01

    BACKGROUND: Arrhythmogenic right ventricular (RV) cardiomyopathy (ARVC) is a regional disease of the RV myocardium with variable degrees of left ventricular involvement. Three-dimensional echocardiography and Doppler tissue imaging (DTI) are new echocardiographic modalities for the evaluation...... of the longitudinal motility appears to be a sensitive marker of preclinical left ventricular involvement....

  20. Bradyarrhythmias: first presentation of arrhythmogenic right ventricular cardiomyopathy?

    Science.gov (United States)

    Burghouwt, Danielle E; Kammeraad, Janneke Ae; Knops, Paul; du Plessis, Frederik A; de Groot, Natasja Ms

    2015-04-01

    Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a disorder characterized by progressive replacement of myocardial cells by fibro-fatty tissue giving rise to ventricular tachyarrhythmias. In this case report, we describe a pediatric patient with sinoatrial arrests and second degree atrioventricular conduction block several years before ARVC became apparent. These findings suggest that bradyarrhythmias can also be the first expression of ARVC.

  1. ATIPICIDADES EN UN CASO CON DISPLASIA ARRITMOGÉNICA DEL VENTRÍCULO DERECHO O ENFERMEDAD DE UHL / Report of an atypical case with arrhythmogenic right ventricular dysplasia or Uhl´s anomaly

    Directory of Open Access Journals (Sweden)

    Aníbal González Trujillo

    2012-10-01

    Full Text Available ResumenLa displasia arritmogénica del ventrículo derecho es una miocardiopatía caracterizada por arritmias ventriculares malignas y anomalías estructurales progresivas, que afectan primariamente al ventrículo derecho. Se presenta por una sustitución progresiva parcial o masiva del miocardio por tejido adiposo o fibroadiposo. La enfermedad de Uhl puede ser una manifestación extrema y generalizada de la displasia arritmogénica del ventrículo derecho, trastorno congénito muy poco frecuente con ausencia de miocardio ventricular derecho, por lo que sus paredes son delgadas como el papel. Se comenta el caso de un paciente masculino de 56 años que presentó pérdida de conocimiento y se le realizó el diagnóstico clínico y ecocardiográfico. Se discuten las características clínicas, el diagnóstico y la conducta a seguir ante esta cardiopatía potencialmente letal en pacientes que sufren síncope, taquicardia ventricular o parada cardíaca. / AbstractArrhythmogenic right ventricular dysplasia is a cardiomyopathy characterized by malignant ventricular arrhythmias and progressive structural abnormalities, affecting primarily the right ventricle. It appears due to a partial or massive progressive replacement of the myocardium by fibroadipose or adipose tissue. Uhl's disease may be an extreme and widespread manifestation of arrhythmogenic right ventricular dysplasia, a rare congenital disorder with absence of right ventricular myocardium, so that its walls are paper thin. The case of a 56 year old male patient who had loss of consciousness and underwent clinical and echocardiographic diagnosis is presented. The clinical features, diagnosis and action to take against this potentially fatal heart disease in patients with syncope, ventricular tachycardia or cardiac arrest are discussed.

  2. Kocher-Debre-Semelaigne syndrome with arrhythmogenic right ventricular cardiomyopathy: A hitherto unrecognized association

    Directory of Open Access Journals (Sweden)

    Nagaraja Moorthy

    2012-01-01

    Full Text Available Kocher-Debre-Semelaigne (KDS syndrome is a rare form of hypothyroid myopathy, with associated hypertrophy of muscles. Although cardiac manifestations of hypothyroidism are well known, reports of cardiac involvement in KDS have only described the occurrence of pericardial effusion as an association. This report describes an adolescent male presenting with typical features of this rare syndrome along with arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D, an association not yet described in the literature.

  3. Wide spectrum of desmosomal mutations in Danish patients with arrhythmogenic right ventricular cardiomyopathy

    DEFF Research Database (Denmark)

    Christensen, A H; Benn, M; Bundgaard, H;

    2010-01-01

    Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a lethal condition characterised by ventricular tachyarrhythmias, right and/or left ventricular involvement and fibrofatty infiltrations in the myocardium. The disease has been associated with mutations in genes encoding desmosomal proteins....

  4. Arrhythmogenic right ventricular cardiomyopathy, clinical manifestations, and diagnosis.

    Science.gov (United States)

    Haugaa, Kristina H; Haland, Trine F; Leren, Ida S; Saberniak, Jørg; Edvardsen, Thor

    2016-07-01

    This review aims to give an update on the pathogenesis, clinical manifestations, and diagnosis of arrhythmogenic right ventricular cardiomyopathy (ARVC). Arrhythmogenic right ventricular cardiomyopathy is mainly an autosomal dominant inherited disease linked to mutations in genes encoding desmosomes or desmosome-related proteins. Classic symptoms include palpitations, cardiac syncope, and aborted cardiac arrest due to ventricular arrhythmias. Heart failure may develop in later stages. Diagnosis is based on the presence of major and minor criteria from the Task Force Criteria revised in 2010 (TFC 2010), which includes evaluation of findings from six different diagnostic categories. Based on this, patients are classified as having possible, borderline, or definite ARVC. Imaging is important in ARVC diagnosis, including both echocardiography and cardiac magnetic resonance imaging for detecting structural and functional abnormalities, but importantly these findings may occur after electrical alterations and ventricular arrhythmias. Electrocardiograms (ECGs) and signal-averaged ECGs are analysed for depolarization and repolarization abnormalities, including T-wave inversions as the most common ECG alteration. Ventricular arrhythmias are common in ARVC and are considered a major diagnostic criterion if originating from the RV inferior wall or apex. Family history of ARVC and detection of an ARVC-related mutation are included in the TFC 2010 and emphasize the importance of family screening. Electrophysiological studies are not included in the diagnostic criteria, but may be important for differential diagnosis including RV outflow tract tachycardia. Further differential diagnoses include sarcoidosis, congenital abnormalities, myocarditis, pulmonary hypertension, dilated cardiomyopathy, and athletic cardiac adaptation, which may mimic ARVC. PMID:26498164

  5. Cardiac sarcoidosis mimicking right ventricular dysplasia.

    Science.gov (United States)

    Shiraishi, Jun; Tatsumi, Tetsuya; Shimoo, Kazutoshi; Katsume, Asako; Mani, Hiroki; Kobara, Miyuki; Shirayama, Takeshi; Azuma, Akihiro; Nakagawa, Masao

    2003-02-01

    A 59-year-old woman with skin sarcoidosis was admitted to hospital for assessment of complete atrioventricular block. Cross-sectional echocardiography showed that the apical free wall of the right ventricle was thin and dyskinetic with dilation of the right ventricle. Thallium-201 myocardial imaging revealed a normal distribution. Both gallium-67 and technetium-99m pyrophosphate scintigraphy revealed no abnormal uptake in the myocardium. Right ventriculography showed chamber dilation and dyskinesis of the apical free wall, whereas left ventriculography showed normokinesis, mimicking right ventricular dysplasia. Cardiac sarcoidosis was diagnosed on examination of an endomyocardial biopsy specimen from the right ventricle. A permanent pacemaker was implanted to manage the complete atrioventricular block. After steroid treatment, electrocardiography showed first-degree atrioventricular block and echocardiography revealed an improvement in the right ventricular chamber dilation. Reports of cardiac sarcoidosis mimicking right ventricular dysplasia are extremely rare and as this case shows, right ventricular involvement may be one of its manifestations.

  6. Imaging of programmed cell death in arrhythmogenic right ventricle cardiomyopathy/dysplasia

    Energy Technology Data Exchange (ETDEWEB)

    Campian, Maria E. [Academic Medical Center, University of Amsterdam, Heart Failure Research Center, Amsterdam (Netherlands); Tan, Hanno L. [Academic Medical Center, University of Amsterdam, Heart Failure Research Center, Amsterdam (Netherlands); Academic Medical Center, University of Amsterdam, Department of Cardiology, Amsterdam (Netherlands); Moerkerken, Astrid F. van; Eck-Smit, Berthe L.F. van; Verberne, Hein J. [Academic Medical Center, University of Amsterdam, Department of Nuclear Medicine, PO box 22700, Amsterdam (Netherlands); Tukkie, Raymond [Department of Cardiology, Kennemer Gasthuis, Haarlem (Netherlands)

    2011-08-15

    Arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) is a myocardial disease that predominantly affects the right ventricle (RV). Its hallmark feature is fibrofatty replacement of the RV myocardium. Apoptosis in ARVC/D has been proposed as an important process that mediates the slow, ongoing loss of heart muscle cells which is followed by ventricular dysfunction. We aimed to establish whether cardiac apoptosis can be assessed noninvasively in patients with ARVC/D. Six patients fulfilling the ARVC/D criteria were studied. Regional myocardial apoptosis was assessed with {sup 99m}Tc-annexin V scintigraphy. Overall, the RV wall showed a higher {sup 99m}Tc-annexin V signal than the left ventricular wall (p = 0.049) and the interventricular septum (p = 0.026). However, significantly increased uptake of {sup 99m}Tc-annexin V in the RV was present in only three of the six ARVC/D patients (p = 0.001, compared to {sup 99m}Tc-annexin V uptake in the RV wall of the other three patients). Our results are suggestive of a chamber-specific apoptotic process. Although the role of apoptosis in ARVC/D is unsolved, the ability to assess apoptosis noninvasively may aid in the diagnostic course. In addition, the ability to detect apoptosis in vivo with {sup 99m}Tc-annexin V scintigraphy might allow individual monitoring of disease progression and response to diverse treatments aimed at counteracting ARVC/D progression. (orig.)

  7. Usefulness of immunostaining for plakoglobin as a diagnostic marker of arrhythmogenic right ventricular cardiomyopathy

    DEFF Research Database (Denmark)

    Munkholm, Julie; Christensen, Alex H; Svendsen, Jesper H;

    2012-01-01

    The clinical diagnosis of arrhythmogenic right ventricular cardiomyopathy (ARVC) is often challenging due to phenotypic variation, reduced/age-related penetrance, and lack of a diagnostic test. A single report has suggested quantitative myocardial immunoanalysis for the desmosomal protein...

  8. Case study of right ventricle arrhythmogenic dysplasia within one family

    Directory of Open Access Journals (Sweden)

    Bockeria L. A.

    2012-03-01

    Elder child had manifestations of end-stage heart failure which required heart transplantation associated with using the assisted circulation system. The second child manifested heart rhythm and conduction disturbances along with reduction of right ventricular myocardial contractility. He underwent subsequent implantation of cardioverter-defibrillator. The youngest child had no clinical signs of the disease.

  9. Clinical and familial study of arrhythmogenic right ventricular cardiomyopathy

    Institute of Scientific and Technical Information of China (English)

    单其俊; 曹克将; 黄元铸; 廖铭扬; 陈明龙; 李闻奇; 邹建刚; 朱必顺; 马文珠

    2001-01-01

    Objective To explore the characteristics of arrhythmogenic rightventricular cardiomyopathy (ARVC). Methods Seven patients with arrhythmogenic right ventricular cardiomyopathy and 34 members of three families were studied. All patients and family members underwent history collection, clinical examination, electrocardiogram (ECG), two-dimensional echocardiography (2-DE) and a signal averaging electrocardiogram. Programmed ventricular stimulation was performed in five patients. Results All patients and family members had normal morphologic characteristics and normal function of the left ventricular by 2-DE. Fourteen persons had abnormal findings indicating ARVC. Five had enlargement of the right ventricular with diffused hypocontractility, eight had thin and systolic bulging in the focal anterior wall with hypokinesia and one had bulging of the inferior wall. Twenty-five persons (seven patients and 18 family members) had abnormal findings in ECG. Positive ventricular late potential was recorded in 13 persons (six patients). Two to three monomorphic ventricular tachycardia (VT) with left bundle branch block (LBBB) configurations were induced in five patients. Ventricular fibrillation was induced in two patients during the electrophysiologic study (EPS). Five patients had very high pacing threshold and/or ineffective pacing in one or many regions of the right ventricle. Two members of one family died suddenly. One member was a dwarf with ARVC. Spontaneous VT with a left bundle branch block (LBBB) configuration was recorded in five patients, polymorphic VT with extremely short coupling interval in one, and premature ventricular complexes with LBBB configuration in 12 (six patients). Conclusion Our familial study strongly suggests that ARVC may be a hereditary disease and it is helpful in the diagnosis and detection of ARVC. The most common manifestations were abnormal structure and function of the right ventricle and abnormal ECG of repolarization and ventricular

  10. Microvascular dysfunction in nonfailing arrhythmogenic right ventricular cardiomyopathy

    Energy Technology Data Exchange (ETDEWEB)

    Paul, Matthias [University Hospital Muenster, Department of Cardiology and Angiology, Muenster (Germany); University Hospital Muenster, Institute for Genetics of Heart Diseases, Muenster (Germany); Rahbar, Kambiz; Kies, Peter; Schober, Otmar [University Hospital Muenster, Department of Nuclear Medicine, Muenster (Germany); Gerss, Joachim [University of Muenster, Institute of Biostatistics and Clinical Research, Muenster (Germany); Schaefers, Klaus; Schaefers, Michael [University of Muenster, European Institute for Molecular Imaging - EIMI, Muenster (Germany); Breithardt, Guenter [University Hospital Muenster, Department of Cardiology and Angiology, Muenster (Germany); Schulze-Bahr, Eric [University Hospital Muenster, Institute for Genetics of Heart Diseases, Muenster (Germany); Wichter, Thomas [Marienhospital Osnabrueck, Department of Cardiology, Niels-Stensen-Kliniken, Osnabrueck (Germany)

    2012-03-15

    Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a nonischaemic cardiomyopathy and leading cause of sudden death in the young. It has been shown that microvascular dysfunction reflected by an impaired myocardial blood flow (MBF) response to stress is present in patients with other forms of nonischaemic cardiomyopathy, e.g. dilated cardiomyopathy, and that the reduced MBF may be related to a poor prognosis. Therefore, we quantified MBF, coronary flow reserve and coronary vascular resistance in patients with nonfailing ARVC using H{sub 2}{sup 15} O and PET. In ten male patients with ARVC (mean age 49 {+-} 14 years), MBF was quantified at rest and during adenosine-induced hyperaemia using H{sub 2}{sup 15} O PET. Results were compared with those obtained in 20 age-matched healthy male control subjects (mean age 46 {+-} 14 years). Resting MBF was not significantly different between patients with ARVC and controls (MBF{sub rest} 1.19 {+-} 0.29 vs. 1.12 {+-} 0.20 ml/min/ml). However, hyperaemic MBF was significantly lower in patients with ARVC than in controls (2.60 {+-} 0.96 vs. 3.68 {+-} 0.84 ml/min/ml; p = 0.005). Consequently, patients with ARVC had a significantly lower coronary flow reserve than control subjects (2.41 {+-} 1.34 vs. 3.39 {+-} 0.93; p = 0.030). In addition, hyperaemic coronary vascular resistance was increased in patients with ARVC (36.79 {+-} 12.91 vs. 26.31 {+-} 6.49 mmHg x ml{sup -1} x min x ml; p = 0.007), but was found to be unchanged at rest. In this small well-characterized cohort of patients with nonfailing ARVC, we found a significantly reduced hyperaemic MBF and increased coronary vascular resistance. Further studies are necessary to corroborate this potential new functional aspect of the pathophysiological mechanisms underlying ARVC. (orig.)

  11. Arrhythmogenic cardiomyopathy : diagnosis, genetic background, and risk management

    NARCIS (Netherlands)

    Groeneweg, J. A.; van der Heijden, J. F.; Dooijes, D.; van Veen, T. A. B.; van Tintelen, J. P.; Hauer, R. N.

    2014-01-01

    Arrhythmogenic cardiomyopathy (AC), also known as arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C), is a hereditary disease characterised by ventricular arrhythmias, right ventricular and/or left ventricular dysfunction, and fibrofatty replacement of cardiomyocytes. Patients with A

  12. Abnormal atrial activation is common in patients with arrhythmogenic right ventricular cardiomyopathy

    DEFF Research Database (Denmark)

    Platonov, Pyotr G; Christensen, Alex H; Holmqvist, Fredrik;

    2011-01-01

    INTRODUCTION: Structural right atrial abnormalities have been described in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC). However, little is known about electrocardiographic signs of atrial involvement in ARVC because no systematic studies have been conducted. METHODS: P......%, whereas 15 patients (37%) had atypical P-wave positive in all 3 leads (P right ventricular abnormality. CONCLUSIONS: Patients with ARVC commonly demonstrate deteriorated...... atrial activation expressed either as prolonged P-wave duration or abnormal P-wave morphology. The P-wave abnormalities were not secondary to right ventricular dilatation. These findings show that atrial involvement is common in ARVC and may represent yet another manifestation of the disease...

  13. Management of patients with Arrhythmogenic Right Ventricular Cardiomyopathy in the Nordic countries

    DEFF Research Database (Denmark)

    Haugaa, Kristina H; Bundgaard, Henning; Edvardsen, Thor;

    2015-01-01

    OBJECTIVES: Diagnostics of patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) are complex, and based on the 2010 Task Force document including different diagnostic modalities. However, recommendations for clinical management and follow-up of patients with ARVC and their relatives...... the need of anti-arrhythmic therapy and ICD implantation. Mutation-positive family members should be followed regularly for detection of early disease and risk stratification of ventricular arrhythmias....

  14. Transcatheter closure of atrial septal defect associated with arrhythmogenic right ventricular cardiomyopathy: a case report and literature review.

    Science.gov (United States)

    Wang, Haiyan; Ding, Hongyu; Lei, Lei; Zhang, Xiaohong; Gong, Yuling; Hou, Yinglong

    2015-03-01

    Arrhythmogenic right ventricular cardiomyopathy is characterised by progressive, fibrofatty replacement of myocardium, and ventricular arrhythmias, and its prognosis is usually poor. Arrhythmogenic right ventricular cardiomyopathy associated with atrial septal defect is very rare, and this combination may make the diagnosis, treatment, and prognosis difficult. We present a case of a patient with this association who underwent interventional treatment with a septal defect occluder. Transcatheter closure of atrial septal defect in a patient with arrhythmogenic right ventricular cardiomyopathy is hitherto unreported. During a 3-year follow-up he remained relatively stable. We also review the cases reported in the medical literature describing this uncommon association between arrhythmogenic right ventricular cardiomyopathy and atrial septal defect or patent foramen ovale.

  15. [Right ventricular dysplasia and dilated cardiomyopathy observed by radionuclide images].

    Science.gov (United States)

    Takamura, I; Ando, J; Miyamoto, A; Kobayashi, T; Sakamoto, S; Yasuda, H

    1985-12-01

    Four cases of right ventricular dysplasia (RVD) and 28 cases of dilated cardiomyopathy (DCM) were studied. RVD was characterized clinically by syncope, sustained recurrent ventricular tachycardia with left bundle branch block patterns on the surface electrocardiogram, and right heart failure. Furthermore, moderate to severe dilatation of the right ventricle and depressed right ventricular function were apparent on radionuclide angiography. However, left ventricular dilatation and depressed left ventricular function were documented in DCM. Right ventricular volume was proportional to left ventricular volume in DCM, however, right ventricular volume was disproportionately greater in RVD. On the T1-201 perfusion image, left ventricular perfusion defects were delineated in 10 of 26 patients with DCM, and in one of four RVD patients. During two to eight year follow-up periods, six patients died suddenly five of whom had left ventricular perfusion defects. However, in 19 patients without left ventricular perfusion defects, only one sudden death was observed. A connecting link between sudden death and left ventricular perfusion defect is suggested. PMID:3841888

  16. Nationwide (Denmark) Study of Symptoms Preceding Sudden Death due to Arrhythmogenic Right Ventricular Cardiomyopathy

    DEFF Research Database (Denmark)

    Sadjadieh, Golnaz; Jabbari, Reza; Risgaard, Bjarke;

    2014-01-01

    In this study, we investigated medical history and symptoms before death in all subjects aged 1 to 35 years who died a sudden cardiac death (SCD) from arrhythmogenic right ventricular cardiomyopathy (ARVC) in Denmark in the years 2000 to 2006. All deaths (n=6,629) in subjects aged 1 to 35 years in...... Denmark in the period 2000 to 2006 were included. A total of 16 cases of SCD due to ARVC were identified based on histopathologic examination. Information on medical history was retrieved from The National Patient Registry, general practitioners, and hospitals. Symptoms before death were compared with 2...

  17. Arrhythmogenic right ventricular cardiomyopathy: From genetics to diagnostic and therapeutic challenges

    Institute of Scientific and Technical Information of China (English)

    Bruno; Pinamonti; Francesca; Brun; Luisa; Mestroni; Gianfranco; Sinagra

    2014-01-01

    Arrhythmogenic right ventricular cardiomyopathy(ARVC) is a genetic disease characterized by myocyte loss and fibro-fatty tissue replacement. Diagnosis of ARVC remains a clinical challenge mainly at its early stages and in patients with minimal echocardiographic right ventricular(RV) abnormalities. ARVC shares some common features with other cardiac diseases, such as RV outflow ventricular tachycardia, Brugada syndrome, and myocarditis, due to arrhythmic expressivity and biventricular involvement. The identification of ARVC can be often challenging, because of the heterogeneous clinical presentation, highly variable intra- and inter-family expressivity and incomplete penetrance. This genotypephenotype “plasticity” is largely unexplained. A familial history of ARVC is present in 30% to 50% of cases, and the disease is considered a genetic cardiomyopathy, usually inherited in an autosomal dominant pattern with variable penetrance and expressivity; in addition, autosomal recessive forms have been reported(Naxos disease and Carvajal syndrome). Diagnosis of ARVC relays on a scoring system, with major or minorcriteria on the Revised Task Force Criteria. Implantable cardioverter defibrillators(ICDs) are increasingly utilized in patients with ARVC who have survived sudden death(SD)(secondary prevention). However, there are few data available to help identifying ARVC patients in whom the prophylactic implantation of an ICD is truly warranted. Prevention of SD is the primary goal of management. Pharmacologic treatment of arrhythmias, catheter ablation of ventricular tachycardia, and ICD are the mainstay of treatment of ARVC.

  18. De novo desmin-mutation N116S is associated with arrhythmogenic right ventricular cardiomyopathy.

    Science.gov (United States)

    Klauke, Baerbel; Kossmann, Sabine; Gaertner, Anna; Brand, Kristina; Stork, Ines; Brodehl, Andreas; Dieding, Mareike; Walhorn, Volker; Anselmetti, Dario; Gerdes, Désirée; Bohms, Birte; Schulz, Uwe; Zu Knyphausen, Edzard; Vorgerd, Matthias; Gummert, Jan; Milting, Hendrik

    2010-12-01

    Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an inherited heart muscle disease, frequently accompanied by sudden cardiac death and terminal heart failure. Genotyping of ARVC patients might be used for palliative treatment of the affected family. We genotyped a cohort of 22 ARVC patients referred to molecular genetic screening in our heart center for mutations in the desmosomal candidate genes JUP, DSG2, DSC2, DSP and PKP2 known to be associated with ARVC. In 43% of the cohort, we found disease-associated sequence variants. In addition, we screened for desmin mutations and found a novel desmin-mutation p.N116S in a patient with ARVC and terminal heart failure, which is located in segment 1A of the desmin rod domain. The mutation leads to the aggresome formation in cardiac and skeletal muscle without signs of an overt clinical myopathy. Cardiac aggresomes appear to be prominent, especially in the right ventricle of the heart. Viscosimetry and atomic force microscopy of the desmin wild-type and N116S mutant isolated from recombinant Escherichia coli revealed severe impairment of the filament formation, which was supported by transfections in SW13 cells. Thus, the gene coding for desmin appears to be a novel ARVC gene, which should be included in molecular genetic screening of ARVC patients.

  19. Association of competitive and recreational sport participation with cardiac events in patients with arrhythmogenic right ventricular cardiomyopathy

    DEFF Research Database (Denmark)

    Ruwald, Anne-Christine; Marcus, Frank; Estes, N A Mark;

    2015-01-01

    AIMS: It has been proposed that competitive sport increases the risk of ventricular tachyarrhythmias (VTA) and death in patients with arrhythmogenic right-ventricular cardiomyopathy (ARVC). However, it is unknown whether this only applies to competitive sport or if recreational sports activity also...... participated in recreational sport (38 ± 17 years) (P = 0.015) and inactive patients (41 ± 11 years) (P = 0.002). No difference in age at first symptom was seen between patients who participated in recreational sport and inactive patients (P = 0.651). CONCLUSION: Competitive sport was associated with a two...

  20. The right heart in athletes. Evidence for exercise-induced arrhythmogenic right ventricular cardiomyopathy.

    Science.gov (United States)

    Heidbüchel, H; La Gerche, A

    2012-06-01

    Although 'athlete's heart' usually constitutes a balanced dilation and hypertrophy of all four chambers, there is increasing evidence that intense endurance activity may particularly tax the right ventricle (RV), both acutely and chronically. We review the evidence that the high wall stress of the RV during intense sports may explain observed B-type natriuretic peptide (BNP) elevations immediately after a race, may lead to cellular disruption and leaking of cardiac enzymes, and may even result in transient RV dilatation and dysfunction. Over time, this could lead to chronic remodelling and a pro-arrhythmic state resembling arrhythmogenic RV cardiomyopathy (ARVC) in some cases. ARVC in high-endurance athletes most often develops in the absence of underlying desmosomal abnormalities, probably only as a result of excessive RV wall stress during exercise. Therefore, we have labelled this syndrome 'exercise-induced ARVC'. Sports cardiologists should be aware that excessive sports activity can lead to cardiac sports injuries in some individuals, just like orthopaedic specialists are familiar with musculoskeletal sports injuries. This does not negate the fact that moderate exercise has positive cardiovascular effects and should be encouraged. PMID:22782727

  1. In vitro functional analyses of arrhythmogenic right ventricular cardiomyopathy-associated desmoglein-2-missense variations.

    Directory of Open Access Journals (Sweden)

    Anna Gaertner

    Full Text Available BACKGROUND: Although numerous sequence variants in desmoglein-2 (DSG2 have been associated with arrhythmogenic right ventricular cardiomyopathy (ARVC, the functional impact of new sequence variations is difficult to estimate. METHODOLOGY/PRINCIPAL FINDINGS: To test the functional consequences of DSG2-variants, we established an expression system for the extracellular domain and the full-length DSG2 using the human cell line HT1080. We established new tools to investigate ARVC-associated DSG2 variations and compared wild-type proteins and proteins with one of the five selected variations (DSG2-p.R46Q, -p.D154E, -p.D187G, -p.K294E, -p.V392I with respect to prodomain cleavage, adhesion properties and cellular localisation. CONCLUSIONS/SIGNIFICANCE: The ARVC-associated DSG2-p.R46Q variation was predicted to be probably damaging by bioinformatics tools and to concern a conserved proprotein convertase cleavage site. In this study an impaired prodomain cleavage and an influence on the DSG2-properties could be demonstrated for the R46Q-variant leading to the classification of the variant as a potential gain-of-function mutant. In contrast, the variants DSG2-p.K294E and -p.V392I, which have an arguable impact on ARVC pathogenesis and are predicted to be benign, did not show functional differences to the wild-type protein in our study. Notably, the variants DSG2-p.D154E and -p.D187G, which were predicted to be damaging by bioinformatics tools, had no detectable effects on the DSG2 protein properties in our study.

  2. In Vitro Functional Analyses of Arrhythmogenic Right Ventricular Cardiomyopathy-Associated Desmoglein-2-Missense Variations

    Science.gov (United States)

    Gaertner, Anna; Klauke, Baerbel; Stork, Ines; Niehaus, Karsten; Niemann, Gesa; Gummert, Jan; Milting, Hendrik

    2012-01-01

    Background Although numerous sequence variants in desmoglein-2 (DSG2) have been associated with arrhythmogenic right ventricular cardiomyopathy (ARVC), the functional impact of new sequence variations is difficult to estimate. Methodology/Principal Findings To test the functional consequences of DSG2-variants, we established an expression system for the extracellular domain and the full-length DSG2 using the human cell line HT1080. We established new tools to investigate ARVC-associated DSG2 variations and compared wild-type proteins and proteins with one of the five selected variations (DSG2-p.R46Q, -p.D154E, -p.D187G, -p.K294E, -p.V392I) with respect to prodomain cleavage, adhesion properties and cellular localisation. Conclusions/Significance The ARVC-associated DSG2-p.R46Q variation was predicted to be probably damaging by bioinformatics tools and to concern a conserved proprotein convertase cleavage site. In this study an impaired prodomain cleavage and an influence on the DSG2-properties could be demonstrated for the R46Q-variant leading to the classification of the variant as a potential gain-of-function mutant. In contrast, the variants DSG2-p.K294E and -p.V392I, which have an arguable impact on ARVC pathogenesis and are predicted to be benign, did not show functional differences to the wild-type protein in our study. Notably, the variants DSG2-p.D154E and -p.D187G, which were predicted to be damaging by bioinformatics tools, had no detectable effects on the DSG2 protein properties in our study. PMID:23071725

  3. Genome-wide association identifies a deletion in the 3’ untranslated region of Striatin in a canine model of arrhythmogenic right ventricular cardiomyopathy

    Science.gov (United States)

    Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a familial cardiac disease characterized by rapid ventricular tachycardia and sudden cardiac death. It is most frequently inherited as an autosomal dominant trait with incomplete and age-related penetrance and variable clinical expression. Th...

  4. Is cardiac MRI an effective test for arrhythmogenic right ventricular cardiomyopathy diagnosis?

    Institute of Scientific and Technical Information of China (English)

    Santhi; Chellamuthu; Alyson; M; Smith; Steven; M; Thomas; Catherine; Hill; Peter; W; G; Brown; Abdallah; Al-Mohammad

    2014-01-01

    AIM:To evaluate the referrals with suspected arrhythmogenic right ventricular cardiomyopathy(ARVC)and compare cardiac MR(cMR)findings against clinical diagnosis.METHODS:A retrospective analysis of 114(age range16 to 83,males 55%and females 45%)patients referred for cMR with a suspected diagnosis of ARVC between May 2006 and February 2010 was performed after obtaining institutional approval for service evaluation.Reasons for referral including clinical symptoms and family history of sudden death,electrocardiogram and echo abnormalities,cMR findings,final clinical diagnosis and information about clinical management were obtained.The results of cMR were classified as major,minor,non-specific or negative depending on both functional and tissue characterisation and the cMR results were compared against the final clinical diagnosis.RESULTS:The most common reasons for referral included arrhythmias(30%)and a family history of sudden death(20%).Of the total cohort of 114 patients:4 patients(4%)had major cMR findings for ARVC,13patients(11%)had minor cMR findings,2 patients had non-specific cMR findings relating to the right ventricle and 95 patients had a negative cMR.Of the 4 patients who had major cMR findings,3(75%)had a positive clinical diagnosis.In contrast,of the 13 patients who had minor cMR findings,only 2(15%)had a positive clinical diagnosis.Out of the 95 negative patients,clinical details were available for 81 patients and none of them had ARVC.Excluding the 14 patients with no clinical data and final diagnosis,the sensitivity of the test was 100%,specificity 87%,positive predictive value29%and the negative predictive value 100%.CONCLUSION:CMR is a useful tool for ARVC evaluation because of the high negative predictive value as the outcome has a significant impact on the clinical decision-making.

  5. Predictors of appropriate ICD therapy in patients with arrhythmogenic right ventricular cardiomyopathy: long term experience of a tertiary care center.

    Directory of Open Access Journals (Sweden)

    Pia K Schuler

    Full Text Available INTRODUCTION: Arrhythmogenic right ventricular cardiomyopathy (ARVC is a rare genetically transmitted disease prone to ventricular arrhythmias. We therefore investigated the clinical, echocardiographical and electrophysiological predictors of appropriate implantable cardioverter defibrillator (ICD therapy in patients with ARVC. METHODS: A retrospective analysis was performed in 26 patients (median age of 40 years at diagnosis, 21 males and 5 females with ARVC who underwent ICD implantation. RESULTS: Over a median (range follow-up period of 10 (2.7, 37 years, appropriate ICD therapy for ventricular arrhythmias was documented in 12 (46% out of 26 patients. In all patients with appropriate ICD therapy the ICD was originally inserted for secondary prevention. Median time from ICD implantation to ICD therapy was 9 months (range 3.6, 54 months. History of heart failure was a significant predictor of appropriate ICD therapy (p = 0.033. Left ventricular disease involvement (p = 0.059 and age at implantation (p = 0.063 were borderline significant predictors. Patients with syncope at time of diagnosis were significantly less likely to receive ICD therapy (p = 0.02. Invasive electrophysiological testing was not significantly associated with appropriate ICD therapy. CONCLUSION: In our cohort of patients with ARVC, history of heart failure was a significant predictor of appropriate ICD therapy, whereas left ventricular involvement and age at time of ICD implantation were of borderline significance. These predictors should be tested in larger prospective cohorts to optimize ICD therapy in this rare cardiomyopathy.

  6. Patient's Guide to Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy

    Science.gov (United States)

    ... LIBRARY Hello, Guest! My alerts Sign In Join Facebook Twitter Home About this Journal Editorial Board General Statistics Circulation Cover Doodle → Blip the Doodle Go Red For Women's Issue Information for Advertisers Author Reprints Commercial Reprints Customer Service and Ordering ...

  7. Stop-gain mutations in PKP2 are associated with a later age of onset of arrhythmogenic right ventricular cardiomyopathy.

    Directory of Open Access Journals (Sweden)

    Mireia Alcalde

    Full Text Available BACKGROUND: Arrhythmogenic right ventricular cardiomyopathy (ARVC is a cardiac disease characterized by the presence of fibrofatty replacement of the right ventricular myocardium, which may cause ventricular arrhythmias and sudden cardiac death. Pathogenic mutations in several genes encoding mainly desmosomal proteins have been reported. Our aim is to perform genotype-phenotype correlations to establish the diagnostic value of genetics and to assess the role of mutation type in age-related penetrance in ARVC. METHODS AND RESULTS: Thirty unrelated Spanish patients underwent a complete clinical evaluation. They all were screened for PKP2, DSG2, DSC2, DSP, JUP and TMEM43 genes. A total of 70 relatives of four families were also studied. The 30 patients fulfilled definite disease diagnostic criteria. Genetic analysis revealed a pathogenic mutation in 19 patients (13 in PKP2, 3 in DSG2, 2 in DSP, and 1 in DSC2. Nine of these mutations created a truncated protein due to the generation of a stop codon. Familial assessment revealed 28 genetic carriers among family members. Stop-gain mutations were associated to a later age of onset of ARVC, without differences in the severity of the pathology. CONCLUSIONS: Familial genetic analysis helps to identify the cause responsible for the pathology. In discrepancy with previous studies, the presence of a truncating protein does not confer a worse severity. This information could suggest that truncating proteins may be compensated by the normal allele and that missense mutations may act as poison peptides.

  8. Arrhythmogenic cardiomyopathy: diagnosis, genetic background, and risk management

    OpenAIRE

    Groeneweg, J. A.; van der Heijden, J. F.; Dooijes, D.; van Veen, T.A.B.; van Tintelen, J.P.; Hauer, R.N.

    2014-01-01

    Arrhythmogenic cardiomyopathy (AC), also known as arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C), is a hereditary disease characterised by ventricular arrhythmias, right ventricular and/or left ventricular dysfunction, and fibrofatty replacement of cardiomyocytes. Patients with AC typically present between the second and the fourth decade of life with ventricular tachycardias. However, sudden cardiac death (SCD) may be the first manifestation, often at young age in the con...

  9. New Features of Electrocardiogram in a Case Report of Arrhythmogenic Right Ventricular Cardiomyopathy: A Care-Compliant Article.

    Science.gov (United States)

    Pei, Haifeng; Yu, Qiujun; Su, Xiaohua; Wang, Zhen; Zhao, Heng; Yang, Dachun; Yang, Yongjian; Li, De

    2016-04-01

    Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a crucial health problem. With sudden death often being the first presentation, early diagnosis for ARVC is essential. Up to date, electrocardiogram (ECG) is a widely used diagnostic method without invasive harms. To diagnose and treat ARVC as well as possible, we should clearly elucidate its pathophysiological alterations. A 66-year-old farmer presented to the Emergency Department with continuous palpitation, chest tightness, profuse sweating, and nausea with no obvious predisposing causes. An ECG indicated ventricular tachycardia (VT). The patient experienced a sudden drop in blood pressure and acute confusion. After an immediate electrical conversion, his consciousness was gradually restored, and symptoms relieved. The patient was then transferred to the Department of Cardiology to receive ECG, echocardiography, coronary angiogram, biochemical assays, endocardiac tracing, and radiofrequency ablation. In the end, he was diagnosed with ARVC, evidenced by bilateral ventricle dilation and epsilon waves in leads V1-V3. Appropriate therapies were provided for this patient including pharmacological intervention and radiofrequency ablation. Although the diagnosis of ARVC is not difficult, this patient's ECG manifested several interesting features and should be further investigated: T wave inversions were found extensively in the anterior and inferior leads, revealing the involvement of bilateral ventricles; VTs with different morphologies and cycle lengths were found, and some VTs manifested the feature of irregularly irregular rhythm, reminding us to carefully differentiate some special VTs from atrial fibrillation (AF); and epsilon waves gradually appeared in leads V1-V3 and avR since the onset of ARVC. Most importantly, the epsilon waves behind QRS complex appeared in both sinus rhythm and ventricular premature beats/VT originating from cardiac apex, whereas the epsilon waves prior to QRS complex occurred in

  10. Mutation analysis and evaluation of the cardiac localization of TMEM43 in arrhythmogenic right ventricular cardiomyopathy

    DEFF Research Database (Denmark)

    Christensen, A H; Andersen, C B; Tybjærg-Hansen, A;

    2011-01-01

    ventricular cardiomyopathy (ARVC). We aimed at performing mutational analysis of the gene and characterizing the associated immunohistochemical features. Sixty-five unrelated patients (55 fulfilling Task Force criteria and 10 borderline cases) were screened for mutations in TMEM43. Immunohistochemistry......; in two related patients) and one novel variant (c.705+ 7G> A; in one patient) of unknown significance. All three patients fulfilled Task Force criteria and did not carry mutations in any other ARVC-related gene. Immunostaining with TMEM43 antibody showed intense staining of the sarcolemma. The signal...

  11. Impact of New Electrocardiographic Criteria in Arrhythmogenic Cardiomyopathy

    OpenAIRE

    Richard NW Hauer; Moniek eCox; Judith eGroeneweg

    2012-01-01

    Arrhythmogenic cardiomyopathy (AC) has originally been described as a disorder characterized by fibrofatty replacement of the myocardium, primarily of the right ventricle (RV), and ventricular tachyarrhythmias, sudden death, and at a late stage progressive heart failure. Arrhythmogenic right ventricular dysplasia or cardiomyopathy (ARVD/C) was the previous name of the disease. However, similar histopathologic changes are also found in the left ventricle (LV). AC is also considered a hereditar...

  12. Vigorous physical activity impairs myocardial function in patients with arrhythmogenic right ventricular cardiomyopathy and in mutation positive family members

    DEFF Research Database (Denmark)

    Saberniak, Jørg; Hasselberg, Nina E; Borgquist, Rasmus;

    2014-01-01

    patients and 45 mutation-positive family members. Athletes were defined as subjects with ≥4 h vigorous exercise/week [≥1440 metabolic equivalents (METs × minutes/week)] during a minimum of 6 years. Athlete definition was fulfilled in 37/110 (34%) subjects. We assessed right ventricular (RV) and left...

  13. Persistently elevated right ventricular index of myocardial performance in preterm infants with incipient bronchopulmonary dysplasia.

    Directory of Open Access Journals (Sweden)

    Christoph Czernik

    Full Text Available OBJECTIVES: Elevated pulmonary vascular resistance occurs during the first days after birth in all newborn infants and persists in infants at risk for bronchopulmonary dysplasia (BPD. It is difficult to measure in a non-invasive fashion. We assessed the usefulness of the right ventricular index of myocardial performance (RIMP to estimate pulmonary vascular resistance in very low birth weight infants. STUDY DESIGN: Prospective echocardiography on day of life (DOL 2, 7, 14, and 28 in 121 preterm infants (median [quartiles] gestational age 28 [26]-[29] weeks, birth weight 998 [743-1225] g of whom 36 developed BPD (oxygen supplementation at 36 postmenstrual weeks. RESULTS: RIMP derived by conventional pulsed Doppler technique was unrelated to heart rate or mean blood pressure. RIMP on DOL 2 was similar in infants who subsequently did (0.39 [0.33-0.55] and did not develop BPD (0.39 [0.28-0.51], p = 0.467. RIMP declined steadily in non-BPD infants but not in BPD infants (DOL 7: 0.31[0.22-0.39] vs. 0.35[0.29-0.48], p = 0.014; DOL 14: 0.23[0.17-0.30] vs. 0.35[0.25-0.43], p<0.001; DOL 28: 0.21[0.15-0.28] vs. 0.31 [0.21-0.35], p = 0.015. CONCLUSIONS: In preterm infants, a decline in RIMP after birth was not observed in those with incipient BPD. The pattern of RIMP measured in preterm infants is commensurate with that of pulmonary vascular resistance.

  14. 致心律失常性右室心肌病的临床分析%Clinical analysis of arrhythmogenic right ventricular cardiomyopathy

    Institute of Scientific and Technical Information of China (English)

    王彩虹; 杨向军

    2012-01-01

    目的 探讨致心律失常性右室心肌病(ARVC)的临床特点.方法 回顾分析符合欧洲心脏病协会ARVC诊断标准的15例患者的临床表现、心电图、超声心动图、MRI及电生理检查等,评价ARVC的检查手段及治疗方法.结果 15例患者均有心悸,其中13例有晕厥,有右室扩大及明确右室心力衰竭临床表现者7例.5例静息心电图出现Epsilon波,10例表现为平均QRS时程延长(≥110 ms),13例记录到室性心动过速.15例患者超声心动图均提示右室受累.治疗上以药物治疗为主,经导管射频消融治疗者2例,1例患者植入ICD.结论 ARVC临床表现隐匿,典型者常以反复发作性室性心动过速、晕厥、猝死为首发症状,部分呈家族遗传倾向.Epsilon波、右胸导联QRS波时限≥110 ms及T波倒置是其特征性心电图表现.经导管射频消融治疗室性心动过速成功率低,药物治疗效果不佳,埋藏式心脏转复除颤器治疗较为可行.%Objective To study the clinical feature of arrhythmogenic right ventricular cardiomyopathy ( ARVC ). Methods Fifteen patients with ARVC were involved in our study according to the diagnosis criteria published by European Society of Cardiology. The clinical data including the clinical manifestations, ECG, echocardiogram, MRI and electrophysiology study was investigated retrospectively. Results All the patients experienced palpitation attack and syncope in 13 patients, dilated right ventricle and heart failure in 7 patients. Seen from the ECG we can find the Epsilon waves in 5 patients, a QRS duration ≥ 110 ms in right precordial leads in 10 patients, ventricular tachycardia in 13 patients. The echocardiogram showed right ventricle involved in 15 patients. Drug therapy was the main treatment, 2 patients underwent radiofrequence catheter ablation, 1 patient implanted ICD. Conclusion The clinical manifestations of ARVC are delitescence. The common symptoms include recurrent ventricular tachycardia

  15. 致心律失常性右室心肌病21例临床分析%Clinical study on arrhythmogenic right ventricular vardiomyopathy

    Institute of Scientific and Technical Information of China (English)

    王倩英

    2016-01-01

    目的 探讨致心律失常性右室心肌病(ARVC)的临床表现、心电图、影像学检查及治疗情况.方法 回顾性分析2007年至2014年收治的21例致心律失常性右室心肌病患者的资料,均符合2010年国际专家组《欧洲心脏杂志》再次修订的ARVC诊断标准,总结其临床特征及治疗情况.结果 21例患者主要表现为心悸、头晕、胸闷、气促者11例,心悸、反复晕厥者7例,窦房结功能障碍l例,体检发现右心增大2例,均出现室性心律失常,右胸导QRS平均间期大于左胸导,12例患者V1 ~3导出现Epsilon波,超声心动图及MRI示右心室增大,室壁局灶性变薄,心肌致密化不全,右室心尖部、流出道、前壁脂肪浸润,收缩功能减弱.8例导管射频消融患者即刻成功5例,2例置入ICD后产生有效放电干预,其余患者长期应用药物治疗.结论 ARVC临床表现无特异性,早期诊断困难,应提高疾病认识,综合分析家族史、临床表现、心电图及影像学检查等,选择合适治疗方法,提高诊疗效果.%Objective To investigate the clinical manifestation, electrocardiogram, imageological examination and treatment conditions of arrhythmogenic right ventricular vardiomyopathy(ARVC).Methods Retrospectively analyzed the clinical data of 21 patients with ARVC who were treated in the Fourth People' s Hospital of Shangqiu from February 2007 to March 2014.All of them conformed to ARVC diagnostic criteria which amended again by international expert group in "European Heart Journal" in 2010, and also summarized their clinical features and treatment conditions.Results Among the 21 cases, 11 patients had major performances with palpitation, dizzy giddy, chest congestion and anhelation, 7 patients with palpitation and recurrent syncope, 1 patient with sinus node dysfunction, and 2 patients with right heart enlargement though medical examination, all of them had the performance of ventricular arrhythmias.The QRS average period

  16. 致心律失常性右心室心肌病致病蛋白的挖掘%Mining Arrhythmogenic Right Ventricular Cardiomyopathy Potential Disease Protein

    Institute of Scientific and Technical Information of China (English)

    崔丹; 闫玉清; 李琬; 陈丽娜; 李为国; 太京燮; 张良才; 宿滨; 李心玲

    2012-01-01

    Objective: Identification of disease proteins is important to understand the mechanism of Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC). Computational biological methods can be used to mine potential disease proteins in disease-related network. Methods: We integrated protein-protein interaction data from HPRD and BioGRID databases to obtain a more comprehensive and trustworthy protein-protein interaction data. The method of text mining combined with statistical tests was used to screen ARVC candidate proteins. ARVC-Protein-Protein Interaction Network (PPIN) was built through the nearest-neighbor expansion method and weighted each protein pair in the network using PRINCESS. Then an ARVC-related score strategy was presented to rank each protein of the network. Results: Top 50 candidate proteins were analyzed, and most candidate proteins were closely associated with ARVC, such as PRKCA, CDH1, SMAD4, SMAD2, CDH5, CTNNA1, DSC1. They played an important role in regulating myocardial contractility, cell degeneration, heart development and maintaining the integrity of desmosomes. Conclusions: Our approach reported here provides new insights for the identification of disease genes, and will be helpful for the studies on the pathogenesis of ARVC in depth.%目的:鉴定疾病蛋白对深入理解致心律失常性右心室心肌病(ARVC)致病机制至关重要.可以采用计算生物学的方法,在ARVC疾病相关网络中挖掘新的潜在的致病蛋白.方法:本文整合HPRD和BioGRID的蛋白质互作数据,获得了较为全面且真实可靠的蛋白质互作数据;通过结合文本挖掘和统计学检验筛选出ARVC种子蛋白,应用最近邻居扩增的方法,构建ARVC蛋白质互作网络(PPIN),并采用PRINCESS法则对网络中每对互作蛋白加权;最后,基于ARVC关联得分策略对网络中的每个蛋白质打分并排秩.结果:分析发现排秩前50的候选蛋白大都与ARVC关系密切,如PRKCA,CDH1,SMAD4,SMAD2,CDH5,CTNNA1,DSC1

  17. Ventricular Tachycardia in the Young Athlete: A Systematic Approach to Selection of Drug Therapy.

    Science.gov (United States)

    Podrid, Philip J.

    1986-01-01

    Sustained ventricular tachyarrythmias are uncommon in young people, and underlying heart disease is usually present. This article presents a case study of a 24-year-old male athlete with arrhythmogenic right ventricular dysplasia and points out the value of combinations of drugs versus the use of a single agent. (MT)

  18. Prevalence of Epsilan wave in patients with arrhythmogenic right ventricular cardiomyopathy%致心律失常性右室心肌病患者Epsilon波的检出率

    Institute of Scientific and Technical Information of China (English)

    王静; 居维竹; 陈凯; 曹克将; 杨兵; 陈明龙; 单其俊; 邹建刚; 陈椿; 张凤祥; 侯晓峰; 陈红武

    2009-01-01

    目的 探讨不同体表心电图记录方法对国人致心律失常性有室心肌病(arrhythmogenic right ventricular eardiomyopathy,ARVC)患者Epsilon波检出率的影响.方法 共人选ARVC患者32例,男性24例,女性8例,年龄18~70(42.3±13.3)岁.于安静仰卧位记录窦性心律情况下的标准12导联同步心电图(standard twelve leads electrocardiography,S-ECG)、右胸导联心电图(right precordial leads ECG,R-ECG)及Fontaine双极胸导联心电图(Fontaine bipolar precordial leads ECG,F-ECG)o Epsilon波判断标准为位于QRS波之后、sT段起始部的低波幅棘波、振荡波或平缓电位.结果 该组病例S-ECG、R-ECG及F-ECG对Epsilon波的检出率分别为37.5%、37.5%和50.0%,三种心电图记录方法之间Epsilon波检出率的比较差异无统计学意义(均为P>0.05).其中1例Epsilon波仅见于S-ECG,3例仅见于R-ECG,5例仅见于F-ECG.S-ECG联合R-ECG的检出率为50.0%,S-ECG联合F-ECG的检出率为56.3%,三种记录方法的联合检出率为65.6%,S-ECG联合F-ECG的枪出率与S-ECG相比明显提高(P<0.05),联合三种心电图记录方法的检出率与S-ECG相比有显著提高(P<0.01).结论 联合使用S-ECG、R-ECG及F-ECG三种心电图记录方法,可以显著提高ARVC患者Epsilon波的检出率,且三种记录方法之间可以相互补充.%Objective To investigate the prevalence of Epsilon wave in patients with arrhythmogenic right ventrieular cardiomyopathy (ARVC). Methods The Epsilon wave was detected in 32 patients [24 men, mean age (42.3±13.3) years] with ARVC using three different electrocardiography (ECG) recording methods: standard twelve leads ECG (S-ECG), right precordial leads ECG (R-ECG) and Fontaine bipolar precordiai leads ECG (F-ECG). The Epsilon wave was defined as wiggle, small spike wave and smooth potential between the end of the QRS complex and the beginning of the ST segment. Results Epsilon wave was detected in 37.5%, 37.5% and 50.0% patients with ARVC by S-ECG, R

  19. Science and practice of arrhythmogenic cardiomyopathy: A paradigm shift

    Directory of Open Access Journals (Sweden)

    Mohamed ElMaghawry

    2012-03-01

    Full Text Available The clinical, genetic, and molecular paradigm of arrhythmogenic right ventricular cardiomyopathy (ARVC has markedly progressed through the last three decades, shifting from the classical ARVC as a progressive condition characterized by fibrofatty replacement of the right ventricle,2,3,4 into a wider spectrum of arrhythmogenic cardiomyopathy (AC,5 which covers ARVC with its various clinical phases (occult, electric, right heart failure and late stage biventricular heart failure, biventricular arrhythmic cardiomyopathy, left dominant arrhythmic cardiomyopathy, Naxos and Carvajal syndromes. Epidemiologically, the disease was first associated with the Mediterranean basin (mainly Italy and France, however further studies have reported AC in many races and ethnic backgrounds6,7,8. Moreover, with regard to the pathoitiology of the disease, dysplasia was originally assumed as the disease mechanism. Other mechanisms were later postulated, such as inflammation and transdifferentiation. However, more recent animal models have established that dystrophy, either by myocyte necrosis or apoptosis, is the founding pathological process of AC.

  20. Assessment of right ventricular systolic function by tissue Doppler echocardiography

    DEFF Research Database (Denmark)

    Kjærgaard, Jesper

    2012-01-01

    on right ventricular hemodynamics: pulmonary embolism, Arrhythmogenic right ventricular cardiomyopathy and pulmonary regurgitation, the latter in an animal model. The conclusions of the thesis are: Color tissue Doppler echocardiography accurately measures velocities, SR and strain in vitro. No systematic......This thesis summarizes a series of studies performed in order to assess the clinical usefulness of a novel echocardiographic technology that allows non-invasive assessment of regional right ventricular myocardial velocities and deformation: tissue Doppler echocardiography. While the technology...... is a promising tool for improving our understanding of right ventricular hemodynamics, several aspects of the technology must be evaluated. The accuracy and reproducibility of the technology is evaluated in vitro, and normal values, impact of changes in loading of the right ventricle, response to exercise...

  1. High-resolution electrocardiography in the diagnosis of arrhythmogenic right ventricular cardiomyopathy in Boxer dogs Eletrocardiografia de alta resolução no diagnóstico da cardiomiopatia arritmogênica do ventrículo direito em cães da raça Boxer

    Directory of Open Access Journals (Sweden)

    Evandro Zacché Pereira

    2013-06-01

    Full Text Available To evaluate the reliability of high-resolution electrocardiography in the diagnosis of arrhythmogenic right ventricular cardiomyopathy in Boxers, 20 dogs with no structural cardiac alterations at echocardiographic examination were grouped on the basis of frequency of ventricular arrhythmias, evaluated by 24-hour ambulatory ECG, and undergoing a high-resolution electrocardiography. High frequency QRS duration, duration of terminal QRS complex less than 40µV (LAS40 and root mean square voltage of the terminal 40 milliseconds of the QRS complex (RMS40 were measured. Differences in high-resolution ECG variables were not observed between groups. Therefore, the results of this investigation suggest that high-resolution electrocardiography is not a useful method for the diagnosis of arrhythmogenic right ventricular cardiomyopathy in Boxers without detectable myocardial alterations or systolic dysfunction.Com o objetivo de avaliar a importância da eletrocardiografia de alta resolução no diagnóstico da cardiomiopatia arritmogênica do ventrículo direito do Boxer, 20 cães sem evidências de doença cardíaca estrutural à avaliação ecodopplercardiográfica foram agrupados de acordo com a frequência de arritmias ventriculares, avaliadas pela eletrocardiografia ambulatorial de 24 horas, e submetidos ao exame eletrocardiográfico de alta resolução. Duração do complexo QRS filtrado, duração dos sinais de baixa amplitude (menor que 40µV dos últimos 40 milissegundos do complexo QRS e raiz quadrada média da voltagem ao quadrado dos últimos 40 milissegundos do complexo QRS (RMS40 foram as variáveis avaliadas. Não foram observadas diferenças significativas entre os grupos em relação às variáveis estudadas. Sendo assim, os resultados do presente estudo sugerem que a eletrocardiografia de alta resolução não é uma ferramenta útil no auxílio diagnóstico da cardiomiopatia arritmogênica do ventrículo direito dos cães da raça Boxer

  2. Chamber-specific effects of hypokalaemia on ventricular arrhythmogenicity in isolated, perfused guinea-pig heart

    DEFF Research Database (Denmark)

    Osadchii, Oleg E; Bentzen, Bo Hjorth; Olesen, Søren-Peter

    2009-01-01

    of hypokalaemic perfusion (2.5 mm K(+) for 30 min) were assessed in isolated guinea-pig heart preparations using simultaneous recordings of volume-conducted electrocardiogram and monophasic action potentials from six ventricular epicardial sites. Effective refractory periods, ventricular fibrillation thresholds...... by extrastimulus application at earlier time points during LV repolarization. Increased prematurity of extrastimulus-evoked propagating responses was associated with exaggerated local inhomogeneities in intraventricular conduction and action potential duration in hypokalaemic LV, thus creating a favourable stage...... for re-entrant tachyarrhythmias. Taken together, these findings suggest that proarrhythmic effects of hypokalaemia are mostly attributed to increased LV arrhythmogenicity in the guinea-pig heart....

  3. Role of Strain Imaging in Right Heart Disease: A Comprehensive Review

    OpenAIRE

    Kannan, Arun; Poongkunran, Chithra; Jayaraj, Mahendran; Janardhanan, Rajesh

    2014-01-01

    Advances in the imaging techniques of the heart have fueled the interest in understanding of right heart pathology. Recently, speckle tracking echocardiography has shown to aid in understanding various right heart diseases and better management. Its role is well established in diagnosing right heart failure, pulmonary artery hypertension, arrhythmogenic right ventricular dysplasia and congenital heart disease. We review the basic mechanics of speckle tracking and analyze its role in various r...

  4. Postpartal right ventricular thrombosis.

    Science.gov (United States)

    Velicki, Lazar; Milosavljević, Aleksandar; Majin, Marijan; Vujin, Bojan; Kovacević, Pavle

    2008-11-01

    The discovery of an intracardial mass in patients presents a serious diagnostic dilemma. The differential diagnosis of this condition may seem abundant, but myxomas and intracardial thrombosis are the most frequent diagnoses. A connection between pregnancy and the presence of thrombosis has been documented frequently. Normal pregnancy leads to changes of the coagulative and fibrinolytic status toward a hypercoagulable condition which has its own physiological justification (the risk of blood loss decreases during labor). The case of a patient suffering from postpartal right ventricular thrombosis, which was successfully resolved by surgery as described in this contribution, demonstrates the value of a multidisciplinary approach.

  5. Arrhythmogenic cardiomyopathy.

    Science.gov (United States)

    Pilichou, Kalliopi; Thiene, Gaetano; Bauce, Barbara; Rigato, Ilaria; Lazzarini, Elisabetta; Migliore, Federico; Perazzolo Marra, Martina; Rizzo, Stefania; Zorzi, Alessandro; Daliento, Luciano; Corrado, Domenico; Basso, Cristina

    2016-01-01

    Arrhythmogenic cardiomyopathy (AC) is a heart muscle disease clinically characterized by life-threatening ventricular arrhythmias and pathologically by an acquired and progressive dystrophy of the ventricular myocardium with fibro-fatty replacement. Due to an estimated prevalence of 1:2000-1:5000, AC is listed among rare diseases. A familial background consistent with an autosomal-dominant trait of inheritance is present in most of AC patients; recessive variants have also been reported, either or not associated with palmoplantar keratoderma and woolly hair. AC-causing genes mostly encode major components of the cardiac desmosome and up to 50% of AC probands harbor mutations in one of them. Mutations in non-desmosomal genes have been also described in a minority of AC patients, predisposing to the same or an overlapping disease phenotype. Compound/digenic heterozygosity was identified in up to 25% of AC-causing desmosomal gene mutation carriers, in part explaining the phenotypic variability. Abnormal trafficking of intercellular proteins to the intercalated discs of cardiomyocytes and Wnt/beta catenin and Hippo signaling pathways have been implicated in disease pathogenesis.AC is a major cause of sudden death in the young and in athletes. The clinical picture may include a sub-clinical phase; an overt electrical disorder; and right ventricular or biventricular pump failure. Ventricular fibrillation can occur at any stage. Genotype-phenotype correlation studies led to identify biventricular and dominant left ventricular variants, thus supporting the use of the broader term AC.Since there is no "gold standard" to reach the diagnosis of AC, multiple categories of diagnostic information have been combined and the criteria recently updated, to improve diagnostic sensitivity while maintaining specificity. Among diagnostic tools, contrast enhanced cardiac magnetic resonance is playing a major role in detecting left dominant forms of AC, even preceding morpho

  6. Reduction of the ventricular arrhythmogenic dose of epinephrine by ketamine administration in halothane-anesthetized cats.

    Science.gov (United States)

    Bednarski, R M; Sams, R A; Majors, L J; Ashcraft, S

    1988-03-01

    The effect of ketamine administration on the ventricular arrhythmogenic dose of epinephrine (VADE) was studied in 4 halothane-anesthetized cats. Each cat was anesthetized 4 times, 1 week apart, with halothane (end-tidal concentration, 1.5%) and with halothane (end-tidal concentration, 1.5%) combined with ketamine infusion (50, 100, and 200 micrograms/kg of body weight/min). Epinephrine was infused in progressively increasing doses. The VADE (micrograms/kg) was calculated as the product of infusion rate of epinephrine and time of infusion necessary to induce 4 or more ventricular premature depolarizations within 15 s. The mean (+/- SD) VADE during halothane anesthesia was 1.1 (+/- 0.30) micrograms/kg. Ketamine infusion significantly (P less than 0.01) lowered the VADE independently of dose. The dose of epinephrine (micrograms/kg) that induced an ECG change in P-wave configuration was calculated similarly. Less epinephrine was necessary to induce a change in P-wave configuration than was necessary to induce 4 or more ventricular premature depolarizations within 15 s. Blood samples were collected after 4 hours of ketamine infusion and again immediately after determination of the VADE for analysis of plasma ketamine and norketamine concentrations by use of gas chromatography. Plasma ketamine and norketamine concentrations after a 4-hour infusion and immediately after determination of the VADE were similar for any given ketamine infusion rate, indicating that steady-state plasma concentrations had been reached for each infusion rate. Blood pressure and heart rate were measured immediately before (base line) and immediately after infusion of the VADE. Ketamine infusion significantly (P less than 005) lowered base-line blood pressure, but not heart rate.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:3358546

  7. Arrhythmia in Acute Right Ventricular Infarction

    Directory of Open Access Journals (Sweden)

    Azin Alizadeh Asl

    2007-09-01

    Full Text Available Acute inferior myocardial infarction (MI frequently involves the right ventricle (RV.1-3 We assessed the prognostic impact of RV myocardial involvement in patients with inferior MI. One hundred seventy patients were admitted to the cardiac care unit of Madani Heart Hospital (Tabriz-Iran with the diagnosis of inferior MI with (group1 or without (group2 the simultaneous involvement of RV during the study period (from 2005 to 2006. Patients presenting within 12h of symptom onset were eligible for inclusion. Patients with simultaneous anterior wall MI or renal impairment (creatinine > 2 mg/dl, as well as those undergoing primary percutaneous translational coronary angioplasty, were excluded. Eighty eight percent of the patients with RVMI and 75% of those with isolated inferior MI had some type of arrhythmia. Atrioventricular (AV block occurred in 42% of the infarctions with RV involvement and only in 29% of the control group. Intra-ventricular conduction disturbance (IVCD was also more frequent in RVMI (29.4% vs. 13.1%, p=0.021, especially right bundle branch block (RBBB (20% vs. 7.4%, P=0.003. There was, however, no meaningful difference in the incidence of left bundle branch block (LBBB between the two groups (3.5% vs. 2.35%, P=0.95. Ventricular fibrillation (VF was observed in 5.2% and 1.2% and ventricular tachycardia in 26% and 12.2% of the patients in groups 1 and 2, respectively. In 27% of patients with RVMI, it was necessary to implant a pacemaker as compared to 10% of those in the control group. Mortality was higher in the patients with inferior infarction extended to the RV (15.3% vs. 3.5%, P= 0.0001. Thus, the differences between the findings in the two groups in terms of the occurrence of post-MI arrhythmias and conduction disorders were quite significant, but there was no meaningful difference with respect to the incidence of LBBB between the two groups. Additionally, patients with inferior MI who also had RV myocardial involvement were

  8. Right Ventricular Dysfunction in Chronic Lung Disease

    OpenAIRE

    Kolb, Todd M.; Hassoun, Paul M.

    2012-01-01

    Right ventricular dysfunction arises in chronic lung disease when chronic hypoxemia and disruption of pulmonary vascular beds contribute to increase ventricular afterload, and is generally defined by hypertrophy with preserved myocardial contractility and cardiac output. Although the exact prevalence is unknown, right ventricular hypertrophy appears to be a common complication of chronic lung disease, and more frequently complicates advanced lung disease. Right ventricular failure is rare, ex...

  9. Myocardial performance is reduced immediately prior to ventricular ectopy

    DEFF Research Database (Denmark)

    Bloch Thomsen, Poul Erik; Hansen, Thomas Fritz; Jons, Christian;

    2012-01-01

    Background: We recently demonstrated local voltage potentials indicating conduction impairment and block in the sinus beats preceding ventricular premature beats (VPBs) originating in the ventricular outflow tracts. Objective: The purpose of this study was to test the hypothesis that impairment...... of impulse conduction would also lead to changes in the contractile performance of sinus beats preceding ventricular ectopy using Tissue Doppler echocardiography. Methods: Twenty-three consecutive patients with VPBs were examined in the apical 4-chamber view with a frame rate of 150 Hz (GE VIVID VII). Eleven...... patients had no structural heart disease, 5 had dilated cardiomyopathy, 4 had ischemic heart disease, 2 had arrhythmogenic right ventricular dysplasia, and 1 had aortic stenosis. The ectopy originated in the ventricular outflow tracts in 15 patients and in the left ventricle 8. Eleven of the patients...

  10. Echocardiographic features of right ventricular volume overload

    Directory of Open Access Journals (Sweden)

    Shah Lilam

    1979-01-01

    Full Text Available Interventricular septal motion is studied in sixty tow cases clas-sified into 3 groups; Gr. 1-right ventricular volume overload (RVVO; Gr. II-combined right ventricular volume overload and left ventricular volume overload (RVVO + LVVO; Gr. III-com-bined right ventricular volume overload and right ventricular pres-sure overload (RVVO + RVPO. A linear relationship was obtained between the right ventricu-lar dimension index (RVDI obtained echocardiographically and the magnitude of the left to right shunt at the atrial level (Qn/Qs. Two rare instances of false negatives in a hemodynamically in-significant left to right shunt and in a large ASD are reported. Modification of abnormal septal motion in Gr. II and Gr. III is studied. Lesion specific features of certain anomalies i.e. Ebstein′s ano-maly, total anomalous pulmonary venous return (TAPVR and en-docardial cushion defects (ECD are discussed.

  11. Impact of New Electrocardiographic Criteria in Arrhythmogenic Cardiomyopathy

    Directory of Open Access Journals (Sweden)

    Richard NW Hauer

    2012-09-01

    Full Text Available Arrhythmogenic cardiomyopathy (AC has originally been described as a disorder characterized by fibrofatty replacement of the myocardium, primarily of the right ventricle (RV, and ventricular tachyarrhythmias, sudden death, and at a late stage progressive heart failure. Arrhythmogenic right ventricular dysplasia or cardiomyopathy (ARVD/C was the previous name of the disease. However, similar histopathologic changes are also found in the left ventricle (LV. AC is also considered a hereditary disease. Recent molecular genetic studies provide accumulating evidence that fibrofatty replacement is preceded by mutation-related desmosomal changes. Desmosomal dysfunction may lead to mechanical en thereafter electrical uncoupling, ultimately resulting in conduction delay. This activation delay and conduction block, provide a substrate for re-entrant mechanisms and thereby ventricular tachycardia (VT. The gold standard for AC diagnosis is demonstration of transmural fibrofatty replacement in cardiac tissue obtained by autopsy or surgery. To facilitate diagnosis in clinical practice, an international Task Force defined in 1994 a set of criteria (TFC based on electrocardiographic, functional and morphologic features, and family history. These criteria have recently been revised. Routine 12-lead electrocardiography is one of the most important tools for AC diagnosis in all stages of the disease. Even in the absence of other markers in the early concealed stage of the disease, in line with early slow conduction and electrical uncoupling ECG analysis may contribute to early diagnosis. Activation delay and site of origin of VT are reflected in various characteristics of the surface 12-lead electrocardiogram. Since the ECG is easy to obtain, this technique is particularly useful, for both diagnosis and follow up of disease progression.

  12. Right ventricular mass estimation by angioechocardiography.

    Science.gov (United States)

    Arcilla, R A; Mathew, R; Sodt, P; Lester, L; Cahill, N; Thilenius, O G

    1976-01-01

    A combined angiocardiographic-echocardiographic method for estimating right ventricular wall mass is described. Biplane cineangiocardiograms are analyzed for ventricular volume in end-diastole, and wall thickness is determined from echocardiograms obtained with a high frequency transducer and strip chart recorder, The intracavitary and the external surface volumes of the ventricle are derived, and the difference multiplied by 1.050, the specific gravity of myocardium. Excellent correlation was observed between right ventricular wall mass and body surface area in normal children (r = 0.93). The mean right ventricular mass was 44.5 g/M2 as compared to 78.1 g/M2 for the left ventricle, corresponding mass/EDV values were 0.48 g/cm3 and 1.26 g/cm3, respectively. In isolated right ventricular pressure overload, the increase in right ventricular mass is chiefly due to the increase in wall thickness; in volume overload, it is due mostly to the increase in chamber volume,

  13. Ventricular arrhythmogenic dose of adrenaline during sevoflurane, isoflurane, and halothane anaesthesia either with or without ketamine or thiopentone in cats.

    Science.gov (United States)

    Hikasa, Y; Okabe, C; Takase, K; Ogasawara, S

    1996-03-01

    The doses of adrenaline required to induce ventricular arrhythmia during sevoflurane, isoflurane and halothane anaesthesia, either with or without infusions of ketamine (76 micrograms kg-1 min-1) or thiopentone (0.5 mg kg-1 min-1), were determined in cats. Groups of six to eight cats were maintained at end-tidal concentrations equivalent to 1.25 times the minimal alveolar concentration of each anaesthetic. The mean dose of adrenaline required to induce arrhythmia during sevoflurane anaesthesia (19.0 micrograms kg-1) was approximately 11 times higher than that required during halothane anaesthesia (1.66 micrograms kg-1) and the same as that required during isoflurane anaesthesia (19.0 micrograms kg-1). Ketamine tended to decrease the requirement of adrenaline during halothane anaesthesia, but not significantly, and did not change the requirement during isoflurane or sevoflurane anaesthesia. Thiopentone did not change the requirement for adrenaline during halothane, isoflurane or sevoflurane anaesthesia. It was concluded that either with or without ketamine or thiopentone, the effect of sevoflurane on the sensitisation of the feline myocardium to the arrhythmogenic effects of adrenaline was significantly less than that of halothane and not different from that of isoflurane. PMID:8685534

  14. Deadly proposal: a case of catecholaminergic polymorphic ventricular tachycardia.

    Science.gov (United States)

    Heiner, Jason D; Bullard-Berent, Jeffrey H; Inbar, Shmuel

    2011-11-01

    Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a rare adrenergically mediated arrhythmogenic disorder classically induced by exercise or emotional stress and found in structurally normal hearts. It is an important cause of cardiac syncope and sudden death in childhood. Catecholaminergic polymorphic ventricular tachycardia is a genetic cardiac channelopathy with known mutations involving genes affecting intracellular calcium regulation. We present a case of a 14-year-old boy who had cardiopulmonary arrest after an emotionally induced episode of CPVT while attempting to invite a girl to the school dance. Review of his presenting cardiac rhythm, induction of concerning ventricular arrhythmias during an exercise stress test, and genetic testing confirmed the diagnosis of CPVT. He recovered fully and was treated with β-blocker therapy and placement of an implantable cardioverter-defibrillator. In this report, we discuss this rare but important entity, including its molecular foundation, clinical presentation, basics of diagnosis, therapeutic options, and implications of genetic testing for family members. We also compare CPVT to other notable cardiomyopathic and channelopathic causes of sudden death in youth including hypertrophic cardiomyopathy, arrhythmogenic right ventricular dysplasia, long QT syndrome, short QT syndrome, and Brugada syndrome. PMID:22068070

  15. Predictive value of electrical restitution in hypokalemia-induced ventricular arrhythmogenicity

    DEFF Research Database (Denmark)

    Osadchii, Oleg E; Larsen, Anders Peter; Olesen, Soren Peter

    2009-01-01

    (+) for 30 min) in isolated guinea pig heart preparations. The restitution of AP duration measured at 90% repolarization (APD(90)) was assessed after premature extrastimulus application at variable coupling stimulation intervals, and ERP restitution was assessed by measuring refractoriness over a wide range......The ventricular action potential (AP) shortens exponentially upon a progressive reduction of the preceding diastolic interval. Steep electrical restitution slopes have been shown to promote wavebreaks, thus contributing to electrical instability. The present study was designed to assess...... of pacing rates. Hypokalemia increased the amplitude of stimulation-evoked repolarization alternans and the inducibility of tachyarrhythmias and reduced ventricular fibrillation threshold. Nevertheless, these changes were associated with flattened rather than steepened APD(90) restitution slopes and slowed...

  16. Evaluation of right ventricular volumes measured by magnetic resonance imaging

    DEFF Research Database (Denmark)

    Møgelvang, J; Stubgaard, M; Thomsen, C;

    1988-01-01

    Right ventricular volumes were determined in 12 patients with different levels of right and left ventricular function by magnetic resonance imaging (MRI) using an ECG gated multisection technique in planes perpendicular to the diastolic position of the interventricular septum. Right ventricular...... stroke volume was calculated as the difference between end-diastolic and end-systolic volume and compared to left ventricular stroke volume and to stroke volume determined simultaneously by a classical indicator dilution technique. There was good agreement between right ventricular stroke volume...... determined by MRI and by the indicator dilution method and between right and left ventricular stroke volume determined by MRI. Thus, MRI gives reliable values not only for left ventricular volumes, but also for right ventricular volumes. By MRI it is possible to obtain volumes from both ventricles...

  17. Pathogenesis of Arrhythmogenic Cardiomyopathy.

    Science.gov (United States)

    Asimaki, Angeliki; Kleber, Andre G; Saffitz, Jeffrey E

    2015-11-01

    Arrhythmogenic cardiomyopathy (ACM) is a primary myocardial disease. It is characterized by frequent ventricular arrhythmias and increased risk of sudden cardiac death typically arising as an early manifestation before the onset of significant myocardial remodelling. Myocardial degeneration, often confined to the right ventricular free wall, with replacement by fibrofatty scar tissue, develops in many patients. ACM is a familial disease but genetic penetrance can be low and disease expression is highly variable. Inflammation might promote disease progression. It also appears that exercise increases disease penetrance and accelerates its development. More than 60% of probands harbour mutations in genes that encode desmosomal proteins, which has raised the possibility that defective cell-cell adhesion might play a role in disease pathogenesis. Recent advances have implicated changes in the canonical wingless-type mouse mammary tumour virus integration site (Wnt)/β-catenin and Hippo signalling pathways and defects in forwarding trafficking of ion channels and other proteins to the intercalated disk in cardiac myocytes. In this review we summarize the current understanding of the pathogenesis of ACM and highlight future research directions. PMID:26199027

  18. Mutationsanalyse an 14 Kandidatengenen für autosomal-dominant vererbte arrhythmogene rechtsventrikuläre Kardiomyopathie (ARVD5)

    OpenAIRE

    Brandt, Kalina

    2011-01-01

    Arrhythmogenic right ventricular cardiomyopathy (ARVC) is characterized by fibrofatty replacement of the right ventricular free wall and leads to ventricular arrhythmias, heart failure, and sudden cardiac death. Genetics gains in importance due to the possibility of preventing sudden death by implantation of a cardioverter defibrillator (ICD) in asymptomatic patients with familial history of ARVC. The aim of this thesis was to identify the mutation for autosomal dominant inherited ARVD5 o...

  19. Right Heart Vorticity and Right Ventricular Diastolic Dysfunction

    Science.gov (United States)

    Browning, James; Hertzberg, Jean; Fenster, Brett; Schroeder, Joyce

    2015-11-01

    Recent advances in cardiac magnetic resonance imaging (CMR) have allowed for the 3-dimensional characterization of blood flow in the right ventricle (RV) and right atrium (RA). In this study, we investigate and quantify differences in the characteristics of coherent rotating flow structures (vortices) in the RA and RV between subjects with right ventricular diastolic dysfunction (RVDD) and normal controls. Fifteen RVDD subjects and 10 age-matched controls underwent same day 3D time resolved CMR and echocardiography. Echocardiography was used to determine RVDD stage as well as pulmonary artery systolic pressure (PASP). CMR data was used for RA and RV vortex quantification and visualization during early ventricular diastole and the results are compared between healthy subjects and those with RVDD. The resulting trends are discussed and hypotheses are presented regarding differences in vortex characteristics between healthy and RVDD subjects cohorts.

  20. Right ventricular myxoma obstructing the right ventricular outflow tract: a case report

    OpenAIRE

    Gribaa, Rym; Slim, Mehdi; Kortas, Chokri; Kacem, Slim; Salem, Helmi Ben; Ouali, Sana; Neffati, Elies; Remadi, Fehmi; Boughzela, Essia

    2014-01-01

    Introduction Primary cardiac tumors are uncommon during infancy and childhood. Myxomas originating from the right ventricle are even less common in pediatric patients. Case presentation Here we describe a case of an 11-year-old Tunisian boy who was referred for syncope. Transthoracic echocardiography revealed a large mobile mass attached to his right ventricle, obstructing his right ventricular outflow tract. Complete surgical excision of the mass with preservation of the pulmonary valve was ...

  1. Right ventricular collagen and fibronectin levels in patients with pulmonary atresia and ventricular septal defect

    NARCIS (Netherlands)

    Peters, Theodorus H F; de Jong, Peter L; Klompe, Lennart; Berger, Rolf M F; Saxena, Pramod R; Sharma, Hari S; Bogers, Ad J J C; Berger, Rudolphus

    2003-01-01

    Pulmonary atresia (PA) with ventricular septal defect (VSD) is an extreme form of tetralogy of Fallot with characteristic right ventricular hypertrophy. To reduce the right ventricular overload, these children have to undergo staged corrective surgery to restore physiological pulmonary perfusion. We

  2. EXPERIMENTAL STUDY OF RIGHT VENTRICULAR ASSIST IN ACUTE RIGHT VENTRICULAR FAILING

    Institute of Scientific and Technical Information of China (English)

    刘明辉; 苏鸿熙; 李功宋; 王加利; 董超; 童健

    1996-01-01

    The efficacy of right atrial-pulmonary artery (RA-PA)bypass during acute right ventricular failure(RVF)produced by pulmonary artery constriction in dogs was examined in this study Control group (n=7)was supported with conventional volume loading and inotropic therapy.In the experimental animals (n=8),RA-PA bypass was initiated 5 min.after the onset of severe RVF.Three control animals died from refractory ventricular fibrillation within one hour of RVF.No animals in the experimental group died within two hours of RA-PA bypass,but the histological study of the lungs in these animals demonstrated peribronchial,preivascular and intraalveolar hemorrhage.Lighr microscopic and electron microscopic examination of the myocardial specimens of the right ventricular free wall displayed the myocardial structures and ultrastructues were maintained effectively with RA-PA bypass wile irreversible myocardial injuries occurred in the control animasls after two hours of RVF with conventional therapy.During the 2hours of RA-PA bypass,the hemodynamic indices were also maintained better when compared to the control animals.It may be concluded,a roller pump right ventricular assist device effectively unloads the acute faijing right ventricle,maintains systemic cardisc output,and significatly reverses the myocardial ischemia during right venrricular failure,but RA-PA bypass may induce pulmonary hypertension due to increased pulmonary vascular resistance secondary to pulmonary edeme and interstitial hemorrhage.

  3. Right ventricular failure after left ventricular assist devices.

    Science.gov (United States)

    Lampert, Brent C; Teuteberg, Jeffrey J

    2015-09-01

    Most patients with advanced systolic dysfunction who are assessed for a left ventricular assist device (LVAD) also have some degree of right ventricular (RV) dysfunction. Hence, RV failure (RVF) remains a common complication of LVAD placement. Severe RVF after LVAD implantation is associated with increased peri-operative mortality and length of stay and can lead to coagulopathy, altered drug metabolism, worsening nutritional status, diuretic resistance, and poor quality of life. However, current medical and surgical treatment options for RVF are limited and often result in significant impairments in quality of life. There has been continuing interest in developing risk models for RVF before LVAD implantation. This report reviews the anatomy and physiology of the RV and how it changes in the setting of LVAD support. We will discuss proposed mechanisms and describe biochemical, echocardiographic, and hemodynamic predictors of RVF in LVAD patients. We will describe management strategies for reducing and managing RVF. Finally, we will discuss the increasingly recognized and difficult to manage entity of chronic RVF after LVAD placement and describe opportunities for future research. PMID:26267741

  4. Right ventricular hydatid cyst ruptured to pericardium

    Directory of Open Access Journals (Sweden)

    Feridoun Sabzi

    2015-01-01

    Full Text Available Cardiac hydatidosis is rare presentation of body hydatidosis. Incidence of cardiac involvements range from 5% to 5% of patients with hydatid disease. Most common site of hydatid cyst in heart is interventricular septum and left ventricular free wall. Right ventricular free wall involvement by cyst that ruptured to pericardial cavity is very rare presentation of hydatid cyst. Cardiac involvement may have serious consequences such as rupture to blood steam or pericardial cavity. Both the disease and its surgical treatment carry a high complication rate, including rupture leading to cardiac tamponade, anaphylaxis and also death. In the present report, a 43-year-old man with constrictive pericarditis secondary to a pericardial hydatid cyst is described.

  5. Loeffler endocarditis: silent right ventricular myocardium!

    Science.gov (United States)

    Çetin, Süha; Heper, Gülümser; Gökhan Vural, Mustafa; Hazirolan, Tuncay

    2016-07-01

    We present the case of a 54-year-old male patient with Loeffler endocarditis. It is a rare disorder characterized by fibrous thickening of the endocardium leading to apical obliteration and restrictive cardiomyopathy resulting in heart failure, thromboembolic events or atrial fibrillation. To the best of our knowledge, this is the first case reporting the electrical silence of the right ventricular (RV) apex caused by fibrothrombotic thickening of this area. Under these circumstances RV apical implantation of an implantable cardioverter defibrillator (ICD) or pacemaker electrode may lead to unsuccessful stimulation of these devices. PMID:26980214

  6. MECHANISMS OF RIGHT VENTRICULAR FAILURE AND BIVENTRICULAR MECHANICAL CIRCULATORY SUPPORT

    Directory of Open Access Journals (Sweden)

    G. P. Itkin

    2013-01-01

    Full Text Available The paper presents a review of the problems of mechanical circulatory support with left ventricular bypass in total cardiac failure. Dysfunction of right ventricular defines the high mortality on left ventricular device. One of the effective methods for solving this problem is the use of right ventricular assisted devices. There are considered of the basic physiological mechanisms of interaction between the right and left ventricles of the heart, affecting on the function of the right heart. Shows the need to assess right ventricular function before deciding on mechanical circulatory support. Provides examples of the estimation the predictors of the right ventricular failure. The basic methods and devices of biventricular circulatory support were con- sidered. 

  7. Right ventricular function before and after percutaneous balloon mitral valvuloplasty.

    Science.gov (United States)

    Burger, W; Brinkies, C; Illert, S; Teupe, C; Kneissl, G D; Schräder, R

    1997-01-01

    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 volume to 124 (112-141) ml/m2 (P improvement of right ventricular ejection fraction correlated inversely with the value of this parameter before valvuloplasty (r = -0.88, P 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.

  8. Recurrent missense mutations in TMEM43 (ARVD5) due to founder effects cause arrhythmogenic cardiomyopathies in the UK and Canada

    KAUST Repository

    Haywood, Annika F M

    2012-11-15

    AimsAutosomal dominant arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) (in the group of arrhythmogenic cardiomyopathies) is a common cause of sudden cardiac death in young adults. It is both clinically and genetically heterogeneous, with 12 loci (ARVC/D1-12) and eight genes identified, the majority of which encode structural proteins of cardiac desmosomes. The most recent gene identified, TMEM43, causes disease due to a missense mutation in a non-desmosomal gene (p.S358L) in 15 extended families from Newfoundland, Canada. To determine whether mutations in TMEM43 cause ARVC/D and arrhythmogenic cardiomyopathy in other populations, we fully re-sequenced TMEM43 on 143 ARVC/D probands (families) from the UK and 55 probands (from 55 families) from Newfoundland.Methods and resultsBidirectional sequencing of TMEM43 including intron-exon boundaries revealed 33 variants, the majority located in non-coding regions of TMEM43. For the purpose of validation, families of probands with rare, potentially deleterious coding variants were subjected to clinical and molecular follow-up. Three missense variants of uncertain significance (p.R28W, p.E142K, p.R312W) were located in highly conserved regions of the TMEM43 protein. One variant (p.R312W) also co-segregated with relatives showing clinical signs of disease. Genotyping and expansion of the disease-associated haplotype in subjects with the p.R312W variant from Newfoundland, Canada, and the UK suggest common ancestry.ConclusionAlthough the p.R312W variant was found in controls (3/378), identification of an ancestral disease p R312W haplotype suggests that the p.R312W variant is a pathogenic founder mutation. © 2012 The Author.

  9. RADIOFREQUENCY ABLATION OF IDIOPATHIC RIGHT VENTRICULAR TACHYCARDIA

    Institute of Scientific and Technical Information of China (English)

    华伟; JituVohra

    1998-01-01

    This paper presents our experieaee with radioreqencey ablation (RFA) for idiopathic ventricular tschycardia (VT) arising from right ventricle in 12 patients(pts). The age range d patients was 21~50, with a mean of 38. 5 years. Ten out of 12 were females, 1 patient had eandia failure due to almost incessant VT while the rest had normal left ventricular function.Twelve pts had VT arising from the fight ventricle; of those, 9 were from the outflow truct, 2 from the RV apex, and l from the RV inflow. In all tats the diagnostic study and therapeutic RFA were combined in a single procedure, pacemapping and local aetlvition time were used to guide the site of RFA in Ors with VT arising froth the tight ventricle.RFA was successful in 11 of the 12 pts ( 91%). Ntmaher of RF applications were 1~27, mean 9. 6; fluoroscopy time were 4~75, mean 26. 9 minutes. RFA for idiopathic RV has a high success rate. This mode of treament should be considered as a nonphartaaeologieal curative treatment for symptomatic pts.

  10. Effect of right ventricular pacing on ventricular rhythm during atrial fibrillation

    NARCIS (Netherlands)

    Wittkampf, F.H.M.; Jongste, M.J.L. de; Lie, H.I.; Meijler, F.L.

    1988-01-01

    In 13 patients with atrial fibrillation, the effect of right ventricular pacing at various rates on spontaneous RR intervals was studied. Five hundred consecutive RR intervals were recorded and measured before and during varying right ventricular pacing rates. As anticipated, all RR intervals longer

  11. Right ventricular exclusion for hepatocellular carcinoma metastatic to the heart

    Directory of Open Access Journals (Sweden)

    Fan Shou-Zen

    2010-10-01

    Full Text Available Abstract We used for the first time a right ventricular exclusion procedure for the treatment of hepatocellular carcinoma metastatic to the right ventricle. Our case report shows that this surgical option can be effective as rescue therapy for right ventricular outflow tract obstruction secondary to myocardial metastasis in critically ill patients. Most notably, this technique can prevent inadvertent dislodgement of tumor cells.

  12. Arrhythmogenic Cardiomyopathy: Electrical and Structural Phenotypes.

    Science.gov (United States)

    Akdis, Deniz; Brunckhorst, Corinna; Duru, Firat; Saguner, Ardan M

    2016-08-01

    This overview gives an update on the molecular mechanisms, clinical manifestations, diagnosis and therapy of arrhythmogenic cardiomyopathy (ACM). ACM is mostly hereditary and associated with mutations in genes encoding proteins of the intercalated disc. Three subtypes have been proposed: the classical right-dominant subtype generally referred to as ARVC/D, biventricular forms with early biventricular involvement and left-dominant subtypes with predominant LV involvement. Typical symptoms include palpitations, arrhythmic (pre)syncope and sudden cardiac arrest due to ventricular arrhythmias, which typically occur in athletes. At later stages, heart failure may occur. Diagnosis is established with the 2010 Task Force Criteria (TFC). Modern imaging tools are crucial for ACM diagnosis, including both echocardiography and cardiac magnetic resonance imaging for detecting functional and structural alternations. Of note, structural findings often become visible after electrical alterations, such as premature ventricular beats, ventricular fibrillation (VF) and ventricular tachycardia (VT). 12-lead ECG is important to assess for depolarisation and repolarisation abnormalities, including T-wave inversions as the most common ECG abnormality. Family history and the detection of causative mutations, mostly affecting the desmosome, have been incorporated in the TFC, and stress the importance of cascade family screening. Differential diagnoses include idiopathic right ventricular outflow tract (RVOT) VT, sarcoidosis, congenital heart disease, myocarditis, dilated cardiomyopathy, athlete's heart, Brugada syndrome and RV infarction. Therapeutic strategies include restriction from endurance and competitive sports, β-blockers, antiarrhythmic drugs, heart failure medication, implantable cardioverter-defibrillators and endocardial/epicardial catheter ablation. PMID:27617087

  13. Effects of right atrial and ventricular DDD pacing on cardiac function and ventricular contraction synchrony

    Institute of Scientific and Technical Information of China (English)

    支力大; 华伟; 张澍; 史蓉芳; 王方正; 陈新

    2004-01-01

    Background Right ventricular apical pacing has been reported to reduce cardiac performance. But there are few reports on the effects of dual chamber (DDD) pacing on cardiac function compared to sinus rhythm. In this study, we evaluated the effects of right atrial and ventricular DDD pacing on cardiac function and ventricular contraction synchrony using equilibrium radionuclide angiography.Methods Ten patients implanted with a right atrial and ventricular DDD pacemaker underwent equilibrium radionuclide angiography. The scintigraphic data were obtained during sinus rhythm and pacing rhythm. Cardiac function parameters were obtained semimanually. Phase analysis was used to study the ventricular activation sequence and ventricular synchrony.Results The left ventricular 1/3 ejection fraction decreased significantly during pacing compared with that during sinus rhythm[(23.4 ±6.1)% vs(27.7 ±4.5)%, P =0.01]. Regional ejection fraction also decreased during pacing, although the difference was not statistically significant. Phase analysis showed that the right ventricle was activated earlier than the left ventricle during pacing, and that the phase shift was significantly greater during pacing than that during sinus rhythm[64.13°±16.80° vs 52.88°± 9.26°, P =0.007]. The activation of both ventricles occurred simultaneously during sinus rhythm, with the activation sequence from proximal septum or base of left ventricle to apex. The earliest activation during pacing occurred at the right ventricular apex, and subsequently spread to the base and left ventricle.Conclusion Right atrial and ventricular DDD pacing impairs left ventricular systolic function and ventricular synchrony.

  14. Right ventricular noncompacted cardiomyopathy-time for a new classification?

    Institute of Scientific and Technical Information of China (English)

    Marija Zdravkovic; Mirjana Krotin

    2009-01-01

    @@ To the Editor: We read with a great interest the recent article by Zhang et al,~1 in which they reported a rare case of isolated right ventricular noncompaction with normal left ventricular systolic function in a 23-year-old female.

  15. Right ventricular failure after implantation of a continuous-flow left ventricular assist device

    DEFF Research Database (Denmark)

    Cordtz, Johan Joakim; Nilsson, Jens C; Hansen, Peter B;

    2014-01-01

    Right ventricular failure (RVF) is a significant complication after implantation of a left ventricular assist device. We aimed to identify haemodynamic changes in the early postoperative phase that predicted subsequent development of RVF in a cohort of HeartMate II (HMII) implanted patients....

  16. Influence of respiratory variations on right ventricular function.

    OpenAIRE

    Caplin, J L; Flatman, W D; Dyke, L; Wiseman, M N; Dymond, D S

    1989-01-01

    Respiratory effort during inspiration, expiration, and the Valsalva manoeuvre changes right ventricular preload and afterload. On inspiration these changes should improve systolic emptying of a larger end diastolic volume and so increase the ejection fraction, whereas on expiration the reverse should be true. The resting right ventricular ejection fraction was measured by first pass radionuclide angiography with gold-195m (half life 30.5 s) in 17 individuals at maximal inspiration and expirat...

  17. Quantitative Assessment of Right Ventricular Systolic Function by the Analysis of Right Ventricular Contrast Time-intensity Curve

    Institute of Scientific and Technical Information of China (English)

    王林; 邓又斌; 李天亮; 杨好意

    2004-01-01

    To study reliability and reliable indices of quantitative assessment of right ventricular systolic function by time-intensity curve (TIC)with right ventricular contrast, 5 % sonicated human albumin was injected intravenously at a does of 0. 08 ml/kg into 10 dogs at baseline status and cardiac insufficiency. Apical four-chamber view was observed for washinand washout of contrast agent from right ventricle. The parameters of TIC were obtained by curve fitting. The differences of parameters were analyzed in different states of cardiac functions. Among the parameters derived from TIC, the time constant (k) was decreased significantly with decline of cardiac function(P<0.001). But half-time of decent of peak intensity (HT) and mean-transit-time (MTT) of washout were increased significantly (P<0. 001). The k was strongly related to cardiac output of right ventricle (CO) and ejection fraction (EF) of left ventricle and fractional shortening (FS)of left ventricle. Right ventricular systolic function could be assessed reliably by the parameters derived from TIC with right ventricular contrast echocardiography. The k, HT and MTT are reliable indices for quantitative assessment of right ventricular systolic function.

  18. Left and right ventricular diastolic function in hemodialysis patients

    Directory of Open Access Journals (Sweden)

    Rudhani Ibrahim

    2010-01-01

    Full Text Available The aim of this prospective study was the assessment of left ventricular and right ventricular diastolic function in patients on hemodialysis (HD and the correlation of this func-tion with the duration of HD. The study included 42 patients (22 females and 20 males with chro-nic renal failure (CRF, treated with HD, and 40 healthy subjects (24 females and 16 males with no history of cardiovascular disease and with normal renal function, who constituted the control group. The groups were matched for age and sex. All study patients and control subjects under-went detailed history taking and physical examination. They also underwent electrocardiogram, echocardiography and biochemical and hematological blood analyses. Significant differences were noted between the two groups in the two-dimensional and M-mode echocardiography findings concerning aortic root dimension, transverse diameter of the left atrium, thickness of the inter-ventricular septum, thickness of the left ventricular posterior wall, left ventricular diastolic diameter, left ventricular systolic diameter, shortening fraction, ejection fraction as well as findings from the pulse Doppler study, including E wave, A wave, E/A ratio, deceleration time of E wave (DT-E, acceleration time of E wave (AT-E, tricuspid E and A waves (E tr and A tr and E tr /A tr , ratio. There were significant changes in HD patients without arterial hypertension as well in the control group subjects. Our study suggests that the left ventricular and left atrial dimensions as well as the left ventricular wall thickness are augmented in patients with CRF treated with HD compared with the control group. Additionally, the left and right ventricular diastolic function is also reduced in these patients. These differences were also noted in patients with CRF without arterial hypertension. Left ventricular diastolic dysfunction had no correlation with the duration of HD.

  19. Screening of Three Novel Candidate Genes in Arrhythmogenic Right Ventricular Cardiomyopathy

    DEFF Research Database (Denmark)

    Christensen, Alex Hørby; Benn, Marianne; Tybjærg-Hansen, Anne;

    2011-01-01

    ), and PERP (PERP)-all important structural proteins located at the intercalated disc-were involved in the pathogenesis of ARVC. We screened 65 unrelated patients (55 fulfilling 1994 Task Force criteria and ten borderline cases) for mutations in CTNNB1, CTNNA3, and PERP by direct sequencing and Light......Scanner melting curve analysis. Our comprehensive mutation scanning did not identify any disease-causing mutations. Thirty-five sequence variants were found, including one rare nonsynonymous variant of unknown significance (CTNNA3 A689V). Fourteen of the variants were novel. In conclusion, in our cohort...

  20. Use of right ventricular support with a centrifugal pump in post-valve surgery right ventricular failure: a case series.

    Science.gov (United States)

    Moulodi, Abdol Rasoul; Sheibat Zadeh, Gholam Reza; Sabzi, Feridoun

    2014-01-12

    The optimal treatment method for right ventricular failure after valve surgery complicated by a low cardiac output has not been determined, although several case reports have been published on patients with ventricular failure and arrhythmia who were bridged to cardiac transplantation using biventricular or left ventricular assist devices. This case series illustrates successful circulatory support of 4 patients with prolonged low cardiac outputs and right ventricular failure and arrhythmias after valvular heart surgery with or without severe pulmonary hypertension. In-hospital death occurred in one patient and 3 patients were discharged from the hospital with good general condition. At two years' follow-up, 2 patients were in functional class one but another patient underwent laparotomy for multiple splenic abscesses and died from multiple organ failure.

  1. Effects of Long-term Right Ventricular Apical Pacing on Left Ventricular Remodeling and Cardiac Function

    Institute of Scientific and Technical Information of China (English)

    2009-01-01

    Objective: To investigate the impacts of long-term right ventricular apical pacing on the ventricular remodeling and cardiac functions of patients with high-grade and third-degree atrioventricular blockage with normal heart structures and cardiac functions. In addition, we provide many evidences for choosing an optimal electrode implantation site.Methods: Study participants included patients who were admitted for pacemaker replacements and revisited for examinations of implanted pacemakers at outpatient. Pa...

  2. Assessment of Ventricular Dissynchrony in Right Ventricular Single Chamber Pacing using Echocardiografic Parameters

    Directory of Open Access Journals (Sweden)

    Vita I

    2014-04-01

    Full Text Available Background: Right ventricular apical pacing has been used since the early years of pace-makers, despite the fact that it determined nonphysiological ventricular depolarization. As medical technologies developed, septal lead implantation became feasible, in order to outrun the above mentioned inconveniences. The question whether the apical or septal lead position is better still gives rise to a lot of controversies. Different echocardiographic parameters are currently used to assess the impact of specific sites of stimulation on ventricular function. The aim of the study was to determine which of the followed synchronicity parameters varied significantly during apical stimulation, compared to septal stimulation in patients requiring single chamber pacing.

  3. Left and right ventricular diastolic function in hemodialysis patients.

    Science.gov (United States)

    Rudhani, Ibrahim Destan; Bajraktari, Gani; Kryziu, Emrush; Zylfiu, Bejtush; Sadiku, Shemsedin; Elezi, Ymer; Rexhepaj, Nehat; Vitia, Arber; Emini, Merita; Abazi, Murat; Berbatovci-Ukimeraj, M; Kryeziu, Kaltrina; Hsanagjekaj, Venera; Korca, Hajrije; Ukimeri, Aferdita

    2010-11-01

    The aim of this prospective study was the assessment of left ventricular and right ventricular diastolic function in patients on hemodialysis (HD) and the correlation of this function with the duration of HD. The study included 42 patients (22 females and 20 males) with chronic renal failure (CRF), treated with HD, and 40 healthy subjects (24 females and 16 males) with no history of cardiovascular disease and with normal renal function, who constituted the control group. The groups were matched for age and sex. All study patients and control subjects underwent detailed history taking and physical examination. They also underwent electrocardiogram, echocardiography and biochemical and hematological blood analyses. Significant differences were noted between the two groups in the two-dimensional and M-mode echocardiography findings concerning aortic root dimension, transverse diameter of the left atrium, thickness of the interventricular septum, thickness of the left ventricular posterior wall, left ventricular diastolic diameter, left ventricular systolic diameter, shortening fraction, ejection fraction as well as findings from the pulse Doppler study, including E wave, A wave, E/A ratio, deceleration time of E wave (DT-E), acceleration time of E wave (AT-E), tricuspid E and A waves (E tr and A tr ) and E tr /A tr , ratio. There were significant changes in HD patients without arterial hypertension as well in the control group subjects. Our study suggests that the left ventricular and left atrial dimensions as well as the left ventricular wall thickness are augmented in patients with CRF treated with HD compared with the control group. Additionally, the left and right ventricular diastolic function is also reduced in these patients. These differences were also noted in patients with CRF without arterial hypertension. Left ventricular diastolic dysfunction had no correlation with the duration of HD.

  4. The feasibility and efficacy of right ventricular assistance without thoracotomy.

    Science.gov (United States)

    Yano, M; Matsuo, K; Hatane, T; Araki, K; Onitsuka, T; Shibata, K; Koga, Y

    1993-01-01

    Mechanical right ventricular assistance has never been percutaneously instituted. We invented a new method for administering right ventricular assistance without thoracotomy (RAWT) and evaluated its effects in acute experiments using dogs. To institute RAWT, an outflow cannula was inserted into the pulmonary artery from the femoral vein, and an inflow cannula was inserted into the right atrium from the right jugular vein. A Swan-Ganz catheter inserted into the outflow cannula led it to the pulmonary artery under blood pressure monitoring only. A Sarns' centrifugal pump was used as a blood pump. We applied this system to biventricular failed hearts supported by a left ventricular assist device. We could increase cardiac output from 53.3 +/- 31.8 to 77.8 +/- 31.7 ml/min/kg, and mean aortic pressure from 43.5 +/- 12.3 to 57.5 +/- 11.2 mm Hg with RAWT. The right ventricular unloading effect of RAWT was not disturbed by regurgitation through the pulmonary or tricuspid valve.

  5. Adverse ventricular-ventricular interactions in right ventricular pressure load: Insights from pediatric pulmonary hypertension versus pulmonary stenosis.

    Science.gov (United States)

    Driessen, Mieke M P; Hui, Wei; Bijnens, Bart H; Dragulescu, Andreea; Mertens, Luc; Meijboom, Folkert J; Friedberg, Mark K

    2016-06-01

    Right ventricular (RV) pressure overload has a vastly different clinical course in children with idiopathic pulmonary arterial hypertension (iPAH) than in children with pulmonary stenosis (PS). While RV function is well recognized as a key prognostic factor in iPAH, adverse ventricular-ventricular interactions and LV dysfunction are less well characterized and the pathophysiology is incompletely understood. We compared ventricular-ventricular interactions as hypothesized drivers of biventricular dysfunction in pediatric iPAH versus PS Eighteen iPAH, 16 PS patients and 18 age- and size-matched controls were retrospectively studied. Cardiac cycle events were measured by M-mode and Doppler echocardiography. Measurements were compared between groups using ANOVA with post hoc Dunnet's or ANCOVA including RV systolic pressure (RVSP; iPAH 96.8 ± 25.4 mmHg vs. PS 75.4 ± 18.9 mmHg; P = 0.011) as a covariate. RV-free wall thickening was prolonged in iPAH versus PS, extending beyond pulmonary valve closure (638 ± 76 msec vs. 562 ± 76 msec vs. 473 ± 59 msec controls). LV and RV isovolumetric relaxation were prolonged in iPAH (P mechanical discoordination and decreased early LV filling in pediatric iPAH much more than PS These adverse mechanics affect systolic and diastolic biventricular efficiency in iPAH and may form the basis for worse clinical outcomes. We used clinically derived data to study the pathophysiology of ventricular-ventricular interactions in right ventricular pressure overload, demonstrating distinct differences between pediatric pulmonary arterial hypertension (iPAH) and pulmonary stenosis (PS). Altered timing of right ventricular free wall contraction and profound septal dyskinesia are associated with interventricular mechanical discoordination and decreased early LV filling in iPAH much more than PS These adverse mechanics affect systolic and diastolic biventricular efficiency, independent of right ventricular systolic pressure. PMID

  6. Total Artificial Heart Implantation after Excision of Right Ventricular Angiosarcoma

    OpenAIRE

    Bruckner, Brian A.; Abu Saleh, Walid K.; Al Jabbari, Odeaa; Copeland, Jack G.; Estep, Jerry D.; Loebe, Matthias; Reardon, Michael J.

    2016-01-01

    Primary cardiac sarcomas, although rare, are aggressive and lethal, requiring thorough surgical resection and adjuvant chemotherapy for the best possible outcome. We report the case of a 32-year-old woman who underwent total artificial heart implantation for right-sided heart failure caused by right ventricular angiosarcoma. For the first several weeks in intensive care, the patient recovered uneventfully. However, a postoperative liver biopsy indicated hepatocellular injury consistent with p...

  7. Acquired Fontan paradox in isolated right ventricular cardiomyopathy.

    Science.gov (United States)

    Saran, Mahim; Sivasubramonian, Sivasankaran; Abhilash, Sreevilasam P; Tharakan, Jaganmohan A

    2016-01-01

    A 44-year-old woman presented with features of congestive heart failure. Echocardiography revealed severe right ventricular dysfunction along with passive minimally pulsatile pulmonary blood flow suggesting very high systemic venous pressures. This was confirmed with cardiac catheterization in which the pressures of superior vena cava and inferior vena cava (19 mmHg) were higher than the pulmonary artery pressures (17 mmHg). Elevation of systemic venous pressures above the pulmonary venous pressures, Fontan paradox, to drive the forward flow, is a specific feature of artificially created cavopulmonary shunts. Late stage of isolated right ventricular cardiomyopathy resulted in the spontaneous evolution of Fontan circulation with a nonfunctional right ventricle in this patient. PMID:27625525

  8. Metastatic right ventricular mass with intracavitary obliteration

    OpenAIRE

    Kalvakuri, Kavitha; Banga, Sandeep; Upalakalin, Nalinee; Shaw, Crystal; Davila, Wilmer Fernando; Mungee, Sudhir

    2016-01-01

    Metastatic cardiac tumors are more common than the primary cardiac tumors. Cervical cancer metastasizing outside of the pelvis is commonly spread to the lungs, liver, bones and lymph nodes than to the heart. Right-sided metastasis to the heart is more common than to the left side. Intramural spread is more common than intracavitary growth of metastatic cardiac tumors leading to delayed clinical presentation. Intracavitary mass can be confused with intracavitary thrombus which can be seen in t...

  9. Progress in Investigations of Arrhythmias Originating in the Right Ventricle%右室相关心律失常的临床和基础

    Institute of Scientific and Technical Information of China (English)

    胡金柱; 洪葵

    2011-01-01

    The structural and electrical remodeling in the left ventricle as a result of coronary heart disease and cardiomyopathy is the primary cause of ventricular arrhythmia and sudden cardiac death. However, arrhythmias can also originate in the right ventricle. Ventricular arrhythmias originating in the right ventricle usually affect younger patients, and can also lead to sudden cardiac death. Advances in available research techniques are providing more information about the pathogenesis, diagnosis and prognosis of right ventricular arrhythmias. Arrhyth-mias originating in the right ventricle mostly occur in arrhythmogenic right ventricular cardiomyopathy/dysplasia, Brugada syndrome, right ventricular outflow tract ventricular tachycardia, and congenital heart defects. This article reviews recent research in these diseases and their connection to right ventricular arrhythmias.%冠心病或心肌病所致左室结构和电重构是室性心律失常和心源性猝死发生的主要原因.近20年来,右室相关心律失常已受到工作者重视,其好发于青壮年患者,易导致心源性猝死,基础研究尤其是分子遗传学的发展推动了人们对右室相关心律失常发病机制、诊断和预后的认识和理解.右室相关心律失常多见于致心律失常型右室心肌病、Brugada综合征、右室流出道室性心动过速及先天性心脏病等,现将对其临床与基础研究进行概述.

  10. Right ventricular volume and mass determined by cine magnetic resonance imaging in HIV patients with possible right ventricular dysfunction

    DEFF Research Database (Denmark)

    Kjaer, Andreas; Lebech, Anne-Mette; Gerstoft, Jan;

    2006-01-01

    Impaired right ventricular (RV) function has been reported to occur in patients with HIV when studied by echocardiography. However, for accurate evaluation of RV function and morphology, first-pass radionuclide ventriculography (RNV) and cine magnetic resonance imaging (cine-MRI) are methods...... ventricular ejection fraction (RVEF). To do so, we screened patients with RNV and performed an additional cine-MRI in those with reduced RVEF determined by RNV. Ninety patients with HIV were included. To evaluate the MRI measures exactly we included 18 age- and gender-matched healthy volunteers to establish...

  11. Right Ventricular Hemodynamics in Patients with Pulmonary Hypertension

    Science.gov (United States)

    Browning, James; Fenster, Brett; Hertzberg, Jean; Schroeder, Joyce

    2012-11-01

    Recent advances in cardiac magnetic resonance imaging (CMR) have allowed for characterization of blood flow in the right ventricle (RV), including calculation of vorticity and circulation, and qualitative visual assessment of coherent flow patterns. In this study, we investigate qualitative and quantitative differences in right ventricular hemodynamics between subjects with pulmonary hypertension (PH) and normal controls. Fifteen (15) PH subjects and 10 age-matched controls underwent same day 3D time resolved CMR and echocardiography. Echocardiography was used to determine right ventricular diastolic function as well as pulmonary artery systolic pressure (PASP). Velocity vectors, vorticity vectors, and streamlines in the RV were visualized in Paraview and total RV Early (E) and Atrial (A) wave diastolic vorticity was quantified. Visualizations of blood flow in the RV are presented for PH and normal subjects. The hypothesis that PH subjects exhibit different RV vorticity levels than normals during diastole is tested and the relationship between RV vorticity and PASP is explored. The mechanics of RV vortex formation are discussed within the context of pulmonary arterial pressure and right ventricular diastolic function coincident with PH.

  12. Impact of the right ventricular lead position on clinical outcome and on the incidence of ventricular tachyarrhythmias in patients with CRT-D

    DEFF Research Database (Denmark)

    Kutyifa, Valentina; Bloch Thomsen, Poul Erik; Huang, David T.;

    2013-01-01

    Data on the impact of right ventricular (RV) lead location on clinical outcome and ventricular tachyarrhythmias in cardiac resynchronization therapy with defibrillator (CRT-D) patients are limited....

  13. A rare case of isolated non-compaction right ventricular myocardium

    Institute of Scientific and Technical Information of China (English)

    ZHANG Xiao-juan; ZHI Guang; HOU Hai-jun; ZHOU Xiao

    2009-01-01

    Isolated right ventricular noncompaction (IRNC) is a rare congenital cardiomyopathy resulting from an arrest in normal endomyocardial embryogenesis. The clinical syndrome includes systolic and diastolic dysfunction; some cases may have ventricular arrhythmias. We report a case of a female with the diagnosis of right ventricular non-compaction myocardium (RVNC) with normal left ventricular systolic function. To the best of our knowledge, there have been no reports of isolated ventricular non-compaction involving only the right ventricular before 2008, and there have only been described in very few cases of newborns and adult patients.

  14. Large Right Ventricular Clot in Pulmonary Atresia With Intact Ventricular Septum: In Defense of Biventricular Approach.

    Science.gov (United States)

    Dutta, Nilanjan; Ghosh, Rajarshi; Awasthy, Neeraj; Iyer, Parvathi U; Girotra, Sumir; Iyer, Krishna S

    2016-09-01

    Thrombus formation within the right ventricle (RV) in the setting of pulmonary atresia with intact ventricular septum (PAIVS) is not a very common occurrence and can be catastrophic. We present the case of a seven-month-old child with PAIVS and RV clot who successfully underwent biventricular repair. We discuss the interesting case and the rationale for management by means of biventricular repair over single ventricle repair when feasible in such a setting.

  15. Right ventricular volume and mass determined by cine magnetic resonance imaging in HIV patients with possible right ventricular dysfunction

    DEFF Research Database (Denmark)

    Kjaer, Andreas; Lebech, Anne-Mette; Gerstoft, Jan;

    2006-01-01

    ventricular ejection fraction (RVEF). To do so, we screened patients with RNV and performed an additional cine-MRI in those with reduced RVEF determined by RNV. Ninety patients with HIV were included. To evaluate the MRI measures exactly we included 18 age- and gender-matched healthy volunteers to establish......Impaired right ventricular (RV) function has been reported to occur in patients with HIV when studied by echocardiography. However, for accurate evaluation of RV function and morphology, first-pass radionuclide ventriculography (RNV) and cine magnetic resonance imaging (cine-MRI) are methods...... of choice. Studies of RV involvement in patients with HIV are of interest since pulmonary hypertension is a known serious complication of HIV recognized with increasing frequency. The aim of the present study was to characterize cardiac function and geometry in patients with HIV and reduced right...

  16. Right ventricular outflow and apical pacing comparably worsen the echocardioghraphic normal left ventricle

    NARCIS (Netherlands)

    T.J.F. ten Cate (Tim); M.G. Scheffer (Michael); G.R. Sutherland (George); J.F. Verzijlbergen (Fred); N.M. van Hemel (Norbert)

    2008-01-01

    textabstractAims: A depressed left ventricular function (LVF) is sometimes observed during right ventricular apical (RVA) pacing, but any prediction of this adverse effect cannot be done. Right ventricular outflow tract (RVOT) pacing is thought to deteriorate LVF less frequently because of a more no

  17. Chest radiographs fail to detect right ventricular enlargement and right atrial enlargement in patients with a pure restrictive ventilatory impairment.

    Science.gov (United States)

    Shivkumar, K; Ravi, K; Henry, J W; Eichenhorn, M S; Stein, P D

    1994-08-01

    The validity of measurements of the cardiac silhouette on chest radiographs for the evaluation of right ventricular enlargement and right atrial enlargement in patients with a pure restrictive ventilatory impairment was investigated in 19 patients. The forced vital capacity (FVC) percent predicted in these patients was 59 +/- 12 percent (mean +/- SD) (range, 29 to 79 percent). Right ventricular enlargement, by two-dimensional echocardiography, was defined as a right ventricular area > 20.4 cm2 and right atrial enlargement was defined as a right atrial area > 15.3 cm2. Chest radiographic measurements in the posteroanterior (PA) projection included distance from the midline to the farthest point of the right border of the cardiac silhouette, transverse cardiac diameter, and cardiothoracic ratio. Measurements in the lateral projection included the lateral horizontal transverse diameter, ventral portion of the lateral broad diameter, and obliteration of the retrosternal space. Neither the right ventricular area nor the right atrial area correlated with any of these radiographic measurements. There were no differences in these chest radiographic measurements among patients with normal right ventricular and right atrial dimensions, patients with right ventricular enlargement, and patients with right atrial enlargement. We conclude, therefore, that PA and lateral chest radiographs do not reliably detect right ventricular enlargement or right atrial enlargement in patients with a pure restrictive ventilatory impairment.

  18. Risk factors predictive of right ventricular failure after left ventricular assist device implantation.

    Science.gov (United States)

    Drakos, Stavros G; Janicki, Lindsay; Horne, Benjamin D; Kfoury, Abdallah G; Reid, Bruce B; Clayson, Stephen; Horton, Kenneth; Haddad, Francois; Li, Dean Y; Renlund, Dale G; Fisher, Patrick W

    2010-04-01

    Right ventricular failure (RVF) after left ventricular assist device (LVAD) implantation appears to be associated with increased mortality. However, the determination of which patients are at greater risk of developing postoperative RVF remains controversial and relatively unknown. We sought to determine the preoperative risk factors for the development of RVF after LVAD implantation. The data were obtained for 175 consecutive patients who had received an LVAD. RVF was defined by the need for inhaled nitric oxide for >/=48 hours or intravenous inotropes for >14 days and/or right ventricular assist device implantation. An RVF risk score was developed from the beta coefficients of the independent variables from a multivariate logistic regression model predicting RVF. Destination therapy (DT) was identified as the indication for LVAD implantation in 42% of our patients. RVF after LVAD occurred in 44% of patients (n = 77). The mortality rates for patients with RVF were significantly greater at 30, 180, and 365 days after implantation compared to patients with no RVF. By multivariate logistic regression analysis, 3 preoperative factors were significantly associated with RVF after LVAD implantation: (1) a preoperative need for intra-aortic balloon counterpulsation, (2) increased pulmonary vascular resistance, and (3) DT. The developed RVF risk score effectively stratified the risk of RV failure and death after LVAD implantation. In conclusion, given the progressively growing need for DT, the developed RVF risk score, derived from a population with a large percentage of DT patients, might lead to improved patient selection and help stratify patients who could potentially benefit from early right ventricular assist device implantation. PMID:20346326

  19. Assessment of right ventricular systolic function by tissue Doppler echocardiography

    DEFF Research Database (Denmark)

    Kjærgaard, Jesper

    2012-01-01

    myocardial velocities, but no changes in SR, strain or isovolumic acceleration could be observed [II and III]. Tissue Doppler echocardiography of the RV free wall in non-massive pulmonary embolism quantifies degree of RV dysfunction, and supports the existence of the McConnell sign of mid-ventricular RV...... structure including significant dilatation, but is well tolerated with only mild reduction in measures of global RV systolic function as estimated by 2D echocardiography in an experimental animal model. Regional RV myocardial function is also only mildly reduced. Also no differences in global or regional RV......This thesis summarizes a series of studies performed in order to assess the clinical usefulness of a novel echocardiographic technology that allows non-invasive assessment of regional right ventricular myocardial velocities and deformation: tissue Doppler echocardiography. While the technology...

  20. Right Ventricular Involvement in either Anterior or Inferior Myocardial Infarction

    Directory of Open Access Journals (Sweden)

    Firoozeh Abtahi

    2016-06-01

    Full Text Available Background: Unlike left ventricular function, less attention has been paid to Right Ventricular (RV function after Myocardial Infarction (MI. Objectives: The current study aimed to compare RV function in patients with inferior and anterior MI. Patients and Methods: During the study period, 60 patients consecutively presented to the Emergency Department with chest pain were divided into two groups based on their electrocardiographic findings. Accordingly, 25 patients had inferior MI (IMI group and 35 ones had anterior MI (AMI group. Echocardiography was performed 48 hours after starting the standard therapy. Conventional echocardiographic parameters and Tissue Doppler Imaging (TDI measurements were acquired from the standard views. Student t-test and the chi-square test were respectively used for comparisons of the normally distributed continuous and categorical variables in the two groups. Besides, P < 0.05 was considered to be statistically significant.

  1. A Novel Mathematical/Numerical Formula for Assessing Right Ventricular Torsion Using Echocardiographic Imaging

    CERN Document Server

    Ranjbar, Saeed

    2015-01-01

    Recently, the ventricular torsional parameters have received special attention because of their significant role in the ventricular systolic and diastolic function. Right ventricular (RV) rotational deformation is a sensitive index for RV performance but difficult to measure. Having assumed RV as a conic shape, the present study serves a novel mathematical formula of right ventricular rotation that uses velocity vector imaging (VVI) for quantifying RV.

  2. Right ventricular noncompaction in a neonate with complex congenital heart disease.

    Science.gov (United States)

    Alehan, Dursun; Dogan, Omer Faruk

    2005-08-01

    Ventricular noncompaction is a rare unclassified cardiomyopathy occurring because of arrest of the normal intrauterine compaction of the loose luminal component of the ventricular myocardium. There is limited data regarding its diagnosis and outcome in children. It is recognised, however, that right ventricular involvement is extremely rare. We report a case in which only the right ventricular myocardium was noncompacted, a situation which led to heart failure soon after birth.

  3. Pulmonary arterial dimensions and right ventricular function by cardiac MRI

    International Nuclear Information System (INIS)

    Objective: To evaluate the diagnostic value of cardiac magnetic resonance imaging (CMRI) for pulmonary arterial hypertension (PAH). Methods: One hundred and thirty patients with PAH confirmed by right cardiac catheterization were examined by CMRI and the results were compared with that of 31 healthy control participants. The main pulmonary artery diameter (MPAD), aortic diameter (AOD), main pulmonary artery diameter/aortic diameter (MPAD/AOD), right ventricular end-diastolic volume (RVEDV), right ventricular end-systolic volume (RVESV), right ventricular ejection fraction (RVEF) and right ventricular mass (RVM) were measured. The independent samples t-test was used to compare the PAH group with the control group. The Pearson correlation analysis and linear regression analysis were used to evaluate the relationship between cardiac and arterial measurements and pulmonary arterial pressure (PAP). Results: The MPAD, MPAD/AOD, RVEDV, RVESV, RVM in PAH group [(3.88 ±0.57) cm,1.36 ±0.17,(161.63 ±56.37) ml,(112.61 ±41.46) ml,(82.70 ± 20.73) g, respectively] were increased compared with those in normal control group [(2.74 ±0.31 ) cm, 0.90 ±0.07, (131.31 ± 15.14) ml, (61.33±9.00) ml, (44.39±5.87) g, respectively]. The RVSV and RVEF in PAH group[(49.02 ±19.20) ml, (30.76 ± 5.85 )%, respectively] were decreased compared with those in normal control group [(69.95 ± 9.63 )ml, (53.28 ± 4.14)%, respectively]. The MPAD, MPAD/AOD, RVEDV, RVESV, RVSV, RVEF, RVM were significantly different between PAH patients and control participants (tMPAD=10.82, tMPAD/AOD=14.93, tRVEDV=2.96, tRVESV=6.83, tRVSV=-5.89, tRVEF=-20.22, tRVM=10.12, respectively, P<0.01). There were no significant correlations between MPAD, RVEDV, RVESV, RVSV and PAP (r=0.299 for MPAD, r=0.127 for RVEDV, r=0.278 for RVESV, r=-0.229 for RVSV). Moderate positive correlations were found between MPAD/AOD, RVM and PAP (r=0.702 for MPAD/AOD, r=0.683 for RVM ). A moderate negative correlation was found between

  4. Special Situations in Pulmonary Hypertension: Pregnancy and Right Ventricular Failure.

    Science.gov (United States)

    Svetlichnaya, Jana; Janmohammed, Munir; De Marco, Teresa

    2016-08-01

    Despite rapid advances in medical therapy, pregnancy and right ventricular (RV) failure predicts a poor prognosis in patients with pulmonary arterial hypertension. Evidence-based therapy for pulmonary arterial hypertension should be initiated early in the disease course to decrease RV wall stress and prevent RV remodeling and fibrosis. In patients with acutely decompensated RV failure, an aggressive and multifaceted approach must be used; a thorough search for triggering factors for the decompensation is a key part of the successful management strategy. Patients with refractory RV failure who are not candidates for surgical intervention should be referred to palliative care to maximize quality of life and symptom relief. PMID:27443142

  5. [Right-sided mechanical circulatory support in acute right ventricular failure in the dog].

    Science.gov (United States)

    Gabauer, I; Okolicány, J; Styk, J; Pancza, D; Holec, V

    1991-05-01

    The technique of surgically induced acute progressive right ventricular failure in experimental animals is described. It sumultates the hemodynamic situation of right ventricular failure in some patients after termination of extracorporeal circulation applied for carrying out procedures on the left ventricle. The described technique consists of rightsided longitudinal ventriculotomy, destruction of the tricuspid valve, and ligation of the right coronary artery. Nine control dogs died within two hours after induction of failure due to low stroke volume caused by low pulmonary and left atrial pressure. The use of rightsided support appliance draining blood from the right atrium in systole and pumping it into the trunk of the pulmonary artery in diastole by means of a membrane pump resulted in further 12 dogs in the restoration of left ventricular diastolic pressure, significant increase of aortal pressure (p less than 0.003) and stroke volume (p less than 0.003) and in a decrease of right atrial pressure (p less than 0.003). The study demonstrated that by using the described mechanical support the circulation can be adequately assisted so that the failing right side of the heart can get restored. (Tab.1,Fig.5,Ref.25.).

  6. Right ventricular pacing: the best site is yet to be defined

    Institute of Scientific and Technical Information of China (English)

    Li ZHOU; Brian Olshansky

    2005-01-01

    @@ The right ventricular (RV) apex is the traditional site to provide stable and reliable chronic ventricular pacing. Interest in alternate site pacing has grown since RV apical pacing has been associated with increased mortality and morbidity compared to normal atrio-ventricular conduction. 1-4 Alternate pacing sites include the RV septum and outflow tract.

  7. Right ventricular dyssynchrony in patients with pulmonary hypertension is associated with disease severity and functional class

    Directory of Open Access Journals (Sweden)

    Murali Srinivas

    2005-08-01

    Full Text Available Abstract Background Abnormalities in right ventricular function are known to occur in patients with pulmonary arterial hypertension. Objective Test the hypothesis that chronic elevation in pulmonary artery systolic pressure delays mechanical activation of the right ventricle, termed dyssynchrony, and is associated with both symptoms and right ventricular dysfunction. Methods Fifty-two patients (mean age 46 ± 15 years, 24 patients with chronic pulmonary hypertension were prospectively evaluated using several echocardiographic parameters to assess right ventricular size and function. In addition, tissue Doppler imaging was also obtained to assess longitudinal strain of the right ventricular wall, interventricular septum, and lateral wall of the left ventricle and examined with regards to right ventricular size and function as well as clinical variables. Results In this study, patients with chronic pulmonary hypertension had statistically different right ventricular fractional area change (35 ± 13 percent, right ventricular end-systolic area (21 ± 10 cm2, right ventricular Myocardial Performance Index (0.72 ± 0.34, and Eccentricity Index (1.34 ± 0.37 than individuals without pulmonary hypertension (51 ± 5 percent, 9 ± 2 cm2, 0.27 ± 0.09, and 0.97 ± 0.06, p Conclusion Lower peak longitudinal right ventricular wall strain and significantly delayed time-to-peak strain values, consistent with right ventricular dyssynchrony, were found in a small heterogeneous group of patients with chronic pulmonary hypertension when compared to individuals without pulmonary hypertension. Furthermore, right ventricular dyssynchrony was associated with disease severity and compromised functional class.

  8. Right ventricular Hemodynamic Alteration after Pulmonary Valve Replacement in Children with Congenital Heart Disease

    Directory of Open Access Journals (Sweden)

    Hamid Bigdelian

    2015-03-01

    Full Text Available Introduction:  In patients who underwent surgery to repair Tetralogy of Fallot, right ventricular dilation from pulmonary regurgitation may be result in right ventricular failure, arrhythmias and cardiac arrest. Hence, pulmonary valve replacement may be necessary to reduce right ventricular volume overload. The aim of present study was to assess the effects of pulmonary valve replacement on right ventricular function after repair of Tetralogy of Fallot.   Materials and  Method:  This retrospective study was carried out between July 2011 and October 2013 on 21 consecutive patients in Chamran Heart Center (Esfahan. The study included 13 male (61.9% and 8 female (38.1%. Cardiac magnetic resonance was performed before, 6 and 12 months after pulmonary valve replacement in all patients (Babak Imaging Center, Tehran with the 1.5 Tesla system. The main reason for surgery at Tetralogy of Fallot repaired time was Tetralogy of Fallot + Pulmonary insufficiency (17 cases and Tetralogy of Fallot + Pulmonary atresia (4 cases. Right ventricular function was assessed before and after pulmonary valve replacement with Two-dimensional echocardiography and ttest was used to evaluate follow-up data.   Results:  Right ventricular end-diastolic volume, right ventricular end- systolic volume significantly decreased (P value ˂ 0.05.Right ventricular ejection fraction had a significant increase (P value ˂ 0.05. Right ventricular mass substantially shrank after pulmonary valve replacement. Moreover, pulmonary regurgitation noticeably decreased in patients. The other hemodynamic parameter such as left ventricular ejection fraction improved but was not significant (P value= 0.79. Conclusion:  Pulmonary valve replacement can successfully restores the impaired hemodynamic function of right ventricle which is caused by direct consequence of volume unloading in patient. Pulmonary valve surgery in children with Tetralogy of Fallot who have moderate to severe pulmonary

  9. Primary angioplasty for infarction due to isolated right ventricular artery occlusion

    Institute of Scientific and Technical Information of China (English)

    Anwar; A; Chahal; Min-Young; Kim; Alexander; N; Borg; Yahya; Al-Najjar

    2014-01-01

    We report an unusual case of an isolated right ventricular infarction with haemodynamic compromise caused by spontaneous isolated proximal occlusion of the right ventricular branch of the right coronary artery(RCA), successfully treated by balloon angioplasty. A 58-yearold gentleman presented with epigastric pain radiating into both arms. Electrocardiograph with right ventricular leads confirmed ST elevation in V4 R and a diagnosis of isolated right ventricular infarction was made. Urgent primary percutaneous intervention was performed which revealed occlusion of the right ventricular branch of the RCA. During the procedure, the patient’s blood pressure dropped to 80/40 mm Hg, and echocardiography showed impaired right ventricular systolic function. Despite aggressive fluid resuscitation, the patient remained hypotensive, continued to have chest pain and persistent electrocardiograph changes, and hence balloon angioplasty was performed on the proximal right ventricular branch which restored flow to the vessel and revealed a severe ostial stenosis. This was treated with further balloon angioplasty which restored TIMI 3 flow with resolution of patient’s symptoms. Repeat echocardiography showed complete resolution of theST-elevation in leads V4 R and V5 R and partial resolution in V1. Subsequent dobutamine-stress echocardiography at 4 wk showed good left and right ventricular contractions. The patient was discharged after a 3-d inpatient stay without any complications.

  10. Quantitative assessment of regional right ventricular function with color kinesis.

    Science.gov (United States)

    Vignon, P; Weinert, L; Mor-Avi, V; Spencer, K T; Bednarz, J; Lang, R M

    1999-06-01

    We used color kinesis, a recent echocardiographic technique that provides regional information on the magnitude and timing of endocardial wall motion, to quantitatively assess regional right ventricular (RV) systolic and diastolic properties in 76 subjects who were divided into five groups, as follows: normal (n = 20), heart failure (n = 15), pressure/volume overload (n = 14), pressure overload (n = 12), and RV hypertrophy (n = 15). Quantitative segmental analysis of color kinesis images was used to obtain regional fractional area change (RFAC), which was displayed in the form of stacked histograms to determine patterns of endocardial wall motion. Time curves of integrated RFAC were used to objectively identify asynchrony of diastolic endocardial motion. When compared with normal subjects, patients with pressure overload or heart failure exhibited significantly decreased endocardial motion along the RV free wall. In the presence of mixed pressure/volume overload, the markedly increased ventricular septal motion compensated for decreased RV free wall motion. Diastolic endocardial wall motion was delayed in 17 of 72 segments (24%) in patients with RV pressure overload, and in 31 of 90 segments (34%) in patients with RV hypertrophy. Asynchrony of diastolic endocardial wall motion was greater in the latter group than in normal subjects (16% versus 10%: p kinesis images allows quantitative assessment of regional RV systolic and diastolic properties.

  11. Right Atrial Pressure Affects the Interaction between Lung Mechanics and Right Ventricular Function in Spontaneously Breathing COPD Patients

    OpenAIRE

    Boerrigter, B.G.; Trip, P.; Bogaard, H.J.; Groepenhoff, H.; Oosterveer, F.; Westerhof, N.; Vonk Noordegraaf, A.

    2012-01-01

    Introduction It is generally known that positive pressure ventilation is associated with impaired venous return and decreased right ventricular output, in particular in patients with a low right atrial pressure and relative hypovolaemia. Altered lung mechanics have been suggested to impair right ventricular output in COPD, but this relation has never been firmly established in spontaneously breathing patients at rest or during exercise, nor has it been determined whether these cardiopulmonary...

  12. Left and right ventricular contributions to the formation of the interventricular septum in the mouse heart

    NARCIS (Netherlands)

    D. Franco; S.M. Meilhac; V.M. Christoffels; A. Kispert; M. Buckingham; R.G. Kelly

    2006-01-01

    Mammalian heart development involves complex morphogenetic events which lead to the formation of fully separated left and right atrial and ventricular chambers from a tubular heart. Separation of left and right ventricular chambers is dependent on a single structure, the interventricular septum (IVS

  13. Lung perfusion and ventilation during implantation of left ventricular assist device as a strategy to avoid postoperative pulmonary complications and right ventricular failure

    OpenAIRE

    Macedo, Francisco Igor B.; Anthony L. PANOS; Andreopoulos, Fotios M.; Salerno, Tomas A.; Pham, Si M.

    2013-01-01

    Right ventricular failure is a major contributor to increased morbidity and mortality in patients undergoing left ventricular assist device implantation. Cardiopulmonary bypass is associated with increased pulmonary ischaemia and pulmonary vascular resistance. Continuous pulmonary perfusion and ventilation represents an emerging strategy for pulmonary protection during cardiac surgery. We hypothesize that this technique may have a pivotal role in reducing postoperative right ventricular dysfu...

  14. Exercise-Induced Right Ventricular Outflow Tract Tachycardia in a Patient with Isolated Left Ventricular Noncompaction

    OpenAIRE

    Mehmet Eren; Erkan İlhan; Ahmet Taha Alper; Tolga Sinan Güvenç

    2011-01-01

    Isolated left ventricular noncompaction is a hereditary cardiomyopathy in which a variety of supraventricular and ventricular arrhythmias could be observed. We report a patient with exercise-induced ventricular tachycardia with left bundle branch block morphology that had characteristics of an idiopathic ventricular tachycardia who was subsequently diagnosed as left ventricular noncompaction. Successful remission of arrhythmia was ensured after the introduction of oral beta-blocker therapy.

  15. The Effect of Elective Percutaneous Coronary Intervention of the Right Coronary Artery on Right Ventricular Function

    Directory of Open Access Journals (Sweden)

    Farahnaz Nikdoust

    2014-12-01

    Full Text Available Background: Right Ventricular (RV dysfunction has been introduced as a predictor of mortality in acute myocardial infarction. Objectives: This study aimed to investigate the effect of right coronary revascularization on systolic and diastolic RV dysfunction. Patients and Methods: This study was conducted on unstable angina patients who were candidate for elective Percutaneous Revascularization Intervention (PCI on the right coronary artery. The participants were initially evaluated by transthoracic echocardiography and tissue Doppler imaging prior to PCI and the RV function parameters were assessed. Echocardiography was repeated two months after PCI and the results were compared with baseline. Paired t-test was used to compare the pre- and post-procedural measurements. Besides, Pearson’s correlation was used to find out the linear association between the RV function parameters and Left Ventricular Ejection Fraction (LVEF. P value < 0.05 was considered as statistically significant. Results: This study was conducted on 30 patients (mean age = 60.00 ± 8.44 years; 24 [80%] males. In the pre-procedural echocardiography, 15 patients (50% had normal RV function, 14 patients (46.7% had grade-1 RV dysfunction, and only 1 patient (3.3% had grade-2 RV dysfunction. Following PCI, however, all the patients had normal systolic and diastolic RV functions. Comparison of echocardiographic RV function parameters showed an improvement in both systolic and diastolic functional parameters of the RV. Nonetheless, no significant correlation was observed between these parameters and Left Ventricular (LV function. Conclusions:: A significant improvement was found in RV function, but not LV function, after right coronary PCI. Revascularization of the right coronary artery may be beneficial for the patients who suffer from RV failure due to ischemia

  16. Echocardiographic evaluation of right ventricular function in congenital heart disease

    Institute of Scientific and Technical Information of China (English)

    Yiu-fai Cheung

    2014-01-01

    Objective This review aims to provide an overview of conventional and novel indices used in clinical and research arenas for evaluation of right ventricular (RV) function in congenital heart diseases with a dual-chambered circulation.Data sources Articles cited in this review were selected using PubMed search of publications in English with no date limits.The search terms included "echocardiography","right ventricle","RV function","cardiac function",and "congenital heart disease".Key references were also searched for additional publications.Study selection Articles related to description of echocardiographic techniques in the evaluation of subpulmonary or systemic RV function and their applications in congenital cardiac malformations were retrieved and reviewed.Results Three approaches have been used to evaluate subpulmonary and systemic RV function:(1) assessment of changes in RV size in the cardiac cycle,(2) determination of Doppler-derived velocities and systolic and diastolic time intervals,and (3) quantification of myocardial velocities and deformation.Conclusions Conventional and novel echocardiographic techniques enable the evaluation of subpulmonary and systemic RV function.Novel echocardiographic techniques have further allowed quantification of RV volumes and direct interrogation of myocardial deformation.These new techniques show promise in a more comprehensive evaluation beyond "eye-bailing" of RV function in the growing population of adolescent and adult congenital heart patients.

  17. Right ventricular cardiomyopathies: a multidisciplinary approach to diagnosis.

    Science.gov (United States)

    Limongelli, Giuseppe; Rea, Alessandra; Masarone, Daniele; Francalanci, M Paola; Anastasakis, Aris; Calabro', Raffaele; Giovanna, Russo Maria; Bossone, Eduardo; Elliott, Perry Mark; Pacileo, Giuseppe

    2015-01-01

    The physiological importance of the right ventricle (RV) has been underestimated over the past years. Finally in the early 1950s through the 1970s, cardiac surgeons recognized the importance of RV function. Since then, the importance of RV function has been recognized in many acquired cardiac heart disease. RV can be mainly or together with left ventricle (LV) affected by inherited or acquired cardiomyopathy. In fact, RV morphological and functional remodeling occurs more common during cardiomyopathies than in ischemic cardiomyopathies and more closely parallels LV dysfunction. Moreover, there are some cardiomyopathy subtypes showing a predominant or exclusive involvement of the RV, and they are probably less known by cardiologists. The clinical approach to right ventricular cardiomyopathies is often challenging. Imaging is the first step to raise the suspicion and to guide the diagnostic process. In the differential diagnosis, cardiologists should consider athlete's heart, congenital heart diseases, multisystemic disorders, and inherited arrhythmias. However, a multiparametric and multidisciplinary approach, involving cardiologists, experts in imaging, geneticists, and pathologists with a specific expertise in these heart muscle disorders is required.

  18. Effect of arotinolol on right ventricular function in patients with dilated cardiomyopathy

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Objective Dilated cardiomyopathy (DCM) is generally considered to be accompanied by both left and right ventricular dysfunction,but most studies only analyze the left ventricular function. In this study, we evaluated the effect of arotinolol on right ventricular function in patients with DCM. Methods Right ventricular ejection fraction (RVEF) and right ventricular diameter (RVD) were measured by two-dimensional echocardiography (2-DE) in 33 DCM patients; RVEF measured by first-pass radionuclide angiography (FPRA) was compared with that by 2-DE. Results The treatment with arotinolol for one year resulted in a reduction in the right ventricular diameter (baseline, 23.0 ± 8.3 mm vs after one-year treatment, 20.7 ± 5.4 mm; P=0.004 ) and an associated increase in ejection fraction (baseline, 36.9 ± 10.3% vs after one-year treatment, 45.8 ± 9.6%; P < 0.001 ); there is a high correlation between the 2-DE method and radionuclide ventriculographic method. The correlation coefficient is 0.933 (P<0.001). Conclusion Arotinolol therapy could not only improve left ventricular function, but also improve right ventricular function in DCM patients.

  19. Right ventricular cyclic nucleotide signaling is decreased in hyperoxia-induced pulmonary hypertension in neonatal mice

    Science.gov (United States)

    Heilman, Rachel P.; Lagoski, Megan B.; Lee, Keng Jin; Taylor, Joann M.; Kim, Gina A.; Berkelhamer, Sara K.; Steinhorn, Robin H.

    2015-01-01

    Pulmonary hypertension (PH) and right ventricular hypertrophy (RVH) affect 25–35% of premature infants with significant bronchopulmonary dysplasia (BPD), increasing morbidity and mortality. We sought to determine the role of phosphodiesterase 5 (PDE5) in the right ventricle (RV) and left ventricle (LV) in a hyperoxia-induced neonatal mouse model of PH and RVH. After birth, C57BL/6 mice were placed in room air (RA) or 75% O2 (CH) for 14 days to induce PH and RVH. Mice were euthanized at 14 days or recovered in RA for 14 days or 42 days prior to euthanasia at 28 or 56 days of age. Some pups received sildenafil or vehicle (3 mg·kg−1·dose−1 sc) every other day from P0. RVH was assessed by Fulton's index [RV wt/(LV + septum) wt]. PDE5 protein expression was analyzed via Western blot, PDE5 activity was measured by commercially available assay, and cGMP was measured by enzyme-linked immunoassay. Hyperoxia induced RVH in mice after 14 days, and RVH did not resolve until 56 days of age. Hyperoxia increased PDE5 expression and activity in RV, but not LV + S, after 14 days. PDE5 expression normalized by 28 days of age, but PDE5 activity did not normalize until 56 days of age. Sildenafil given during hyperoxia prevented RVH, decreased RV PDE5 activity, and increased RV cGMP levels. Mice with cardiac-specific overexpression of PDE5 had increased RVH in RA. These findings suggest normal RV PDE5 function is disrupted by hyperoxia, and elevated PDE5 contributes to RVH and remodeling. Therefore, in addition to impacting the pulmonary vasculature, sildenafil also targets PDE5 in the neonatal mouse RV and decreases RVH. PMID:25862831

  20. Electrically contractile polymers augment right ventricular output in the heart.

    Science.gov (United States)

    Ruhparwar, Arjang; Piontek, Patricia; Ungerer, Matthias; Ghodsizad, Ali; Partovi, Sasan; Foroughi, Javad; Szabo, Gabor; Farag, Mina; Karck, Matthias; Spinks, Geoffrey M; Kim, Seon Jeong

    2014-12-01

    Research into the development of artificial heart muscle has been limited to assembly of stem cell-derived cardiomyocytes seeded around a matrix, while nonbiological approaches to tissue engineering have rarely been explored. The aim of the study was to apply electrically contractile polymer-based actuators as cardiomyoplasty for positive inotropic support of the right ventricle. Complex trilayer polypyrrole (PPy) bending polymers for high-speed applications were generated. Bending motion occurred directly as a result of electrochemically driven charging and discharging of the PPy layers. In a rat model (n = 5), strips of polymers (3 × 20 mm) were attached and wrapped around the right ventricle (RV). RV pressure was continuously monitored invasively by direct RV cannulation. Electrical activation occurred simultaneously with either diastole (in order to evaluate the polymer's stand-alone contraction capacity; group 1) or systole (group 2). In group 1, the pressure generation capacity of the polymers was measured by determining the area under the pressure curve (area under curve, AUC). In group 2, the RV pressure AUC was measured in complexes directly preceding those with polymer contraction and compared to RV pressure complexes with simultaneous polymer contraction. In group 1, the AUC generated by polymer contraction was 2768 ± 875 U. In group 2, concomitant polymer contraction significantly increased AUC compared with complexes without polymer support (5987 ± 1334 U vs. 4318 ± 691 U, P ≤ 0.01). Electrically contractile polymers are able to significantly augment right ventricular contraction. This approach may open new perspectives for myocardial tissue engineering, possibly in combination with fetal or embryonic stem cell-derived cardiomyocytes.

  1. Repaired tetralogy of Fallot with coexisting unrepaired partial anomalous pulmonary venous connection is associated with diminished right ventricular ejection fraction and more severe right ventricular dilation

    Energy Technology Data Exchange (ETDEWEB)

    Chan, Sherwin S. [Children' s Mercy Hospital and Clinics, Department of Radiology, Kansas City, MO (United States); Whitehead, Kevin K.; Kim, Timothy S.; Fu, Gregory L.; Fogel, Mark A.; Harris, Matthew A. [Children' s Hospital of Philadelphia, Department of Cardiology, Philadelphia, PA (United States); Keller, Marc S. [Children' s Hospital of Philadelphia, Department of Radiology, Philadelphia, PA (United States)

    2015-09-15

    There is an established association between tetralogy of Fallot and partial anomalous pulmonary venous connections. This association is important because surgically repaired tetralogy patients have increased risk of right heart failure. We hypothesize that partial anomalous venous connections increase right ventricular volumes and worsen right ventricular failure. We reviewed cardiac MRI exams performed at a tertiary pediatric hospital from January 2005 to January 2014. We identified patients with repaired tetralogy and unrepaired partial anomalous pulmonary venous connection. We used age- and gender-matched repaired tetralogy patients without partial anomalous pulmonary venous connection as controls. We analyzed the MRI results and surgical course and performed comparative statistics to identify group differences. There were eight patients with repaired tetralogy and unrepaired partial anomalous pulmonary venous connection and 16 controls. In all cases, the partial anomalous pulmonary venous connection was not detected on preoperative echocardiography. There were no significant differences in surgical course and body surface area between the two groups. Repaired tetralogy patients with unrepaired partial anomalous pulmonary venous connection showed significantly higher indexed right ventricular end diastolic volume (149 ± 33 mL/m{sup 2} vs. 118 ± 30 mL/m{sup 2}), right ventricle to left ventricle size ratios (3.1 ± 1.3 vs. 1.9 ± 0.5) and a higher incidence of reduced right ventricular ejection fraction compared to controls (3/8 vs. 0/16). Repaired tetralogy of Fallot with unrepaired partial anomalous pulmonary venous connection is associated with reduced right ventricular ejection fraction and more significant right ventricular dilation. (orig.)

  2. Repaired tetralogy of Fallot with coexisting unrepaired partial anomalous pulmonary venous connection is associated with diminished right ventricular ejection fraction and more severe right ventricular dilation

    International Nuclear Information System (INIS)

    There is an established association between tetralogy of Fallot and partial anomalous pulmonary venous connections. This association is important because surgically repaired tetralogy patients have increased risk of right heart failure. We hypothesize that partial anomalous venous connections increase right ventricular volumes and worsen right ventricular failure. We reviewed cardiac MRI exams performed at a tertiary pediatric hospital from January 2005 to January 2014. We identified patients with repaired tetralogy and unrepaired partial anomalous pulmonary venous connection. We used age- and gender-matched repaired tetralogy patients without partial anomalous pulmonary venous connection as controls. We analyzed the MRI results and surgical course and performed comparative statistics to identify group differences. There were eight patients with repaired tetralogy and unrepaired partial anomalous pulmonary venous connection and 16 controls. In all cases, the partial anomalous pulmonary venous connection was not detected on preoperative echocardiography. There were no significant differences in surgical course and body surface area between the two groups. Repaired tetralogy patients with unrepaired partial anomalous pulmonary venous connection showed significantly higher indexed right ventricular end diastolic volume (149 ± 33 mL/m2 vs. 118 ± 30 mL/m2), right ventricle to left ventricle size ratios (3.1 ± 1.3 vs. 1.9 ± 0.5) and a higher incidence of reduced right ventricular ejection fraction compared to controls (3/8 vs. 0/16). Repaired tetralogy of Fallot with unrepaired partial anomalous pulmonary venous connection is associated with reduced right ventricular ejection fraction and more significant right ventricular dilation. (orig.)

  3. Predictors of right ventricular failure after left ventricular assist device implantation.

    Science.gov (United States)

    Koprivanac, Marijan; Kelava, Marta; Sirić, Franjo; Cruz, Vincent B; Moazami, Nader; Mihaljević, Tomislav

    2014-12-01

    Number of left ventricular assist device (LVAD) implantations increases every year, particularly LVADs for destination therapy (DT). Right ventricular failure (RVF) has been recognized as a serious complication of LVAD implantation. Reported incidence of RVF after LVAD ranges from 6% to 44%, varying mostly due to differences in RVF definition, different types of LVADs, and differences in patient populations included in studies. RVF complicating LVAD implantation is associated with worse postoperative mortality and morbidity including worse end-organ function, longer hospital length of stay, and lower success of bridge to transplant (BTT) therapy. Importance of RVF and its predictors in a setting of LVAD implantation has been recognized early, as evidenced by abundant number of attempts to identify independent risk factors and develop RVF predictor scores with a common purpose to improve patient selection and outcomes by recognizing potential need for biventricular assist device (BiVAD) at the time of LVAD implantation. The aim of this article is to review and summarize current body of knowledge on risk factors and prediction scores of RVF after LVAD implantation. Despite abundance of studies and proposed risk scores for RVF following LVAD, certain common limitations make their implementation and clinical usefulness questionable. Regardless, value of these studies lies in providing information on potential key predictors for RVF that can be taken into account in clinical decision making. Further investigation of current predictors and existing scores as well as new studies involving larger patient populations and more sophisticated statistical prediction models are necessary. Additionally, a short description of our empirical institutional approach to management of RVF following LVAD implantation is provided. PMID:25559829

  4. Percutaneous mechanical assist for severe cardiogenic shock due to acute right ventricular failure.

    Science.gov (United States)

    Kipp, Ryan; Raval, Amish N

    2015-05-01

    Acute right ventricular failure can lead to severe cardiogenic shock and death. Recovery may be achieved with early supportive measures. In many patients, intravenous fluid and inotropic resuscitation is inadequate to improve cardiac output. In these cases, percutaneous mechanical assist may provide a non-surgical bridge to recovery. Herein, we describe a case series of patients with severe, refractory cardiogenic shock due to acute right ventricular failure who received a continuous flow percutaneous ventricular device primarily utilizing the right internal jugular vein for out flow cannula placement.

  5. QRS fragmentation: its role in sherlocking the arrhythmogenic heart

    Directory of Open Access Journals (Sweden)

    Hafeez Ul Hassan Virk

    2016-07-01

    Full Text Available The electrocardiogram (ECG is a commonly available basic diagnostic modality in in-patient, out-patient, and emergency departments. In patients with coronary artery disease (CAD, the presence of a fragmented QRS (f-QRS, which is an extra R wave (R′, notching of the single R wave, notching of the S wave in at least two contiguous leads on the 12-lead ECG, is associated with a myocardial scar from previous myocardial injury. Furthermore, the presence of f-QRS has been shown to be associated with adverse outcomes in CAD and non-CAD patients. In the present paper, we will solely focus on the usefulness and utilization of f-QRS in predicting ventricular tachyarrhythmia in many heart diseases, that is, ischemic cardiomyopathy, non-ischemic cardiomyopathy, hypertrophic obstructive cardiomyopathy, Brugada syndrome, and arrhythmogenic right ventricular cardiomyopathy. In the majority of such cases, ventricular tachyarrhythmia results in sudden cardiac death. Diagnosing them beforehand can lead to prevention and/or early treatment of these arrhythmias to prevent potential morbidity and mortality.

  6. Screening for, and management of, possible arrhythmogenic syndromes (channelopathies/ion channel diseases)

    DEFF Research Database (Denmark)

    Svendsen, Jesper Hastrup; Geelen, Peter

    2010-01-01

    This survey assesses the current management strategies for individuals with electrocardiographic features, suggesting an arrhythmogenic syndrome [including long QT syndrome (LQTS), Brugada syndrome (BS), catecholaminergic polymorphic ventricular tachycardia (CPVT) or short QT syndrome] or family...

  7. Missense variants in plakophilin-2 in arrhythmogenic right ventricular cardiomyopathy patients--disease-causing or innocent bystanders?

    DEFF Research Database (Denmark)

    Christensen, Alex Hørby; Benn, Marianne; Tybjærg-Hansen, Anne;

    2010-01-01

    missense mutations may not be pathogenic. Methods: We screened 53 unrelated patients fulfilling Task Force criteria for ARVC/D for mutations in PKP2 by direct sequencing. Results: Seven different mutations were identified: two insertion/deletions (E329fsX352, P401fsX406), 1 splice site (2146-2A>T), 1 non......-sense (R79X) and 4 missense mutations (Q62K in 2 patients, G489R, G673V) of undeterminable pathogeneity. None of these mutations was present in 650 controls. Five of the mutations were novel. Seven patients carried reported missense mutations (D26N, S140F, V587I); however, these mutations were identified...

  8. Stenting of the right ventricular outflow tract in symptomatic neonatal tetralogy of Fallot.

    Science.gov (United States)

    Haas, Nikolaus A; Laser, Thorsten K; Moysich, Axel; Blanz, Ute; Sandica, Eugen

    2014-04-01

    There is ongoing debate regarding the initial management of symptomatic neonates with tetralogy of Fallot. Although neonatal repair can be performed with low mortality, it is associated with increased morbidity and long-term impact on right ventricular performance. Traditionally, the modified Blalock-Taussig shunt remains the palliative procedure of choice. Differential pulmonary artery flow may occur and subsequently result in underdevelopment and distortion of pulmonary vessels. Transcatheter therapy was previously limited to balloon valvulotomy when the obstruction is predominantly at the pulmonary valve level. Stenting of the right ventricular outflow tract can enable adequate forward flow; however, pulmonary regurgitation may impact on right ventricular performance and cardiac output. Stenting of the right ventricular outflow tract with valve sparing placement of the stent thus treating the underlying pathophysiology of the hypercyanotic spells provides a safe and effective management strategy, improving arterial oxygen saturation, avoiding pulmonary regurgitation and encouraging pulmonary artery growth. PMID:23534437

  9. Acute inferior myocardial infarction with right ventricular infarction is more prone to develop cardiogenic shock.

    Science.gov (United States)

    Bari, M A; Roy, A K; Islam, M Z; Aditya, G; Bhuiyan, A S

    2015-01-01

    Cardiogenic shock is rare in isolated acute inferior myocardial infarction but there is relationship of cardiogenic shock with inferior myocardial infarction if associated with right ventricular infarction. A prospective study was carried out to see the association of cardiogenic shock with inferior myocardial infarction if associated with right ventricular infarction. This study was conducted from January 2011 to November 2011. A total of 100 cases were selected as study population which was taken from the Department of Cardiology, Mymensingh Medical College Hospital, Mymensingh, Bangladesh. Among them 50 were in Group A and 50 were in Group B. Group A was the patients of acute myocardial infarction with right ventricular infarction. Group B was the patients of acute myocardial infarction without right ventricular infarction. It revealed that 9(18%) in Group A and 3(6%) in Group B developed cardiogenic shock which is statistically significant (pcardiogenic shock.

  10. Independent effects of both right and left ventricular function on plasma brain natriuretic peptide

    DEFF Research Database (Denmark)

    Vogelsang, Thomas Wiis; Jensen, Ruben J; Monrad, Astrid L;

    2007-01-01

    BACKGROUND: Brain natriuretic peptide (BNP) is increased in heart failure; however, the relative contribution of the right and left ventricles is largely unknown. AIM: To investigate if right ventricular function has an independent influence on plasma BNP concentration. METHODS: Right (RVEF), left...... ventricular ejection fraction (LVEF), and left ventricular end-diastolic volume index (LVEDVI) were determined in 105 consecutive patients by first-pass radionuclide ventriculography (FP-RNV) and multiple ECG-gated equilibrium radionuclide ventriculography (ERNV), respectively. BNP was analyzed by immunoassay......, which is a strong prognostic marker in heart failure, independently depends on both left and right ventricular systolic function. This might, at least in part, explain why BNP holds stronger prognostic value than LVEF alone....

  11. Right Atrial Pressure Affects the Interaction between Lung Mechanics and Right Ventricular Function in Spontaneously Breathing COPD Patients

    Science.gov (United States)

    Boerrigter, Bart; Trip, Pia; Bogaard, Harm Jan; Groepenhoff, Herman; Oosterveer, Frank; Westerhof, Nico; Vonk Noordegraaf, Anton

    2012-01-01

    Introduction It is generally known that positive pressure ventilation is associated with impaired venous return and decreased right ventricular output, in particular in patients with a low right atrial pressure and relative hypovolaemia. Altered lung mechanics have been suggested to impair right ventricular output in COPD, but this relation has never been firmly established in spontaneously breathing patients at rest or during exercise, nor has it been determined whether these cardiopulmonary interactions are influenced by right atrial pressure. Methods Twenty-one patients with COPD underwent simultaneous measurements of intrathoracic, right atrial and pulmonary artery pressures during spontaneous breathing at rest and during exercise. Intrathoracic pressure and right atrial pressure were used to calculate right atrial filling pressure. Dynamic changes in pulmonary artery pulse pressure during expiration were examined to evaluate changes in right ventricular output. Results Pulmonary artery pulse pressure decreased up to 40% during expiration reflecting a decrease in stroke volume. The decline in pulse pressure was most prominent in patients with a low right atrial filling pressure. During exercise, a similar decline in pulmonary artery pressure was observed. This could be explained by similar increases in intrathoracic pressure and right atrial pressure during exercise, resulting in an unchanged right atrial filling pressure. Conclusions We show that in spontaneously breathing COPD patients the pulmonary artery pulse pressure decreases during expiration and that the magnitude of the decline in pulmonary artery pulse pressure is not just a function of intrathoracic pressure, but also depends on right atrial pressure. PMID:22272306

  12. Right atrial pressure affects the interaction between lung mechanics and right ventricular function in spontaneously breathing COPD patients.

    Directory of Open Access Journals (Sweden)

    Bart Boerrigter

    Full Text Available INTRODUCTION: It is generally known that positive pressure ventilation is associated with impaired venous return and decreased right ventricular output, in particular in patients with a low right atrial pressure and relative hypovolaemia. Altered lung mechanics have been suggested to impair right ventricular output in COPD, but this relation has never been firmly established in spontaneously breathing patients at rest or during exercise, nor has it been determined whether these cardiopulmonary interactions are influenced by right atrial pressure. METHODS: Twenty-one patients with COPD underwent simultaneous measurements of intrathoracic, right atrial and pulmonary artery pressures during spontaneous breathing at rest and during exercise. Intrathoracic pressure and right atrial pressure were used to calculate right atrial filling pressure. Dynamic changes in pulmonary artery pulse pressure during expiration were examined to evaluate changes in right ventricular output. RESULTS: Pulmonary artery pulse pressure decreased up to 40% during expiration reflecting a decrease in stroke volume. The decline in pulse pressure was most prominent in patients with a low right atrial filling pressure. During exercise, a similar decline in pulmonary artery pressure was observed. This could be explained by similar increases in intrathoracic pressure and right atrial pressure during exercise, resulting in an unchanged right atrial filling pressure. CONCLUSIONS: We show that in spontaneously breathing COPD patients the pulmonary artery pulse pressure decreases during expiration and that the magnitude of the decline in pulmonary artery pulse pressure is not just a function of intrathoracic pressure, but also depends on right atrial pressure.

  13. Effects of Cardiac Rehabilitation Program on Right Ventricular Function after Coronary Artery Bypass Graft Surgery

    OpenAIRE

    Akram Sardari; Seyed Kianoosh Hosseini; Ali Taherian; Arezoo Zoroufian; Mehrdad Sheikhvatan

    2012-01-01

    Background: Cardiac rehabilitation has been recognized as one of the most effective strategies for managing cardiovascular indices as well as controlling the cardiovascular risk profile, in particular after coronary artery bypass graft surgery (CABG). However, the effect of this program on right ventricular function following CABG is unclear. The aim of this study was to evaluate the impact of cardiac rehabilitation on the right ventricular (RV) function in a cohort of patients who underwent ...

  14. Right Ventricular Myocardial Stiffness in Experimental Pulmonary Arterial Hypertension

    Science.gov (United States)

    Rain, Silvia; Andersen, Stine; Najafi, Aref; Gammelgaard Schultz, Jacob; da Silva Gonçalves Bós, Denielli; Handoko, M. Louis; Bogaard, Harm-Jan; Vonk-Noordegraaf, Anton; Andersen, Asger; van der Velden, Jolanda; Ottenheijm, Coen A.C.

    2016-01-01

    Background— The purpose of this study was to determine the relative contribution of fibrosis-mediated and myofibril-mediated stiffness in rats with mild and severe right ventricular (RV) dysfunction. Methods and Results— By performing pulmonary artery banding of different diameters for 7 weeks, mild RV dysfunction (Ø=0.6 mm) and severe RV dysfunction (Ø=0.5 mm) were induced in rats. The relative contribution of fibrosis- and myofibril-mediated RV stiffness was determined in RV trabecular strips. Total myocardial stiffness was increased in trabeculae from both mild and severe RV dysfunction in comparison to controls. In severe RV dysfunction, increased RV myocardial stiffness was explained by both increased fibrosis-mediated stiffness and increased myofibril-mediated stiffness, whereas in mild RV dysfunction, only myofibril-mediated stiffness was increased in comparison to control. Histological analyses revealed that RV fibrosis gradually increased with severity of RV dysfunction, whereas the ratio of collagen I/III expression was only elevated in severe RV dysfunction. Stiffness measurements in single membrane-permeabilized RV cardiomyocytes demonstrated a gradual increase in RV myofibril stiffness, which was partially restored by protein kinase A in both mild and severe RV dysfunction. Increased expression of compliant titin isoforms was observed only in mild RV dysfunction, whereas titin phosphorylation was reduced in both mild and severe RV dysfunction. Conclusions— RV myocardial stiffness is increased in rats with mild and severe RV dysfunction. In mild RV dysfunction, stiffness is mainly determined by increased myofibril stiffness. In severe RV dysfunction, both myofibril- and fibrosis-mediated stiffness contribute to increased RV myocardial stiffness. PMID:27370069

  15. Right ventricular wall abscess in structurally normal heart after leg osteomyelitis: First case.

    Science.gov (United States)

    Ahmad, Tanveer; Pasarad, Ashwini Kumar; Kishore, Kolkebaile Sadanand; Maheshwarappa, Nandakumar Neralakere

    2016-09-01

    A 3-year-old girl presented with fever and acute dyspnea for 4 days. She had suffered an injury to the left lower leg 3 weeks earlier, with abscess formation. Magnetic resonance imaging showed osteomyelitis of the lower tibia. Echocardiography showed a mass in the right ventricular wall. She underwent concomitant heart surgery for removal of the right ventricular mass and limb arthrotomy. We believe this is a first reported case in which a ventricular wall abscess developed in a structurally normal heart following leg osteomyelitis.

  16. Beyond right ventricular size and function: the importance of evaluating the right ventricle's capacity for recovery.

    Science.gov (United States)

    Addetia, Karima; Patel, Amit R

    2014-11-01

    Historically, the right ventricle (RV) has received less attention than the left probably because morbidity and mortality associated with left ventricular disease is clinically more apparent. Right heart disease, in contrast, tends to have a more prolonged and, in the early stages, often subclinical course. Furthermore, the left ventricle is easier to image, model and quantify, so that research has been successful at amassing a great deal of clinically useful information about the left heart while the right heart still remains, in many ways, a mystery. In this perspective, the authors sought to explore the topic of RV recovery potential that has important clinical implications in the evaluation and treatment of advanced right-sided valvular heart disease, congenital heart disease, pulmonary arterial disease and even lung disease which impacts the RV. We see a clear need for a better understanding of RV viability given our increasing appreciation that RV failure is a significant contributor to morbidity and mortality in many disease states and the fact that newer imaging modalities and innovative changes to older modalities make more comprehensive evaluation of the RV feasible. PMID:25264241

  17. Clinical application of a right ventricular pressure-volume loop determined by gated blood-pool imaging and simultaneously measured right ventricular pressure

    Energy Technology Data Exchange (ETDEWEB)

    Yasue, Takao; Watanabe, Sachiro; Sugishita, Nobuyoshi; Tanaka, Tsutomu; Yokoyama, Hideo (Prefectural Gifu Hospital (Japan))

    1983-09-01

    The data obtained by ECG-gated radionuclide angiography were collected simultaneously with right ventricular pressure and thermal cardiac output (CO) obtained by a Swan-Ganz catheter in Scintipac 1200 (Shimazu Co) in order to create a right ventricular pressure-volume (RV P-V) loop. Subjects consisted of 15 patients with old myocardial infarction (MI group), seven with angina pectoris (AP group), six with congestive cardiomyopathy (CCM group) and five with neurocirculatory asthenia (NCA group). Right ventricular end-diastolic volume (RVEDV) was calculated as RVEDV = CO/(EF x HR) (CO = cardiac output; HR = heart rate). Systolic work (W sub(S)), diastolic work (W sub(D)) and net work (W sub(N)) were calculated from a RV P-V loop by Simpson's method. The measurements were performed before and 5 min after sublingual administration of nitroglycerin (NG) (0.3 mg). The results were as follows: 1. RV P-V loops shifted towards the left lower part of the P-V plane after sublingual administration of nitroglycerin, indicating the reduction of pressure and volume of the right ventricle. 2. Right ventricular ejection fraction (RVEF) in the MI, AP and CCM groups showed smaller values than that of the NCA group. 3. Right ventricular end-diastolic volume index (RVEDVI) showed a converse relation with RVEF. 4. Cardiac index in all groups decreased after NG and a statistical significance was seen in the MI, AP and NCA groups (p<0.05). 5. RV W sub(S), RV W sub(D) and RV W sub(N) showed no difference among each groups in the control state, and significantly decreased after NG. We conclude that the present method using RV P-V loop might be useful as a noninvasive bedside monitoring and permits the evaluation of RV function in a clinical setting.

  18. Clinical application of a right ventricular pressure-volume loop determined by gated blood-pool imaging and simultaneously measured right ventricular pressure

    International Nuclear Information System (INIS)

    The data obtained by ECG-gated radionuclide angiography were collected simultaneously with right ventricular pressure and thermal cardiac output (CO) obtained by a Swan-Ganz catheter in Scintipac 1200 (Shimazu Co) in order to create a right ventricular pressure-volume (RV P-V) loop. Subjects consisted of 15 patients with old myocardial infarction (MI group), seven with angina pectoris (AP group), six with congestive cardiomyopathy (CCM group) and five with neurocirculatory asthenia (NCA group). Right ventricular end-diastolic volume (RVEDV) was calculated as RVEDV = CO/(EF x HR) (CO = cardiac output; HR = heart rate). Systolic work (W sub(S)), diastolic work (W sub(D)) and net work (W sub(N)) were calculated from a RV P-V loop by Simpson's method. The measurements were performed before and 5 min after sublingual administration of nitroglycerin (NG) (0.3 mg). The results were as follows: 1. RV P-V loops shifted towards the left lower part of the P-V plane after sublingual administration of nitroglycerin, indicating the reduction of pressure and volume of the right ventricle. 2. Right ventricular ejection fraction (RVEF) in the MI, AP and CCM groups showed smaller values than that of the NCA group. 3. Right ventricular end-diastolic volume index (RVEDVI) showed a converse relation with RVEF. 4. Cardiac index in all groups decreased after NG and a statistical significance was seen in the MI, AP and NCA groups (p<0.05). 5. RV W sub(S), RV W sub(D) and RV W sub(N) showed no difference among each groups in the control state, and significantly decreased after NG. We conclude that the present method using RV P-V loop might be useful as a noninvasive bedside monitoring and permits the evaluation of RV function in a clinical setting

  19. Sildenafil attenuates pulmonary inflammation and fibrin deposition, mortality and right ventricular hypertrophy in neonatal hyperoxic lung injury

    Directory of Open Access Journals (Sweden)

    Boersma Hester

    2009-04-01

    Full Text Available Abstract Background Phosphodiesterase-5 inhibition with sildenafil has been used to treat severe pulmonary hypertension and bronchopulmonary dysplasia (BPD, a chronic lung disease in very preterm infants who were mechanically ventilated for respiratory distress syndrome. Methods Sildenafil treatment was investigated in 2 models of experimental BPD: a lethal neonatal model, in which rat pups were continuously exposed to hyperoxia and treated daily with sildenafil (50–150 mg/kg body weight/day; injected subcutaneously and a neonatal lung injury-recovery model in which rat pups were exposed to hyperoxia for 9 days, followed by 9 days of recovery in room air and started sildenafil treatment on day 6 of hyperoxia exposure. Parameters investigated include survival, histopathology, fibrin deposition, alveolar vascular leakage, right ventricular hypertrophy, and differential mRNA expression in lung and heart tissue. Results Prophylactic treatment with an optimal dose of sildenafil (2 × 50 mg/kg/day significantly increased lung cGMP levels, prolonged median survival, reduced fibrin deposition, total protein content in bronchoalveolar lavage fluid, inflammation and septum thickness. Treatment with sildenafil partially corrected the differential mRNA expression of amphiregulin, plasminogen activator inhibitor-1, fibroblast growth factor receptor-4 and vascular endothelial growth factor receptor-2 in the lung and of brain and c-type natriuretic peptides and the natriuretic peptide receptors NPR-A, -B, and -C in the right ventricle. In the lethal and injury-recovery model we demonstrated improved alveolarization and angiogenesis by attenuating mean linear intercept and arteriolar wall thickness and increasing pulmonary blood vessel density, and right ventricular hypertrophy (RVH. Conclusion Sildenafil treatment, started simultaneously with exposure to hyperoxia after birth, prolongs survival, increases pulmonary cGMP levels, reduces the pulmonary

  20. Ventricular assist device

    Science.gov (United States)

    VAD; RVAD; LVAD; BVAD; Right ventricular assist device; Left ventricular assist device; Biventricular assist device; Heart pump; Left ventricular assist system; LVAS; Implantable ventricular assist device

  1. Effect of Hemodialysis on Left and Right Ventricular Volume and Function

    International Nuclear Information System (INIS)

    With the improvement of hemodialysis, the course of thc discase in patient with endstage renal disease has been clearly improved. Nevertheless, among several shortcomings to our present mode of renal replacement therapy, cardiovascular complications have been the leading cause of morbidity and mortality. Several factors such as anemia, arteriovenous shunting of blood, intermittent extracorporeal circulation and hypertension may be contributing. But little is known about the quantitative cardiac hemodynamic characteristics occurred during hemodialysis. The purpose of this study is to observe the sequential hemodynamic changes before, during and after the hemodialysis and to investigate: reliable parameters in the detection of ventricular dysfunction. In the present study, equilibrium radionuclide cardiac angiography was performed and left and right ventricular volume indices, ejection phase indices of both ventricular, performance were measured in the 16 stable patients with chronic renal failure treated with maintenance hemodialysis sequentially i.e. before, during (carly and late phase) and after the hemodialysis. The results obtained were as follows; 1) The indices of the left ventricular function were not changed during the hemodialysis but increased after the hemodialysis. 2) The indices of the right ventricular function(EF, SVI) were significantly decreased in the early phase (15, 30 minutes after starting extracorporeal circulation) but recovered after the hemodialysis, 3) The ratio of right ventricular to left ventricular ejection fraction was significantly decreased in the early phase and the lung volume indices were significantly increased at the same phase. As a conclusion, hemodialysis improves left ventricular function maybe du to increased contractility, and effects on the right ventricular function maybe due to the increased lung volume in the early phase of hemodialysis.

  2. Right Ventricular Enlargement within Months of Arteriovenous Fistula Creation in 2 Hemodialysis Patients.

    Science.gov (United States)

    Ragupathi, Loheetha; Johnson, Drew; Marhefka, Gregary D

    2016-08-01

    Surgically created arteriovenous fistulae (AVF) for hemodialysis can contribute to hemodynamic changes. We describe the cases of 2 male patients in whom new right ventricular enlargement developed after an AVF was created for hemodialysis. Patient 1 sustained high-output heart failure solely attributable to the AVF. After AVF banding and subsequent ligation, his heart failure and right ventricular enlargement resolved. In Patient 2, the AVF contributed to new-onset right ventricular enlargement, heart failure, and ascites. His severe pulmonary hypertension was caused by diastolic heart failure, diabetes mellitus, and obstructive sleep apnea. His right ventricular enlargement and heart failure symptoms did not improve after AVF ligation. We think that our report is the first to specifically correlate the echocardiographic finding of right ventricular enlargement with AVF sequelae. Clinicians who treat end-stage renal disease patients should be aware of this potential sequela of AVF creation, particularly in the upper arm. We recommend obtaining preoperative echocardiograms in all patients who will undergo upper-arm AVF creation, so that comparisons can be made postoperatively. Alternative consideration should be given to creating the AVF in the radial artery, because of less shunting and therefore less potential for right-sided heart failure and pulmonary hypertension. A multidisciplinary approach is optimal when selecting patients for AVF banding or ligation.

  3. The effect of open lung ventilation on right ventricular and left ventricular function in lung-lavaged pigs

    OpenAIRE

    Miranda, D.R.; Klompe, L; Cademartiri, Filippo; Haitsma, J.J.; Palumbo, Alessandro; Lachmann, Burkhard; Bogers, Ad; Gommers, Diederik; Takkenberg, Hanneke

    2006-01-01

    textabstractINTRODUCTION: Ventilation according to the open lung concept (OLC) consists of recruitment maneuvers, followed by low tidal volume and high positive end-expiratory pressure, aiming at minimizing atelectasis. The minimization of atelectasis reduces the right ventricular (RV) afterload, but the increased intrathoracic pressures used by OLC ventilation could increase the RV afterload. We hypothesize that when atelectasis is minimized by OLC ventilation, cardiac function is not affect...

  4. Position dependent right ventricular dysfunction caused by a giant right coronary artery aneurysm.

    Science.gov (United States)

    Mora, Bruno; Urbanek, Bernhard; Loewe, Christian; Grimm, Michael; Dworschak, Martin

    2011-01-01

    We describe an instructive case of a 79-year-old patient with a giant coronary aneurysm and a second smaller aneurysm with an uncommon symptomatology. Giant coronary artery aneurysms (>2 cm diameter) are rare pathologic entities with a prevalence of 0.02%. They either can be congenital malformations or are atherosclerotic in origin. Although spontaneous rupture of giant coronary artery aneurysms has been reported, they generally remain silent or induce myocardial ischemia. Our patient, however, showed no signs of myocardial malperfusion but transient position-dependent pre-syncope. The cardiologic work-up and the intraoperative considerations regarding patient management are described. During surgery, manipulation of the giant coronary artery aneurysm caused impairment of right ventricular function and regional wall hypokinesia, as assessed by transesophageal echocardiography. Venous cannulation of the right atrium was thus abandoned and extracorporeal circulation was established via the femoral vein. Subsequent dissection and surgical repair were uneventful and further recovery of the elderly patient was uncomplicated. This case underlines that once the diagnosis is established, proper perioperative management enables successful surgical treatment even of patients of advanced age. PMID:21253776

  5. Prognostic significance of radionuclide-assessed right ventricular function in dilated cardiomyopathy

    Energy Technology Data Exchange (ETDEWEB)

    Ohno, Akira; Nishimura, Tsunehiko; Uehara, Toshiisa; Shimonagata, Tsuyoshi; Kumita, Shinichiro; Ogawa, Youji; Nagata, Seiki; Miyatake, Kunio (National Cardiovascular Center, Suita, Osaka (Japan))

    1991-09-01

    To assess the prognostic significance of right ventricular function in dilated cardiomyopathy (DCM), we studied consecutive 57 DCM patients. There were 41 men and 16 women, whose mean age was 48 years (range 3-68 years). The mean left ventricular ejection fraction (LVEF) in all patients was 29{+-}11%, and the mean interval from the onset of symptom of cardiac failure (CHF history) was 4 years (range 0-33 years). With follow-up of 3.8 years, five patients had died until the first year, and 14 had died until the third year. By using multivariate regression analysis, there were no prognostic significance in clinical parameters such as age, CHF history, sex, atrial fibrillation, except for NYHA class, and medication at the third year. In survival curves according to Kaplan-Meier method, right ventricular ejection fraction (RVEF) and mean pulmonary artery (PA) had predictive value (p<0.05), while LVEF did not. The patients with RVEF<45% had poor survival rate compared to those with RVEF{>=}45%. The patients with RVEF<45% showed lower LVEF and left ventricular end-systolic volume index. RVEF may offer prognostic predictive value through the effect of not only mean PA but also left ventricular parameter. In conclusion, radionuclide assessment of right ventricular function should be valuable for the prognostic evaluation of DCM patients. (author).

  6. Reflex Seizures Triggered by Exposure to Characters With Numerical Value: A Case With Right Temporal Cortical Dysplasia.

    Science.gov (United States)

    Erdener, Şefik Evren; Tezer, F Irsel; Oğuz, Kader K; Kamışlı, Özden; Ergün, Eser Lay; Söylemezoğlu, Figen; Saygi, Serap

    2016-07-01

    Reflex seizures can be triggered by a variety of stimuli. We present a case with drug-resistant complex partial seizures originating in right temporal lobe triggered extensively by visual, auditory, and mental exposure to multidigit numbers. The patient was investigated in video-EEG monitoring unit and seizures were triggered by numerical stimuli. Scalp EEG findings suggested a right temporal focus but ictal semiological findings suspicious for an extratemporal area necessitated the invasive EEG study. A right anterior temporal seizure focus was established with invasive monitoring and cortical stimulation studies. Magnetic resonance imaging showed a cortical dysplasia in right anterior temporal lobe and ictal single-photon emission computed tomography confirmed the epileptogenic focus, leading to a right temporal lobectomy and amygdalohippocampectomy and a pathological diagnosis of focal cortical dysplasia type Ia. The patient is seizure-free at the end of the second postoperative year despite repeated exposures to numbers. To our knowledge, this is the first report of seizures triggered by numbers. It is also of particular importance as the reflex seizures are associated with a cortical lesion and it may suggest involvement of right anterior temporal lobe in numerical processing.

  7. First successful repair of an aortico-to-right ventricular tunnel (ARVT) in d-transposition of the great arteries with aortic valve atresia and ventricular septal defect.

    Science.gov (United States)

    Wagner, Robert; Vollroth, Marcel; Daehnert, Ingo; Kostelka, Martin

    2015-04-01

    The presented case reports on the first successful complex biventricular repair in a neonate with an aortico-to-right ventricular tunnel and dextrotransposition of the great arteries complicated by aortic atresia.

  8. Comparison of right ventricular weight at necropsy in interstitial pulmonary fibrosis and in chronic bronchitis and emphysema.

    OpenAIRE

    Packe, G E; Cayton, R M; Edwards, C. W.

    1986-01-01

    The ventricular weights in 43 patients with interstitial pulmonary fibrosis were retrospectively compared with those in 172 patients with emphysema and chronic bronchitis. The mean right ventricular weight of patients with interstitial pulmonary fibrosis and those with emphysema and chronic bronchitis was 85.5 g (SD 23.2) and 88.8 g (34.3), respectively. Thirty five patients (81%) with interstitial pulmonary fibrosis had a right ventricular weight over 65 g compared with 124 (72%) of those wi...

  9. Pre-chemotherapy values for left and right ventricular volumes and ejection fraction by gated tomographic radionuclide angiography using a cadmium-zinc-telluride detector gamma camera

    DEFF Research Database (Denmark)

    Haarmark, Christian; Haase, Christine; Jensen, Maria Maj;

    2016-01-01

    BACKGROUND: Estimation of left ventricular ejection fraction (LVEF) using equilibrium radionuclide angiography is an established method for assessment of left ventricular function. The purpose of this study was to establish normative data on left and right ventricular volumes and ejection fraction...... age and both left and right ventricular volumes in women (r = -0.4, P cancer patients without other known cardiopulmonary...

  10. Combined left and right ventricular volume determination by radionuclide angiocardiography using double bolus and equilibrium technique

    DEFF Research Database (Denmark)

    Stokholm, K H; Stubgaard, M; Møgelvang, J;

    1990-01-01

    by indicator dilution. The radionuclide technique comprised four steps: (1) a first-pass study of right ventricle; (2) a bolus study of left ventricle; (3) an equilibrium study of left ventricle; (4) determination of the distribution volume of red blood cells. Absolute volumes of left ventricle were determined......Eighteen patients with ischaemic heart disease were studied. Left and right ventricular volumes including cardiac output (forward flow) were determined by radionuclide angiocardiography using a double bolus and equilibrium technique. As reference, cardiac output was simultaneously measured...... from steps 2 + 3 + 4. Absolute volumes of right ventricle were calculated from stroke volume and right ventricular ejection fraction (EF) which in turn was determined from step 1 by creating composite systolic and composite diastolic images. There was an acceptable agreement between stroke volume...

  11. Predictors of right ventricular function as measured by tricuspid annular plane systolic excursion in heart failure

    DEFF Research Database (Denmark)

    Kjaergaard, Jesper; Iversen, Kasper K; Akkan, Dilek;

    2009-01-01

    in heart failure patients, in particular with reduced septal longitudinal motion. TAPSE is decreased in patients with heart failure of ischemic etiology. However, the absolute reduction in TAPSE is small and seems to be of minor importance in the clinical utilization of TAPSE whether applied as a measure...... of right ventricular systolic function or as a prognostic factor....

  12. Right ventricular dysfunction in patients with end-stage renal disease on regular hemodialysis

    Directory of Open Access Journals (Sweden)

    Mohamed Momtaz

    2013-01-01

    Conclusion Subclinical RV dysfunction - as estimated by RV function indices; tricuspid plane systolic excursion, right ventricle fractional area change, and LTDISº - is increased among HD patients. A high prevalence of pulmonary hypertension was found among HD patients and this was not associated significantly with RV or left ventricular dysfunction in these patients.

  13. A cornerstone of heart failure treatment is not effective in experimental right ventricular failure

    NARCIS (Netherlands)

    Borgdorff, Marinus A.; Bartelds, Beatrijs; Dickinson, Michael G.; Steendijk, Paul; Berger, Rolf M. F.

    2013-01-01

    Background: Right ventricular (RV) failure due to increased pressure load causes significant morbidity and mortality in patients with congenital heart diseases and pulmonary arterial hypertension. It is unknown whether renin-angiotensin-aldosterone-system (RAAS) inhibition (the cornerstone of left v

  14. Right ventricular lipomatous mass and biventricular multifocal fat in a young woman: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Bo Rahm; Park, Jae Hyeong; Ahn, Kye Taek; Kim, Song Soo; Jeong, Jin Ok; Choi, Si Wan; Jin, Seon Ah; Lee, Jae Hwan [Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon (Korea, Republic of)

    2015-04-15

    Cardiac lipoma is a rare neoplasm of encapsulated mature adult adipose tissue. It is usually asymptomatic, but it may be related to hemodynamic obstruction depending on its location. We report a typical case of right ventricular lipomatous mass and multifocal fat infiltration of both ventricles, which were detected incidentally in a young woman.

  15. [Isolated left ventricular--right atrial shunt after blunt chest trauma (author's transl)].

    Science.gov (United States)

    Kreuzer, E; Beyer, J

    1978-12-01

    A case of left-ventricular-right-atrial septal defect secundary to blunt chest trauma is described. The etiology of this type of septal defect, e. g. congenital, following aortic and mitral valve replacement, endocarditis and trauma, is discussed. Early defect closure is recommended in the presence of significant shunt volume. PMID:751280

  16. Changes in Fetal Left and Right Ventricular Strain Mechanics during Normal Pregnancy.

    NARCIS (Netherlands)

    Kapusta, L.; Mainzer, G.; Weiner, Z.; Deutsch, L.; Khoury, A.; Haddad, S.; Lorber, A.

    2013-01-01

    BACKGROUND: The aim of this study was to detect normal changes in fetal two-dimensional speckle-tracking echocardiography-derived values for global and regional longitudinal left and right ventricular strain, strain rate, and time to peak (T2P) global strain during pregnancy. METHODS: Forty-four hea

  17. Right ventricular lipomatous mass and biventricular multifocal fat in a young woman: A case report

    International Nuclear Information System (INIS)

    Cardiac lipoma is a rare neoplasm of encapsulated mature adult adipose tissue. It is usually asymptomatic, but it may be related to hemodynamic obstruction depending on its location. We report a typical case of right ventricular lipomatous mass and multifocal fat infiltration of both ventricles, which were detected incidentally in a young woman.

  18. Left ventricular to right atrial shunt resulting from infective endocarditis.

    Science.gov (United States)

    Ellis, C J; Gray, K E; Ainscow, D A

    1975-02-01

    A unique case is described in which infective endocarditis of the aortic valve led to intractable heart failure and necropsy examination showed that the patient had developed a communication between the left ventricle and right atrium.

  19. Right ventricular endomyocardial fibrosis (2013 Grover Conference series)

    OpenAIRE

    Mocumbi, Ana Olga

    2014-01-01

    Endomyocardial fibrosis (EMF) is a restrictive cardiomyopathy of unknown origin, affecting predominantly the right side of the heart. Its highest prevalence is in poor regions of sub-Saharan Africa, where it is usually found in children and adolescents. In areas where it is endemic, EMF is a major cause of heart failure and premature death. EMF of the right ventricle has unique clinical, electrocardiographic, and echocardiographic signs. Several features of advanced disease are not fully unde...

  20. Extra-anatomic right ventricle to pulmonary artery conduit: the apical-aortic equivalent for complex right ventricular outflow tract reconstruction.

    Science.gov (United States)

    Mori, Makoto; Siddharthan, Ragavan; Kogon, Brian

    2015-03-01

    We describe the case of a 22-year-old with tetralogy of Fallot, who underwent complete repair with ventricular septal defect closure and right ventricle to pulmonary artery conduit placement. She has undergone numerous subsequent conduit changes, each complicated by early stenosis and failure. Unfortunately, serial conduit changes can become increasingly challenging. While extra-anatomic conduits have been described for complex left ventricular outflow tract obstruction, they have not been described for right-sided obstruction. Herein, we present a patient who underwent successful placement of an extra-anatomic valved right ventricle to pulmonary artery conduit in the setting of complex right ventricular outflow tract obstruction.

  1. Wnt5a attenuates hypoxia-induced pulmonary arteriolar remodeling and right ventricular hypertrophy in mice.

    Science.gov (United States)

    Jin, Yuling; Wang, Wang; Chai, Sanbao; Liu, Jie; Yang, Ting; Wang, Jun

    2015-12-01

    Hypoxic pulmonary hypertension (HPH), which is characterized by pulmonary arteriolar remodeling and right ventricular hypertrophy, is still a life-threatening disease with the current treatment strategies. The underlying molecular mechanisms of HPH remain unclear. Our previously published study showed that Wnt5a, one of the ligands in the Wnt family, was critically involved in the inhibition of hypoxia-induced pulmonary arterial smooth muscle cell proliferation by downregulation of β-catenin/cyclin D1 in vitro. In this study, we investigated the possible functions and mechanisms of Wnt5a in HPH in vivo. Recombinant mouse Wnt5a (rmWnt5a) or phosphate buffered saline (PBS) was administered to male C57/BL6 mice weekly from the first day to the end of the two or four weeks after exposed to hypoxia (10% O2). Hypoxia-induced pulmonary hypertension was associated with a marked increase in β-catenin/cyclin D1 expression in lungs. Right ventricular systolic pressure and right ventricular hypertrophy index were reduced in animals treated with rmWnt5a compared with PBS. Histology showed less pulmonary vascular remodeling and right ventricular hypertrophy in the group treated with rmWnt5a than with PBS. Treatment with rmWnt5a resulted in a concomitant reduction in β-catenin/cyclin D1 levels in lungs. These data demonstrate that Wnt5a exerts its beneficial effects on HPH by regulating pulmonary vascular remodeling and right ventricular hypertrophy in a manner that is associated with reduction in β-catenin/cyclin D1 signaling. A therapy targeting the β-catenin/cyclin D1 signaling pathway might be a potential strategy for HPH treatment.

  2. Evaluation of global and regional left ventricular systolic function in patients with frequent isolated premature ventricular complexes from the right ventricular outflow tract

    Institute of Scientific and Technical Information of China (English)

    YAO Jing; XU Jing; YONG Yong-hong; CAO Ke-jiang; CHEN Shao-liang; XU Di

    2012-01-01

    Background Frequent premature ventricular complexes from the right ventricular outflow tract (RVOT-PVCs) are associated with left ventricular dysfunction.This study adopted two-dimensional speckle tracking imaging to evaluate global and regional left ventricular myocardial function in patients with frequent RVOT-PVCs.Methods This study included 30 patients with frequent RVOT-PVCs and 30 healthy subjects.Aortic systolic velocity-time integral (AoVTI) and myocardium strain in circumferential (CS),radial (RS) and longitudinal (LS) directions were evaluated by conventional echocardiography and speckle tracking imaging.All values of patients with RVOT-PVCs were recorded during sinus (PVC-S) and PVC beats (PVC-V).Results Significant differences were demonstrated in global CS,RS and LS between the control subjects and the PVC-V (CS:(17.46±2.48)% vs.(11.52±3.28)%,RS:(48.26±10.20)% vs.(20.92±9.78)%,LS:(19.89±2.62)% vs.(11.79±3.66)%,P <0.01),and in segmental RS and LS of nearly all the left ventricular segments.Statistical differences in segmental CS between the PVC-V and the control subjects were only observed in anterior,anteroseptal and septal segments (only seen in anteroseptal and septal segments at apex).Furthermore,V/S AoVTI (AoVTI during the PVC beat divided by AoVTI during the sinus beat,then multiplied by 100%) correlated with coupling interval (r=0.67,P <0.001) and global strain (CS:r=0.48,P=0.007; RS:r=0.65,P <0.001; LS:r=0.65,P <0.001).Conclusions Frequent RVOT-PVCs can induce global and regional left ventricular systolic dysfunction.The reduction of hemodynamic parameters relates to the coupling interval and the global systolic function.

  3. Beta-blockers, left and right ventricular function, and in-vivo calcium influx in muscular dystrophy cardiomyopathy.

    Directory of Open Access Journals (Sweden)

    Alison Blain

    Full Text Available Beta-blockers are used to treat acquired heart failure in adults, though their role in early muscular dystrophy cardiomyopathy is unclear. We treated 2 different dystrophic mouse models which have an associated cardiomyopathy (mdx: model for Duchenne Muscular Dystrophy, and Sgcd-/-: model for limb girdle muscular dystrophy type 2F and wild type controls (C57 Bl10 with the beta blocker metoprolol or placebo for 8 weeks at an early stage in the development of the cardiomyopathy. Left and right ventricular function was assessed with cardiac magnetic resonance imaging (MRI and in-vivo myocardial calcium influx with manganese enhanced MRI. In the mdx mice at baseline there was reduced stroke volume, cardiac index, and end-diastolic volume with preserved left ventricular ejection fraction. These abnormalities were no longer evident after treatment with beta-blockers. Right ventricular ejection fraction was reduced and right ventricular end-systolic volume increased in the mdx mice. With metoprolol there was an increase in right ventricular end-diastolic and end-systolic volumes. Left and right ventricular function was normal in the Sgcd-/- mice. Metroprolol had no significant effects on left and right ventricular function in these mice, though heart/body weight ratios increased after treatment. In-vivo myocardial calcium influx with MEMRI was significantly elevated in both models, though metoprolol had no significant effects on either. In conclusion, metoprolol treatment at an early stage in the development of cardiomyopathy has deleterious effects on right ventricular function in mdx mice and in both models no effect on increased in-vivo calcium influx. This suggests that clinical trials need to carefully monitor not just left ventricular function but also right ventricular function and other aspects of myocardial metabolism.

  4. Pulmonary atresia with intact ventricular septum and hypoplastic right ventricle in an Arabian foal.

    Science.gov (United States)

    Krüger, M U; Wünschmann, A; Ward, C; Stauthammer, C D

    2016-09-01

    Pulmonary atresia with intact ventricular septum, rudimentary tricuspid valve, hypoplastic right ventricle, and right-to-left atrial shunting were identified in a four-day-old, male Arabian foal with clinical signs of cyanotic heart disease. Pulmonary blood flow was apparently derived from a ductus arteriosus. Echocardiographic evaluation revealed the majority of cardiac abnormalities and also findings compatible with right-sided congestive heart failure. Congenital cardiac defects have a high incidence in this breed, and this is the first description of this combination of congenital cardiac defects. PMID:27283083

  5. Study on thallium-201 myocardial perfusion scanning for detection of right ventricular hypertrophy in chronic pulmonary disease

    International Nuclear Information System (INIS)

    Thallium-201 myocardial perfusion scanning was performed in 34 patients with chronic pulmonary disease for the purpose of detecting right ventricular hypertrophy. Thallium-201 activity ratio of left ventricle plus ventricular septum/right ventricle (TAR) was significantly correlated with hemodynamic findings such as pulmonary arterial mean pressure (r = -0.75, p 2 (p < 0.001). Assuming that TAR < 2 or TAR = 2 would indicate pulmonary hypertension, sensitivity was 95%, specificity 79%, validity score 75%, false positive 14% and false negative was 8%. TAR was compared with left to right ventricular mass ratio using Fulton's method in 6 autopsied patients in whom thallium-201 myocardial perfusion scanning were performed within three months before death. TAR closely correlated with left to right ventricular mass ratio (r = 0.978, p < 0.001). The comparison of validity of TAR with those of electrocardiographic interpretation according to WHO, Sasamoto, Roman or Milnor for the detection of right ventricular hypertrophy revealed the former was much superior to all of latters. From the results obtained, it may be inferred that TAR reflects the degree of pulmonary hypertension and anatomical right ventricular hypertrophy and is a useful non-invasive method to detect right ventricular hypertrophy in chronic pulmonary disease. (J.P.N.)

  6. Latest insights in therapeutic options for systemic right ventricular failure: a comparison with left ventricular failure

    NARCIS (Netherlands)

    M.M. Winter; B.J. Bouma; M. Groenink; T.C. Konings; J.G.P. Tijssen; D.J. van Veldhuisen; B.J.M. Mulder

    2009-01-01

    The number of adult patients with a systemic right ventricle (RV) is steadily increasing. Survival is relatively good in these patients, but deterioration of the systemic RV seems inevitable. Although therapeutic options for patients with LV failure are well established, their role in patients with

  7. Double-chambered right ventricle, ventricular septal defect, patent ductus arteriosus in a dog

    International Nuclear Information System (INIS)

    A 4-month-old female mongrel puppy was presented with an anophthalmos. On physical examination, systolic murmur was heard at the 4th left intercostal space near the sternum. However the dog appeared healthy without cyanosis and had no history of exercise intolerance. The phonocardiogram revealed a pansystolic murmur and a continuous murmur on the mitral area. A systolic ejection murmur was also recorded on the pulmonic area. The electrocardiogram indicated bi-ventricular hypertrophy. Left ventricular enlargement was seen on chest radiographs. Ventricular septal defect (VSD) and patent ductus arteriosus (PDA) were diagnosed from these findings. PDA closure was performed at 2 years of age. After 2 months from the operation, the dog died during an attempted repair of the VSD. At necropsy, it was found that the double-chambered right ventricle (DCRV) was formed by an anomalous septal band. The VSD was localized on the proximal conus and was 8 mm in diameter. (author)

  8. Rate of Cure of Right Ventricular Outflow Tract Tachycardia: A Review Paper

    Directory of Open Access Journals (Sweden)

    Dr. Abdel Fuenmayor

    2014-06-01

    Full Text Available Right ventricular outflow tract (RVOT ventricular tachycardias (VT occur in the absence of structural heart disease and are called idiopathic ventricular arrhythmias. These arrhythmias are thought to be produced by adenosine-sensitive, cyclic AMP mediated, triggered activity and are commonly observed in adolescents and young adults. In the ECG, they appear with a wide QRS complex, a left bundle branch block morphology and, usually, an inferior QRS axis. In the last few years, there has been an increasing number of reports suggesting the possibility of a curative treatment of RVOT VT by means of catheter ablation. This paper reviews the rate of cure of such arrhythmias by discussing the effects of catheter ablation on symptoms, arrhythmia detection, possibility of induction, and short- and long-term follow-up studies.

  9. The influence of right ventricular apical pacing on left atrial volume in patients with normal left ventricular function

    Directory of Open Access Journals (Sweden)

    AR Moaref1

    2008-03-01

    Full Text Available Background: Right ventricular apical (RVA pacing has been reported to induce several deleterious effects particularly in the presence of structural heart disease but can also involve patients with normal left ventricular (LV function. Left atrial (LA enlargement is one of these effects, but the majority of studies have measured LA dimension rather than volume.Objective: The present prospective study was designed to assess the effect of RVA pacing on LA volume in patients with normal LV function.Patients and Methods: The study comprised 41 consecutive patients with LV ejection fraction ≥ 45% and LV end diastolic dimension ≤ 56 mm who underwent single-or dual- chamber pacemaker implantation in RVA and followed for LA volume measurement and pacemaker analysis at least during the ensuing 4.2 months. Results: In all, 21 patients were excluded from the study due to five spontaneous wide QRS complex (≥120msec, one recent acute coronary syndrome,one significant valvular heart disease, three pacing frequency <90%, eight death or losing follow up in three cases. In remaining 20 patients, LA volume ragned from 21 to 54 mm3 with mean of 37.3±9.7 mm3 prior to pacemaker implantation that increased to 31 to 103 mm3 (54.3±17.0 during follow-up (P<0.001.Conclusion: RVA pacing might lead to an increase in LA volume even in patients with normal LV function.

  10. Right ventricular dysfunction in patients with Brugada-like electrocardiography: a two dimensional strain imaging study

    Directory of Open Access Journals (Sweden)

    Murata Kazuya

    2011-11-01

    Full Text Available Abstract Background Sodium channel blockers augment ST-segment elevation in the right precordial leads in patients undergoing Brugada-type electrocardiography (ECG. However, their effect on echocardiographic features is not known. We address this by assessing global and regional ventricular function using conventional Doppler and two- dimensional (2D speckle tracking techniques. Methods Thirty-one patients with Brugada-type ECG were studied. A pure sodium channel blocker, pilsicainide, was used to provoke an ECG response. The percentage longitudinal systolic myocardial strain at the base of both the right ventricular (RV free wall and the interventricular septum wall was measured using 2D speckle tracking. Left ventricular (LV and RV myocardial performance (TEI indices were also measured. Results The pilsicainide challenge provoked a positive ECG response in 13 patients (inducible group. In the inducible group, longitudinal strain was significantly reduced only at the RV (-27.3 ± 5.4% vs -22.1 ± 3.6%, P P P Conclusions Temporal and spatial analysis using the TEI index and 2D strain imaging revealed the deterioration of global ventricular function associated with conduction disturbance and RV regional function in patients with Brugada-type ECG and coved type ST elevation due to administration of a sodium channel blocker.

  11. Chronic Thromboembolic Pulmonary Hypertension and Assessment of Right Ventricular Function in the Piglet.

    Science.gov (United States)

    Noly, Pierre-Emmanuel; Guihaire, Julien; Coblence, Matthieu; Dorfmüller, Peter; Fadel, Elie; Mercier, Olaf

    2015-11-04

    An original piglet model of Chronic Thromboembolic Pulmonary Hypertension (CTEPH) associated with chronic Right Ventricular (RV) dysfunction is described. Pulmonary Hypertension (PH) was induced in 3-week-old piglets by a progressive obstruction of the pulmonary vascular bed. A ligation of the left Pulmonary Artery (PA) was performed first through a mini-thoracotomy. Second, weekly embolizations of the right lower pulmonary lobe were done under fluoroscopic guidance with n-butyl-2-cyanoacrylate during 5 weeks. Mean Pulmonary Arterial Pressure (mPAP) measured by ritght heart catheterism, increased progressively, as well as Right Atrial pressure and Pulmonary Vascular Resistances (PVR) after 5 weeks compared to sham animals. Right Ventricular (RV) structural and functional remodeling were assessed by transthoracic echocardiography (RV diameters, RV wall thickness, RV systolic function). RV elastance and RV-pulmonary coupling were assessed by Pressure-Volume Loops (PVL) analysis with conductance method. Histologic study of the lung and the right ventricle were also performed. Molecular analyses on RV fresh tissues could be performed through repeated transcutaneous endomyocardial biopsies. Pulmonary microvascular disease in obstructed and unobstructed territories was studied from lung biopsies using molecular analyses and pathology. Furthermore, the reliability and the reproducibility was associated with a range of PH severity in animals. Most aspects of the human CTEPH disease were reproduced in this model, which allows new perspectives for the understanding of the underlying mechanisms (mitochondria, inflammation) and new therapeutic approaches (targeted, cellular or gene therapies) of the overloaded right ventricle but also pulmonary microvascular disease.

  12. Phenotyping of Left and Right Ventricular Function in Mouse Models of Compensated Hypertrophy and Heart Failure with Cardiac MRI

    NARCIS (Netherlands)

    B.J. van Nierop (Bastiaan); H.C. van Assen (Hans); E.D. van Deel (Elza); L.B.P. Niesen (Leonie); D.J.G.M. Duncker (Dirk); G.J. Strijkers (Gustav); K. Nicolay (Klaas)

    2013-01-01

    textabstractBackground: Left ventricular (LV) and right ventricular (RV) function have an important impact on symptom occurrence, disease progression and exercise tolerance in pressure overload-induced heart failure, but particularly RV functional changes are not well described in the relevant aorti

  13. Pulmonary Vascular and Right Ventricular Reserve in Patients With Normalized Resting Hemodynamics After Pulmonary Endarterectomy

    OpenAIRE

    Claessen, Guido; La Gerche, Andre; Dymarkowski, Steven; Claus, Piet; Delcroix, Marion; Heidbuchel, Hein

    2015-01-01

    Background-Patients with normalized mean pulmonary artery pressure (mPAP) after pulmonary endarterectomy (PEA) for chronic thromboembolic pulmonary hypertension (CTEPH) do not always regain normal exercise capacity. We evaluated right ventricular function, its interaction with both pulsatile and resistive afterload, and the effect of sildenafil during exercise in these patients. Methods and Results-Fourteen healthy controls, 15 CTEPH patients, and 7 patients with normalized resting mPAP (

  14. OBSTRUCTION OF RIGHT VENTRICULAR OUTFLOW TRACT CAUSED BY INTRACAVITARY METASTATIC DISEASE OF PANCREATIC TUMOR

    Institute of Scientific and Technical Information of China (English)

    Meng-tao Li; Wen-ling Zhu

    2005-01-01

    @@ THE pericardium (90%) is the most common loca tion of cardiac involvement by secondary tumor,followed by myocardium and endocardium (10%).1 Cases of right ventricular outflow tract obstruction caused by intracavitary metastatic tumor growth were rarely reported, al though clinical presentation were unique. We herein reported such a case with literature review in order to improve the understanding of malignant cardiac metastasis.

  15. Evaluation of right and left ventricular function in hard metal workers.

    OpenAIRE

    Horowitz, S F; Fischbein, A; Matza, D; Rizzo, J N; Stern, A.; J. Machac; S. J. Solomon

    1988-01-01

    Ingested cobalt has previously been associated with the development of a congestive cardiomyopathy. Despite occasional reports of cardiomyopathy after industrial exposure to cobalt, this association remains controversial. In a study of 30 cemented tungsten carbide workers with a mean duration of exposure to cobalt of 9.9 +/- 5.3 years radionuclide ventriculography was performed to study right and left ventricular ejection fractions at rest and exercise. For the entire group, rest and exercise...

  16. Right ventricular diastolic dysfunction in the postoperative period of tetralogy of Fallot

    Directory of Open Access Journals (Sweden)

    Silvia Meyer Cardoso

    2003-02-01

    Full Text Available OBJECTIVE: To assess right ventricular diastolic function in the intermediate postoperative period of repair of tetralogy of Fallot. METHODS: We carried out a case-control study with 60 patients divided into 2 groups as follows: 1 group I - 30 patients who had undergone repair of tetralogy of Fallot and 2 group II - 30 healthy children. The 2 groups were paired for age, sex, and body surface. The flows in the pulmonary and tricuspid valves were analyzed with Doppler echocardiography. The presence of anterograde flow at the end of diastole in the pulmonary artery defined restrictive right ventricular physiology. Surgical, radiological, electrocardiographic, and echocardiographic variables were analized in the group I. RESULTS: The velocity of the A wave and the E/A ratio for the tricuspid valve showed significant differences between the groups. Cases with E/A < 1.30 predominated in inspiration (group I - 19/30, and group II - 5/30. The duration of the QRS complex on the electrocardiogram was significantly increased in patients with E/A <1.30. Nineteen (63.3% patients had restrictive right ventricular physiology, which had a longer postoperative period, longer duration of the QRS complex, and a lower E/A ratio in inspiration. The surgical and radiological variables showed no statistical difference. CONCLUSION: Restrictive right ventricular physiology was detected on the intermediate follow-up of most patients undergoing repair of tetralogy of Fallot. The postoperative period and QRS duration were increased in patients with impairment in diastolic function.

  17. Pulmonary vascular wall stiffness: An important contributor to the increased right ventricular afterload with pulmonary hypertension

    OpenAIRE

    Wang, Zhijie; Chesler, Naomi C

    2011-01-01

    Pulmonary hypertension (PH) is associated with structural and mechanical changes in the pulmonary vascular bed that increase right ventricular (RV) afterload. These changes, characterized by narrowing and stiffening, occur in both proximal and distal pulmonary arteries (PAs). An important consequence of arterial narrowing is increased pulmonary vascular resistance (PVR). Arterial stiffening, which can occur in both the proximal and distal pulmonary arteries, is an important index of disease p...

  18. Advanced echocardiography and cardiac magnetic resonance in congenital heart disease : insights in right ventricular mechanics and clinical implications

    NARCIS (Netherlands)

    Hulst, Anna Elisabeth van der

    2011-01-01

    The thesis provides new insights into advanced echocardiographic and magnetic resonance imaging techniques for comprehensive mechanical assessment of the right ventricle in healthy children and in pediatric patients with right ventricular dysfunction. It is shown that the right ventricle does not co

  19. Five-week use of a monopivot centrifugal blood pump as a right ventricular assist device in severe dilated cardiomyopathy.

    Science.gov (United States)

    Inoue, Takamichi; Kitamura, Tadashi; Torii, Shinzo; Hanayama, Naoji; Oka, Norihiko; Itatani, Keiichi; Tomoyasu, Takahiro; Irisawa, Yusuke; Shibata, Miyuki; Hayashi, Hidenori; Ono, Minoru; Miyaji, Kagami

    2014-03-01

    Right heart failure is a critical complication in patients requiring mechanical ventricular support. However, it is often difficult to provide adequate right ventricular support in the acute phase. A 41-year-old woman diagnosed with dilated cardiomyopathy with severe right heart failure underwent implantation of a paracorporeal pulsatile left ventricular assist device (LVAD, Nipro Corporation, Tokyo, Japan) and a MERA monopivot centrifugal pump (Senko Medical Instrument Manufacturing Co., Ltd., Tokyo, Japan) as a right ventricular assist device (RVAD). The patient developed ischemic enteritis 3 weeks after surgery, necessitating fasting and reversal of anticoagulation therapy. A target international normalized ratio of 1.5 was selected, and aspirin administration was discontinued. Following recovery without thromboembolic events, the patient failed the RVAD discontinuation test. Five weeks after surgery, the monopivot centrifugal pump was exchanged for a pulsatile pump. No thrombus was evident on the centrifugal pump. The patient was undergoing cardiac rehabilitation at the time of this writing and awaiting heart transplantation.

  20. Angiographic evidence of absent ductus arteriosus in severe right ventricular outflow obstruction.

    Science.gov (United States)

    Lacina, S J; Hamilton, W T; Thilenius, O G; Bharati, S; Lev, M; Arcilla, R A

    1983-01-01

    The angiocardiograms of 5 newborn infants with autopsy and/or surgically-proven congenital absence of the ductus arteriosus (ADA) and right ventricular outflow obstruction (Group A), and of 14 neonates with pulmonary atresia complex and patent ductus arteriosus (Group B) were reviewed. Aortic size was similar in both groups; however, the diameters of the right and left pulmonary arteries were much smaller in Group A than in Group B (right pulmonary artery: 2.6 vs 4.5 mm, P less than 0.005; left pulmonary artery: 2.5 vs 4.3 mm, P less than 0.005). Extensive bronchial collaterals were observed in Group A but not in Group B. Tricuspid aortic valve stenosis was present in 2 patients in Group A but in none in Group B. The diagnosis of ADA may be made in newborn infants with severe right ventricular outflow obstruction if the angiocardiograms reveal hypoplasia of the pulmonary arteries, extensive bronchial collaterals, and nonvisualization of the ductus arteriosus. Other suggestive features include aortic valve stenosis and/or right aortic arch with aberrant left subclavian artery.

  1. Development of left ventricular longitudinal speckle tracking echocardiography in very low birth weight infants with and without bronchopulmonary dysplasia during the neonatal period.

    Directory of Open Access Journals (Sweden)

    Christoph Czernik

    Full Text Available OBJECTIVES: In preterm infants, postnatal myocardial adaptation may be complicated by bronchopulmonary dysplasia (BPD. We aimed to describe the development of left ventricular function by serial 2D, Doppler, and speckle tracking echocardiography (2D-STE in infants with and without BPD during the neonatal period and compare these to anthropometric and conventional hemodynamic parameters. STUDY DESIGN: Prospective echocardiography on day of life (DOL 1, 7, 14, and 28 in 119 preterm infants 10% were seen for the apical segment. While anthropometric parameters show rapid development during the first 4 weeks of life, the speckle tracking parameters did not differ statistically significantly during the neonatal period. Infants with and without BPD differed significantly (p<0.001 in the development of anthropometric parameters, conventional hemodynamic parameters except for heart rate, and 2D-STE parameters: global longitudinal systolic strain rate (GLSSR and longitudinal systolic strain for the mid left wall (LSSR. The largest differences were seen at DOL 1 and 7 in GLSSR (p<0.001 and in LSSR (p<0.01. CONCLUSIONS: Reproducible 2D-STE measurements are possible in preterm infants <1500 g. Cardiac deformation reveals early (DOL 1 and 7 ventricular changes (GLSSR and LSSR in very low birth weight infants who develop BPD.

  2. Usefulness of right ventricular fractional area change to predict death, heart failure, and stroke following myocardial infarction (from the VALIANT ECHO Study)

    DEFF Research Database (Denmark)

    Anavekar, Nagesh S; Skali, Hicham; Bourgoun, Mikhail;

    2008-01-01

    Severe right ventricular dysfunction independent of left ventricular ejection fraction increased the risk of heart failure (HF) and death after myocardial infarction (MI). The association between right ventricular function and other clinical outcomes after MI was less clear. Two-dimensional echoc...

  3. Right and left ventricular ejection fraction at rest and during exercise assessed with radionuclide angiocardiography

    International Nuclear Information System (INIS)

    Right (RVEF) and left ventricular ejection fraction (LVEF) assessed with radionuclide angiocardiography were compared to simultaneously obtained catheterization results at rest and during exercise in patients with pulmonary hypertension and ischemic heart disease. Blood pool imaging was performed with red blood cells (RBC) labelled with 99Tcsup(m) in vivo as this method gave more stable 99Tcsup(m) levels in blood compared to 99Tcsup(m)-labelled human serum albumin and because it was more convenient than labelling RBC in vitro. RVEF measured with first pass (FP) technique and equilibrium (EQ) technique correlated well at rest, r = 0.86, and during exercise, r = 0.91. The FP technique had the best reproducibility and reference values at rest were 49+-5 per cent increasing with exercise. When 99Tcsup(m) and 133Xe were compared to assess RVEF with FP technique, the correlation was good, r = 0.88. LVEF assessed with EQ technique and a fixed end-diastolic region of interest was very reproducible at rest and during exercise; reference values at rest were 56+-8 per cent increasing with exercise. In 10 patients with pulmonary hypertension significant negative correlations were found between RVEF assessed with FP technique and pressures in pulmonary artery and right atrium. Abnormal RVEF was found in all patients with right ventricular disfunction. In 22 patients with recent myocardial infarction measurements of LVEF detected left ventricular disfunction better than did measurement of pulmonary artery diastolic pressure. During effort angina in another 10 patients all had abnormal LVEF and abnormal hemodynamics. By combining ejection fraction and stroke volume, ventricular volumes were calculated at rest and during exercise. (author)

  4. Assessment of right ventricular function by pressure-volume loops in off-pump coronary artery bypass surgery

    Institute of Scientific and Technical Information of China (English)

    ZHAO Hong-wei; YUE Yun; WU An-shi; LIU Yu; RUI Yan; WU Di; LIU Juan; ZHAO Qiu-hua; GUO Shu-rong; ZHANG Yong-qian

    2008-01-01

    Background Right ventricular function plays an important role in the hemodynamic derangement during off-pump coronary artery bypass (OPCAB) surgery. Pressure-volume loops have been shown to provide load-independent information of cardiac function. Therefore, the aim of this study was to investigate the feasibility of construction of right ventricular pressure-volume loops with pressure and volume data measured by a volumetric pulmonary artery catheter (PAC) and to evaluate right ventricular systolic and diastolic function by end-systolic elastance (EEs) and end-diastolic stiffness (EED) in OPCAB surgery.Methods Twenty-eight patients who underwent OPCAB surgery were included. After anesthesia induction, a volumetric PAC was placed via the right internal jugular vein. Data were recorded at: anesthesia steady-state before skin incision (T1); 5 minutes after the stabilizer device was placed for anastomosis on the heart's anterior wall (T2), lateral wall (T3),posterior wall (T4), respectively; after sternal closure (T5). Three sets of data were collected at each time point: first,hemodynamic variables were measured; second, right ventricular EES and EED were calculated; third, right ventricular pressure-volume loops were constructed with pressure and volume data measured from end-diastole point,end-isovolumic systole point, peak-ejection point, end-systole point and end-isovolumic diastole point.Results Right ventricular pressure-volume loops generally shifted to the left during OPCAB surgery. Especially, the end-diastolic point shifted upward and to the left at T2-T5 compared with that at T1. Decrease in right ventricular ejection fraction, stroke volume index and end-diastolic volume index occurred (P<0.05) at T4 compared with values at T1. Pulmonary vascular resistance index at T4 increased relatively compared with that at T2 and T3. The change of EES was not statistically significant during operation. Right atrial pressure increased only during coronary

  5. Acute right ventricular myocardial injury and sudden cardiac arrest in a patient with persistent spontaneous coronary vasospasm

    Institute of Scientific and Technical Information of China (English)

    Hung Ming-Yow; Li Ju-Chi; Hao Wen-Rui; Wu Cheng-Hsueh; Hung Ming-Jui

    2011-01-01

    Coronary vasospasm is a rare diagnosis resulting in sudden arrhythmic cardiac arrest. We report a case of a healthy,non-smoking elderly woman resuscitated from arrhythmic cardiac arrest. She had persistent spontaneous coronaxy vasospasm, leading to right ventricular myocardial injury and failure, and shock. She responded quickly to intravenous normal saline bolus infusion, but had irreversible neurological sequelae. Additionally, she had atrial fibrillation preceding ischemic ventricular fibrillation, a rare finding in coronary vasospasm-related cardiac arrest. We suggest immediate coronary angiography of patients in sudden arrhythmic cardiac arrest with acute right ventricular failure for a prompt,accurate diagnosis and appropriate management of the coronary vasospasm.

  6. Determination of the Effects of Digoxin on the Right Ventricular Function in Patients Undergoing Pneumonectomy

    Directory of Open Access Journals (Sweden)

    Alireza Sharifian Attar

    2014-02-01

    Full Text Available Introduction: Pneumonectomy is the standard treatment of lung cancer, even though patients should undergo several evaluations before surgery; deterioration of cardiopulmonary function after pulmonary resection is inevitable. We have evaluated the effects of digoxin on the improvement of right ventricular function and prevention of probable complications after lung resection surgery. Materials and Methods: All patients who were candidate for pneumonectomy or extensive lobectomy in Ghaem hospital from 2010 to 2012 were enrolled into this study and were divided into two groups randomly. The first group (group D received digoxin during surgery and in the second group (group C normal saline was administered as placebo. Echocardiographic evaluation of the patients was accomplished the day before and the day after surgery. Results: Among 20 patients in each group, male to female ratio was almost 2:1 and mean age was 63.8 (ranged 46-83 years. The most common cause of pneumonectomy was lung cancer. Comparison of the preoperative demographic variables, blood biochemistry, pulmonary function tests, echocardiographic and blood gas indexes showed no statistically significant differences between two groups. ,But postoperative evaluations showed a significant improvement in left ventricular ejection fraction in group D. Right ventricular systolic and diastolic diameters and pulmonary artery pressure were decreased significantly  as well. Conclusion: According to our results, we suggest a single dose of digoxin during lung resection surgery to improve cardiac performance after pneumonectomy.

  7. Chronic pulmonary embolism presenting with right ventricular dilatation on thallium myocardial scintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Cardwell, C.; Keighley, C.; Keady, M.A.; Better, N. [St. F.X. Cabrini Hospital and Alfred Hospital, Melbourne, VIC (Australia). Department of Nuclear Medicine

    1998-06-01

    Full text: A 61 year old male presented to the Nuclear Medicine Department for an exercise thallium study with a three month history of exertional dyspnoea for investigation. Patient history included PTCA to LAD and pulmonary embolism 16 years previously. The patient underwent 5.24 minutes of a standard treadmill Bruce protocol which was terminated due to his usual dyspnoea. The patient was injected with 120 MBq of 201-Thallous Chloride at peak exercise and prone SPECT imaging performed 8 minutes later with a dual head gamma camera. Reconstructed images demonstrated normal myocardial perfusion at a moderate level of haemodynamic stress. However, moderate night ventricular dilatation was noted raising the possibility of respiratory disease as cause for symptoms. Echocardiography confirmed right ventricular dilatation and moderate to severe pulmonary hypertension while subsequent respiratory function tests were unremarkable. The patient was then referred to Nuclear Medicine for a ventilation and perfusion lung scan. A six view ventilation study was performed following inhalation of 99mTc Technegas and corresponding perfusion images were acquired following intravenous administration of 99mTc MAA. The ventilation and perfusion images demonstrated multiple matched segmental defects bilaterally, suggestive of chronic thrombo-embolism. The patient was subsequently anti-coagulated with improvement of symptoms. In conclusion, our study has demonstrated how right ventricular dilatation on myocardial scintigraphy can alert the clinician to alternative causes for dyspnoea, and in our case resulted subsequently in a diagnosis of chronic pulmonary embolism

  8. Clinical study of right ventricular visualization by 201Tl myocardial scintigraphy

    International Nuclear Information System (INIS)

    Thallium-201 myocardial scans of 65 patients were retrospectively reviewed to evaluate the ability to detect right ventricular (RV) overloading. The degree of right ventricular visualization (RVV) was graded as a scale of (-)-(+++) according to RV uptake of the tracer: (-) = none; (+-) = slight RVV; (+) = less than left ventricular visualization (LVV); (++) = equal to LVV; (+++) = greater than LVV. Increased RV uptake was frequently seen in patients with chronic lung disease or congenital heart disease. The best projection angle for RVV was 60 deg in patients with grades (+-) and (+). The degree of RVV was compared with the data from cardiac catheterization performed in 25 of the patients. More increased uptake of the tracer was significantly associated with higher values of RV systolic pressure, pulmonary arterial systolic pressure, mean pulmonary arterial pressure, and pulmonary arterial resistant index. RV end-diastolic pressure, cardiac index, RV work index, RV stroke-work index, and heart rate were independent of the intensity of tracer uptake. The ratio of the RV to the left ventricle was significantly higher with increasing tracer uptake, although there was no significant difference between the groups with (+-) and grade (+). It was also correlated well with RV hemodynamic parameters. (Namekawa, K.)

  9. Assessment of the right ventricular function in patients with chronic obstructive pulmonary disease using MRI

    Energy Technology Data Exchange (ETDEWEB)

    Gao Yan; Du Xiangying; Qin Wen; Li Kuncheng (Dept. of Radiology, Xuanwu Hospital of Capital Medical Univ., Beijing (China)), email: kuncheng.li@gmail.com

    2011-09-15

    Background: Chronic obstructive pulmonary disease (COPD) is often associated with changes of the structure and the function of the right ventricle (RV). Therefore, the assessment of right ventricular function and myocardial mass (MM) is clinically important for the evaluation of the severity of COPD, which may provide an objective basis for therapeutic strategy. Purpose: To assess the right ventricular function and RV MM in patients with mild to severe COPD using magnetic resonance imaging (MRI). Material and Methods: We prospectively studied 49 COPD patients determined by the pulmonary function test (PFT). Using the Global Initiative for COPD classification, the COPD patients were divided into three groups according to the severity of the disease: group I = mild (n = 18); group II = moderate (n = 16); and group III = severe (n = 15). The patient groups were compared to a control group consisting of 30 age-matched, healthy, non-smoking subjects. The RV function and RV MM were obtained by 1.5T cardiac MRI in all of the four groups. The results were compared among the four groups using the ANOVA. Pearson's correlation was used to evaluate the relationship between the right ventricular ejection fraction (RVEF) and MM with the PFT results in COPD patients. Results: The RVEF was significantly lower in group III than in the other groups (P < 0.01). The RV MM differed significantly among all groups (P < 0.01) and gradually increased with the severity of COPD (P < 0.01). The correlation was significant between the MRI results and forced expiratory volume in 1 s (r = 0.860 for RVEF, r = -0.838 for RV MM) in COPD patients. Conclusion: The RVEF and RV MM measured by MRI correlate significantly with the severity of disease as determined by PFT in patients with COPD

  10. Assessment of the right ventricular function in patients with chronic obstructive pulmonary disease using MRI

    International Nuclear Information System (INIS)

    Background: Chronic obstructive pulmonary disease (COPD) is often associated with changes of the structure and the function of the right ventricle (RV). Therefore, the assessment of right ventricular function and myocardial mass (MM) is clinically important for the evaluation of the severity of COPD, which may provide an objective basis for therapeutic strategy. Purpose: To assess the right ventricular function and RV MM in patients with mild to severe COPD using magnetic resonance imaging (MRI). Material and Methods: We prospectively studied 49 COPD patients determined by the pulmonary function test (PFT). Using the Global Initiative for COPD classification, the COPD patients were divided into three groups according to the severity of the disease: group I = mild (n = 18); group II = moderate (n = 16); and group III = severe (n = 15). The patient groups were compared to a control group consisting of 30 age-matched, healthy, non-smoking subjects. The RV function and RV MM were obtained by 1.5T cardiac MRI in all of the four groups. The results were compared among the four groups using the ANOVA. Pearson's correlation was used to evaluate the relationship between the right ventricular ejection fraction (RVEF) and MM with the PFT results in COPD patients. Results: The RVEF was significantly lower in group III than in the other groups (P < 0.01). The RV MM differed significantly among all groups (P < 0.01) and gradually increased with the severity of COPD (P < 0.01). The correlation was significant between the MRI results and forced expiratory volume in 1 s (r = 0.860 for RVEF, r = -0.838 for RV MM) in COPD patients. Conclusion: The RVEF and RV MM measured by MRI correlate significantly with the severity of disease as determined by PFT in patients with COPD

  11. Phosphorylation of PTEN increase in pathological right ventricular hypertrophy in rats with chronic hypoxia induced pulmonary hypertension

    Institute of Scientific and Technical Information of China (English)

    Nie Xin; Shi Yiwei; Yu Wenyan; Xu Jianying; Hu Xiaoyun; Du Yongcheng

    2014-01-01

    Background Phosphatase and tensin homologue on chromosome ten (PTEN) acts as a convergent nodal signalling point for cardiomyocyte hypertrophy,growth and survival.However,the role of PTEN in cardiac conditions such as right ventricular hypertrophy caused by chronic hypoxic pulmonary,hypertension remains unclear.This study preliminarily discussed the role of PTEN in the cardiac response to increased pulmonary vascular resistance using the hypoxia-induced PH rats.Methods Male Sprague Dawley rats were exposed to 10% oxygen for 1,3,7,14 or 21 days to induce hypertension and right ventricular hypertrophy.Right ventricular systolic pressure was measured via catheterization.Hypertrophy index was calculated as the ratio of right ventricular mass to left ventricle plus septum mass.Tissue morphology and fibrosis were measured using hematoxylin,eosin and picrosirius red staining.The expression and phosphorylation levels of PTEN in ventricles were determined by real time PCR and Western blotting.Results Hypoxic exposure of rats resulted in pathological hypertrophy,interstitial fibrosis and remodelling of the right ventricle.The phosphorylation of PTEN increased significantly in the hypertrophic right ventricle compared to the normoxic control group.There were no changes in protein expression in either ventricle.Conclusion Hypoxia induced pulmonary hypertension developed pathological right ventricular hypertrophy and remodelling probablv related to an increased phosohorvlation of PTEN.

  12. Mesenchymal stem cells preserve neonatal right ventricular function in a porcine model of pressure overload.

    Science.gov (United States)

    Wehman, Brody; Sharma, Sudhish; Pietris, Nicholas; Mishra, Rachana; Siddiqui, Osama T; Bigham, Grace; Li, Tieluo; Aiello, Emily; Murthi, Sarah; Pittenger, Mark; Griffith, Bartley; Kaushal, Sunjay

    2016-06-01

    Limited therapies exist for patients with congenital heart disease (CHD) who develop right ventricular (RV) dysfunction. Bone marrow-derived mesenchymal stem cells (MSCs) have not been evaluated in a preclinical model of pressure overload, which simulates the pathophysiology relevant to many forms of CHD. A neonatal swine model of RV pressure overload was utilized to test the hypothesis that MSCs preserve RV function and attenuate ventricular remodeling. Immunosuppressed Yorkshire swine underwent pulmonary artery banding to induce RV dysfunction. After 30 min, human MSCs (1 million cells, n = 5) or placebo (n = 5) were injected intramyocardially into the RV free wall. Serial transthoracic echocardiography monitored RV functional indices including 2D myocardial strain analysis. Four weeks postinjection, the MSC-treated myocardium had a smaller increase in RV end-diastolic area, end-systolic area, and tricuspid vena contracta width (P lesions. PMID:27106046

  13. Cardiac MRI assessment of right ventricular function: impact of right bundle branch block on the evaluation of cardiac performance parameters

    Energy Technology Data Exchange (ETDEWEB)

    Marterer, Robert; Tschauner, Sebastian; Sorantin, Erich [Medical University of Graz, Division of Pediatric Radiology, Department of Radiology, Graz (Austria); Zeng, Hongchun [First Affiliated Hospital of Xinjiang Medical University, Department of Ultrasonography, Urumqi (China); Koestenberger, Martin [Medical University of Graz, Division of Pediatric Cardiology, Department of Pediatrics and Adolescent Medicine, Graz (Austria)

    2015-12-15

    Right ventricular (RV) function represents a prognostic marker in patients with corrected congenital heart disease. In up to 80 % of these patients, right branch bundle block (RBBB) exists and leads to asynchronous ventricular contraction. The aim of this retrospective study was to evaluate the change of RV performance parameters considering delayed RV end-systolic contraction. RV volumes of 33 patients were assessed twice: 1) not taking account of RBBB (group I), and 2) considering RBBB (group II). According to the RV ejection fraction (EF) for both groups, RV function was classified in different categories (>50 % = normal, 40-50 % = mildly-, 30-40 % = moderately-, <30 % = severely-reduced). The mean time difference between maximal systolic contraction of the septum and RV free wall was 90.7 ms ± 42.6. Consequently, RV end-systolic volume was significantly decreased in group II (p < 0.001). Accordingly, RV stroke volume and RV EF were significantly higher in group II (p < 0.001). There was also a significant change in the assessment of RV function (p < 0.02). RBBB induced delayed RV contraction can be detected at CMR. Ignoring the RV physiology in RBBB patients leads to a statistically significant underscoring of RV performance parameters. (orig.)

  14. Cardiac MRI assessment of right ventricular function: impact of right bundle branch block on the evaluation of cardiac performance parameters

    International Nuclear Information System (INIS)

    Right ventricular (RV) function represents a prognostic marker in patients with corrected congenital heart disease. In up to 80 % of these patients, right branch bundle block (RBBB) exists and leads to asynchronous ventricular contraction. The aim of this retrospective study was to evaluate the change of RV performance parameters considering delayed RV end-systolic contraction. RV volumes of 33 patients were assessed twice: 1) not taking account of RBBB (group I), and 2) considering RBBB (group II). According to the RV ejection fraction (EF) for both groups, RV function was classified in different categories (>50 % = normal, 40-50 % = mildly-, 30-40 % = moderately-, <30 % = severely-reduced). The mean time difference between maximal systolic contraction of the septum and RV free wall was 90.7 ms ± 42.6. Consequently, RV end-systolic volume was significantly decreased in group II (p < 0.001). Accordingly, RV stroke volume and RV EF were significantly higher in group II (p < 0.001). There was also a significant change in the assessment of RV function (p < 0.02). RBBB induced delayed RV contraction can be detected at CMR. Ignoring the RV physiology in RBBB patients leads to a statistically significant underscoring of RV performance parameters. (orig.)

  15. One case of tachycardia-induced cardiomyopathy caused by right ventricular outflow tract-ventricular tachycardia%右室流出道室性心动过速诱发心动过速性心肌病1例

    Institute of Scientific and Technical Information of China (English)

    王广强; 杨洋; 张博; 孙健

    2013-01-01

    A 36-year-old woman has suffered from paroxysmal palpitations, chest tightness and shortness of breath for more than 10 years. ECG showed broad QRS, ventricular tachycardia and atrioventricular separation. The ECG pointed to an origin in the right ventricular outflow tract. Echocardiography showed that the left ventricular end-diastolic diameter was 53 mm and the ejection fraction was 40%. B type natriuretic peptide was 7 920 pg/ ml. A single radiofrequency application at the site of ectopy was immediately effective. Holter monitoring was normal after ablation. Final diagnosis was right ventricular outflow tract-ventricular tachycardia, tachycardia-induced cardiomyopathy.

  16. Hydraulic and hemodynamic performance of a minimally invasive intra-arterial right ventricular assist device.

    Science.gov (United States)

    Hsu, Po-Lin; Graefe, Roland; Boehning, Fiete; Wu, Chen; Parker, Jack; Autschbach, Rüdiger; Schmitz-Rode, Thomas; Steinseifer, Ulrich

    2014-09-01

    Right ventricular assistance is still in the early phase of development compared to left ventricular assist device (LVAD) technology. In order to provide flexible pulmonary support and potentially reduce the known complications, we propose a minimally invasive right ventricular assist device (MIRVAD), located in the pulmonary artery (PA) and operating in series with the right ventricle (RV). The MIRVAD is an intra-arterial rotary blood pump containing a single axial impeller, which is not enclosed by a rigid housing but stent-fixed within the vessel. The impeller geometry has been designed with the assistance of analytical methods and computational fluid dynamics (CFD). The hydraulic performance of the impeller was evaluated experimentally with a customized test setup using blood synthetic medium (HES). The blade-tip clearance (BTC) was varied between 0.25-4.25 mm to evaluate the effect of different PA sizes on impeller performance. Furthermore, the Langrangian particle-tracking method was used to estimate the level of hemolysis and generate numerical blood damage indexes.The impeller design generated 25.6 mmHg for flow rates of 5 lpm at a speed of 6,000 rpm at the baseline condition, capable of providing sufficient support for the RV. The BTC presented a significant effect on the static pressure generation and the efficiency, but the operational range is suitable for most vessel sizes. The numerical results demonstrated a low risk of blood damage at the design point (mean Lagrangian damage index 2.6*10(-7)). The preliminary results have encouraged further impeller optimization and development of the MIRVAD. PMID:25262631

  17. Acute effects of levosimendan in experimental models of right ventricular hypertrophy and failure

    DEFF Research Database (Denmark)

    Vildbrad, Mads D; Andersen, Asger; Holmboe, Sarah;

    2014-01-01

    Pulmonary arterial hypertension (PAH) is a fatal disease, and the ultimate cause of death is right ventricular (RV) failure. In this study, we investigated the acute hemodynamic effects of levosimendan in two rat models of RV hypertrophy and failure. Wistar rats were randomized to receive sham....... PTB and MCT injection caused hypertrophy, dilatation, and failure of the RV compared with sham surgery. Levosimendan increased RV end systolic pressure (sham surgery: 16.0% ± 3.8% [P = 0.0038]; MCT: 9.9% ± 3.1% [P = 0.018]; PTB: 24.5% ± 3.3% [P = 0.0001]; mean ± SEM) compared with placebo...

  18. Multimodality imaging of a subtotally obstructive right ventricular myxoma in an asymptomatic 10-year-old girl

    Directory of Open Access Journals (Sweden)

    Gesa Wiegand

    2014-01-01

    Full Text Available A 10-year-old girl presented with a supraventricular tachycardia. A heart murmur was detected during a clinical examination; therefore, echocardiography was performed. This revealed a giant right ventricular myxoma that subtotally obstructed the right ventricular outflow tract. A myxoma in the right ventricle is uncommon in children. This rare intracardiac tumor was examined using multimodality imaging, and the patient underwent surgical resection. The pathologic features confirmed our suspicion and revealed an encapsulated tumor with myxomatoid stroma containing focal hemorrhages.

  19. Quantitative evaluation of right ventricular overload in cor pulmonale using 201Tl myocardial SPECT

    International Nuclear Information System (INIS)

    To determine quantitatively the discriminant and characteristics of cor pulmonale, 201Tl myocardial perfusion SPECT was performed in 16 patients with chronic obstructive pulmonary disease (COPD) and 7 with restrictive pulmonary disease (RPD). One section of the short-axis SPECT image in which the right ventricle was most clearly visualized was selected. Tl-score was defined as the ratio of the sum of counts in the region of interest (ROI) at the anterior, mid, and posterior regions of the right ventricular free wall to the sum of counts in ROI at the posterior, lateral, and anterior walls of the left ventricle, and the anterior and posterior regions of the interventricular septum. In the group of COPD patients, Tl-score was positively correlated with mean pulmonary arterial pressure (mPAP), total pulmonary vascular resistance (TPR), and arterial carbon dioxide tension (PaCO2), while it was inversely correlated with arterial oxygen tension (PaO2). However, there was no significant correlation between Tl-score and mPAP, TPR, PaCO2, and PaO2 in the group of RPD patients. In assessing pulmonary hypertension as defined by mPAP over 20 mmHg, a Tl-score greater than 0.25 was useful with a sensitivity of 69% and a specificity of 90%. The occurrence of cor pulmonale is a major factor in determining the prognosis of COPD patients. It was concluded that 201Tl myocardial SPECT is useful for evaluating right ventricular overload quantitatively, as well as for assessing core pulmonale, especially in COPD patients, since the ratio of Tl counts in the right and left ventricles was significantly correlated with right cardiopulmonary hemodynamic parameters. (N.K.)

  20. Altered right ventricular contractile pattern after cardiac surgery: monitoring of septal function is essential.

    Science.gov (United States)

    Nguyen, Tin; Cao, Long; Movahed, Assad

    2014-10-01

    Assessment of right ventricular (RV) function is important in the management of various forms of cardiovascular disease. Accurately assessing RV volume and systolic function is a challenge in day-to-day clinical practice due to its complex geometry. Tricuspid annular plane systolic excursion (TAPSE) and systolic excursion velocity (S') have been reviewed to further assess their suitability and objectivity in evaluating RV function. Multiple studies have validated their diagnostic and prognostic values in numerous pathologic conditions. Diminished longitudinal contraction after cardiothoracic surgery is a well-known phenomenon, but it is not well validated. Despite significant reduction in RV performance along the long-axis assessed by TAPSE and S' after cardiac surgery, RV ejection fractions did not change as well as the left ventricular parameters and exercise capacity. RV contractile patterns were markedly altered with decreased longitudinal shortening and increased transverse shortening, which are likely resulted from the septal damage during cardiac surgery. The septum is essential for RV performance due to its oblique fiber orientation. This allows ventricular twisting, which is a vital mechanism against increased pulmonary vascular resistance. The septum function along with TAPSE and S' should be adequately assessed during cardiac surgery, and evidence of septal dysfunction should lead to reevaluation of myocardial protection methods. PMID:24919944

  1. Right ventricular bifocal stimulation in the treatment of dilated cardiomyopathy with heart failure

    Directory of Open Access Journals (Sweden)

    José Carlos Pachón Mateos

    1999-12-01

    Full Text Available OBJECTIVE: To describe a new more efficient method of endocardial cardiac stimulation, which produces a narrower QRS without using the coronary sinus or cardiac veins. METHODS: We studied 5 patients with severe dilated cardiomyopathy, chronic atrial fibrillation and AV block, who underwent definitive endocardial pacemaker implantation, with 2 leads, in the RV, one in the apex and the other in the interventricular septum (sub pulmonary, connected, respectively, to ventricular and atrial bicameral pacemaker outputs. Using Doppler echocardiography, we compared, in the same patient, conventional (VVI, high septal ("AAI" and bifocal ("DDT" with AV interval ~ 0 stimulation. RESULTS: The RV bifocal stimulation had the best results with an increase in ejection fraction and cardiac output and reduction in QRS duration, mitral regurgitation and in the left atrium area (p <= 0.01. The conventional method of stimulation showed the worst result. CONCLUSION: These results suggest that, when left ventricular stimulation is not possible, right ventricular bifocal stimulation should be used in patients with severe cardiomyopathy where a pacemaker is indicated.

  2. Altered right ventricular contractile pattern after cardiac surgery: monitoring of septal function is essential.

    Science.gov (United States)

    Nguyen, Tin; Cao, Long; Movahed, Assad

    2014-10-01

    Assessment of right ventricular (RV) function is important in the management of various forms of cardiovascular disease. Accurately assessing RV volume and systolic function is a challenge in day-to-day clinical practice due to its complex geometry. Tricuspid annular plane systolic excursion (TAPSE) and systolic excursion velocity (S') have been reviewed to further assess their suitability and objectivity in evaluating RV function. Multiple studies have validated their diagnostic and prognostic values in numerous pathologic conditions. Diminished longitudinal contraction after cardiothoracic surgery is a well-known phenomenon, but it is not well validated. Despite significant reduction in RV performance along the long-axis assessed by TAPSE and S' after cardiac surgery, RV ejection fractions did not change as well as the left ventricular parameters and exercise capacity. RV contractile patterns were markedly altered with decreased longitudinal shortening and increased transverse shortening, which are likely resulted from the septal damage during cardiac surgery. The septum is essential for RV performance due to its oblique fiber orientation. This allows ventricular twisting, which is a vital mechanism against increased pulmonary vascular resistance. The septum function along with TAPSE and S' should be adequately assessed during cardiac surgery, and evidence of septal dysfunction should lead to reevaluation of myocardial protection methods.

  3. Premature ventricular complex-induced chronic cough and cough syncope.

    Science.gov (United States)

    Stec, S; Dabrowska, M; Zaborska, B; Bielicki, P; Maskey-Warzechowska, M; Tarnowski, W; Chazan, R; Kulakowski, P

    2007-08-01

    The present case study reports a case of chronic cough and cough syncope associated with frequent premature ventricular complexes (PVCs). Careful analysis of cough-related symptoms and ECG monitoring led to the suspicion of PVC-induced cough. A coincidence between PVCs and episodes of cough was also documented by a portable multichannel recorder. Moreover, Doppler echocardiography revealed a PVC-induced transient increase in the pulmonary artery blood flow. After exclusion of other possible aetiologies, complete relief of chronic cough and cough syncope was achieved by radiofrequency ablation of the arrhythmogenic focus located in the right ventricular outflow tract. Premature ventricular complexes should be considered as a cause of chronic cough and cough syncope and an interdisciplinary cooperation can lead to successful diagnosis and treatment of this condition.

  4. Comparison of Venous Return Characteristics with Right Ventricular Mechanics During Cephalic Fluid Shift

    Science.gov (United States)

    Elliott, Morgan; Martin, David

    2015-01-01

    For my summer internship project, I organized a pilot study to analyze the effects of a cephalic fluid shift on venous return and right ventricular mechanics to increase right ventricular and venous knowledge. To accomplish this pilot study, I wrote a testing protocol, obtained Institutional Review Board (IRB) approval, completed subject payment forms, lead testing sessions, and analyzed the data. This experiment used -20deg head down tilt (20 HDT) as the ground based simulation for the fluid shift that occurs during spaceflight and compared it to data obtained from the seated and supine positions. Using echocardiography, data was collected for the right ventricle, hepatic vein, internal jugular vein, external jugular vein, and inferior vena cava. Additionally, non-invasive venous pressure measurements, similar to those soon to be done in-orbit, were collected. It was determined that the venous return from below the heard is increased during 20 HDT, which was supported by increased hepatic vein velocities, increased right ventricular inflow, and increased right ventricular strain at 20 HDT relative to seated values. Jugular veins in the neck undergo an increase in pressure and area, but no significant increase in flow, relative to seated values when a subject is tilted 20 HDT. Contrary to the initial expectations based on this jugular flow, there was no significant increase in central venous pressure, as evidenced by no change in Doppler indices for right arterial pressure or inferior vena cava diameter. It is suspected that these differences in pressure are due to the hydrostatic pressure indifference point shifting during tilt; there is a potential for a similar phenomenon with microgravity. This data will hopefully lead to a more in-depth understanding of the response of the body to microgravity and how those relate to the previously mentioned cardiovascular risk of fluid shift that is associated with spaceflight. These results were presented in greater detail

  5. Carney complex with right ventricular myxoma following second excision of left atrial myxoma.

    Science.gov (United States)

    Tamura, Yamato; Seki, Toshio

    2014-01-01

    We report a case of Carney complex with massive right ventricular myxoma after two-time excision of a left atrial myxoma. The patient was a 45-year-old woman with pyrexia. She temporarily lost consciousness during examination, and echocardiography and computed tomography (CT) showed a massive tumor in the right ventricle. Loss of consciousness was determined to be caused by intracardiac obstruction of blood flow due to the tumor, and corrective surgery was performed. Pathological findings indicated myxoma with no malignancy. Myxomas are benign, but there is frequent recurrence of tumors associated with Carney complex. Because her myxomas were accompanied by unusual skin pigmentation, she was diagnosed with Carney complex. Carney complex has a high rate of myxoma recurrence, and often runs in families. In all cases, it is necessary to observe the patient's course closely.

  6. Solid Right Ventricular Compression by Intraventricular Septum-Hematoma Induced after Percutaneous Coronary Intervention

    Directory of Open Access Journals (Sweden)

    Ibrahim El-Battrawy

    2016-01-01

    Full Text Available Intraventricular septum-hematoma is a rare complication following percutaneous coronary intervention (PCI. This complication may represent a challenge for accurate diagnosis and treatment. This case report is about a 60-year-old male patient being admitted with an acute coronary syndrome. Despite successful PCI with drug eluting stent implantation into the right coronary artery (RCA the patient complained about recurrent angina pectoris according to Canadian Cardiovascular Society (CCS class IV. Cardiac magnetic resonance imaging and transthoracic echocardiography revealed a massive 4.9×9.2 cm sized end-diastolic septum-hematoma, which compromised right ventricular cavity. Emergent recoronary angiography ruled out further contrast extravasation from the RCA. Conservative treatment was intended after discussion in the “heart-team.” The patient completely recovered with nearly complete resolution of the hematoma after 6 months.

  7. Assessment of Right Ventricular Free Wall Longitudinal Myocardial Deformation Using Speckle Tracking Imaging in Normal Subjects

    Institute of Scientific and Technical Information of China (English)

    Chun TONG; Chunlei LI; Jialin SONG; Hongyun LIU; Youbin DENG

    2008-01-01

    To assess right ventricular free wall longitudinal myocardium deformation and examine the changes with normal age by speckle tracking imaging (STI), myocardial systolic peak strain (ε), systolic peak strain rate (SRs), early diastolic peak strain rate (Sre), late diastolic peak strain rate (Sra), the ratio of Sre/Sra were measured in the basal, middle and apical segments of right ventricular free wall in 75 healthy volunteers (age range: 21-71 y) by STI from the apical 4-chamber view. RV longitudinal strain and strain rate were highest in the basal segment of the free wall. Older subjects had lower early diastolic strain rate (Sre) than younger subjects, but they had higher late diastolic strain rate (Sra). A negative correlation between age and the ratio of Sre/Sra was found in all RV free wall segments (r=-0.466 - -0.614, P<0.01). It is concluded that RV diastolic strain rate changes with age and STI can be used for the study of RV myocardial deformation.

  8. Sporadic multicentric right atrial and right ventricular myxoma presenting as acute pulmonary thromboembolism

    Directory of Open Access Journals (Sweden)

    Satyajit Singh

    2016-01-01

    Full Text Available Multicentric cardiac myxoma is a rare syndrome; usually it is familial. We report a rare case of sporadic right atrium (RA and right ventricle (RV myxoma in a 26-year-old female presenting to our hospital for the evaluation of sudden onset of dyspnea and left precordial pain attributed to the embolization of degenerating tumor fragments to the pulmonary artery (PA. The exact incidence of sporadic multicentric RA and RV myxoma presenting as acute pulmonary embolism is unknown as multicentric RA and RV myxoma are very rare. Myxomas presenting as pulmonary embolism is <10%. Majority of cardiac myxomas present as exertional dyspnea, chest pain, positional syncope, fever, weight loss and other constitutional symptoms. Any young patient presenting with acute onset dyspnea with multiple cardiac masses may have tumor embolization to the PA diagnosis with transthoracic echocardiography and high-resolution computed tomography of thorax, fast-tracks patient transfer for urgent cardiac surgery to prevent further embolization.

  9. Beneficial aspects of real time flow measurements for the management of acute right ventricular heart failure following continuous flow ventricular assist device implantation

    Directory of Open Access Journals (Sweden)

    Spiliopoulos Sotirios

    2012-11-01

    Full Text Available Abstract Background Optimal management of acute right heart failure following the implantation of a left ventricular assist device requires a reliable estimation of left ventricular preload and contractility. This is possible by real-time pump blood flow measurements. Clinical case We performed implantation of a continuous flow left ventricular assist device in a 66 years old female patient with an end-stage heart failure on the grounds of a dilated cardiomyopathy. Real-time pump blood flow was directly measured by an ultrasonic flow probe placed around the outflow graft. Diagnosis The progressive decline of real time flow and the loss of pulsatility were associated with an increase of central venous pressure, inotropic therapy and progressive renal failure suggesting the presence of an acute right heart failure. Diagnosis was validated by echocardiography and thermodilution measurements. Treatment Temporary mechanical circulatory support of the right ventricle was successfully performed. Real time flow measurement proved to be a useful tool for the diagnosis and ultimately for the management of right heart failure including the weaning from extracorporeal membrane oxygenation.

  10. Computed tomographic pulmonary angiography in the assessment of severity of chronic thromboembolic pulmonary hypertension and right ventricular dysfunction

    International Nuclear Information System (INIS)

    Purpose: The aim was to investigate the role of computed tomographic pulmonary angiography (CTPA) in the assessment of severity and right ventricular function in chronic thromboembolic pulmonary hypertension (CTEPH). Materials and methods: Clinical and radiological data of 56 patients with CTEPH January 2006–October 2009 were retrospectively reviewed in the present study. All patients received CTPA with a 64-row CT using the retrospective ECG-Gated mode before digital subtraction pulmonary angiography and right-heart catheterization. CTPA findings including Right Ventricular diameter (RVd) and left ventricular diameter (LVd) were measured at the end diastole. CT Pulmonary Artery Obstruction Indexes including Qanadli Index and Mastora Index were used in the assessment of severity of pulmonary arterial obstruction. Hemodynamic parameters and pulmonary hypertension classification were evaluated by right-heart catheterization in all patients. Right ventricular function was measured with echocardiography in 49 patients. Results: Qanadli Index and Mastora Index respectively were (37.93 ± 14.74)% and (30.92 ± 16.91)%, which showed a significant difference (Z = −5.983, P = 0.000) and a good correlation (r = 0.881, P = 0.000). Neither Qanadli nor Mastora Index correlated with pulmonary hypertension classification (r = −0.009, P = 0.920) or New York Heart Association heart function classification (r = −0.031, P = 0.756). Neither Qanadli nor Mastora Index correlated with any echocardiographic right ventricular parameters (P > 0.05), while RVd/LVd by CTPA correlated with echocardiographic right ventricular functional parameters (P 2. CTPA findings correlated with hemodynamic variables. Backward linear regression analysis revealed that the RVd/LVd, Right Ventricular Anterior Wall Thickness (RVAWT), Main Pulmonary Artery trunk diameter (MPAd) were shown to be independently associated with mean Pulmonary Artery Pressure (mPAP) levels (model: r2 = 0.351, P = 0.025; RVd

  11. Right ventricular performance and central circulatory hemodynamics during upright exercise in patients with chronic obstructive pulmonary disease

    International Nuclear Information System (INIS)

    A combined hemodynamic and radionuclide approach was used to evaluate right ventricular performance during upright exercise in 12 male patients with chronic obstructive pulmonary disease. To assess the influence of intrathoracic pressure on hemodynamic parameters, pleural pressure was measured using an esophageal balloon. Mean age was 58.5 +/- 6.7 yr (+/- SD), and all had dyspnea on physical exertion. For the group, forced expiratory volume in one second (FEV1) was 1.04 +/- 0.40 L and arterial oxygen-tension (PaO2) was 77 +/- 11 mmHg. During steady-state, upright exercise on the bicycle ergometer at 58% of maximal oxygen consumption (VO2 max): (1) mean pulmonary artery pressure (Ppa) and pulmonary vascular resistance index (PVRI) increased significantly; (2) right ventricular ejection fraction (RVEF) failed to augment appropriately (less than 5% increase); and (3) right ventricular end-diastolic volume index (RVEDVI) increased significantly, whereas right ventricular end-systolic volume index (RVESVI) did not change. A diminished pulmonary vascular bed, the change in PaO2, and possibly increased alveolar pressure appeared to contribute to the increased load placed on the right ventricle. Both RVEDVI and RVESVI were significantly correlated with Ppa at rest and during exercise. In 2 of the 12 patients, stroke volume index and left ventricular end-diastolic volume index showed minimal change with exercise. VO2max was correlated with the FEV1 (r . 0.75; p . 0.01) as well as resting (r . -0.60; p . 0.02) and exercise (r . -0.61; p . 0.02) PVRI. These results suggest that exercise performance may be limited by right ventricular dysfunction in addition to respiratory impairment in some patients with chronic airway disease

  12. Contemporary management of acute right ventricular failure: a statement from the Heart Failure Association and the Working Group on Pulmonary Circulation and Right Ventricular Function of the European Society of Cardiology.

    Science.gov (United States)

    Harjola, Veli-Pekka; Mebazaa, Alexandre; Čelutkienė, Jelena; Bettex, Dominique; Bueno, Hector; Chioncel, Ovidiu; Crespo-Leiro, Maria G; Falk, Volkmar; Filippatos, Gerasimos; Gibbs, Simon; Leite-Moreira, Adelino; Lassus, Johan; Masip, Josep; Mueller, Christian; Mullens, Wilfried; Naeije, Robert; Nordegraaf, Anton Vonk; Parissis, John; Riley, Jillian P; Ristic, Arsen; Rosano, Giuseppe; Rudiger, Alain; Ruschitzka, Frank; Seferovic, Petar; Sztrymf, Benjamin; Vieillard-Baron, Antoine; Yilmaz, Mehmet Birhan; Konstantinides, Stavros

    2016-03-01

    Acute right ventricular (RV) failure is a complex clinical syndrome that results from many causes. Research efforts have disproportionately focused on the failing left ventricle, but recently the need has been recognized to achieve a more comprehensive understanding of RV anatomy, physiology, and pathophysiology, and of management approaches. Right ventricular mechanics and function are altered in the setting of either pressure overload or volume overload. Failure may also result from a primary reduction of myocardial contractility owing to ischaemia, cardiomyopathy, or arrhythmia. Dysfunction leads to impaired RV filling and increased right atrial pressures. As dysfunction progresses to overt RV failure, the RV chamber becomes more spherical and tricuspid regurgitation is aggravated, a cascade leading to increasing venous congestion. Ventricular interdependence results in impaired left ventricular filling, a decrease in left ventricular stroke volume, and ultimately low cardiac output and cardiogenic shock. Identification and treatment of the underlying cause of RV failure, such as acute pulmonary embolism, acute respiratory distress syndrome, acute decompensation of chronic pulmonary hypertension, RV infarction, or arrhythmia, is the primary management strategy. Judicious fluid management, use of inotropes and vasopressors, assist devices, and a strategy focusing on RV protection for mechanical ventilation if required all play a role in the clinical care of these patients. Future research should aim to address the remaining areas of uncertainty which result from the complexity of RV haemodynamics and lack of conclusive evidence regarding RV-specific treatment approaches. PMID:26995592

  13. Contemporary management of acute right ventricular failure: a statement from the Heart Failure Association and the Working Group on Pulmonary Circulation and Right Ventricular Function of the European Society of Cardiology.

    Science.gov (United States)

    Harjola, Veli-Pekka; Mebazaa, Alexandre; Čelutkienė, Jelena; Bettex, Dominique; Bueno, Hector; Chioncel, Ovidiu; Crespo-Leiro, Maria G; Falk, Volkmar; Filippatos, Gerasimos; Gibbs, Simon; Leite-Moreira, Adelino; Lassus, Johan; Masip, Josep; Mueller, Christian; Mullens, Wilfried; Naeije, Robert; Nordegraaf, Anton Vonk; Parissis, John; Riley, Jillian P; Ristic, Arsen; Rosano, Giuseppe; Rudiger, Alain; Ruschitzka, Frank; Seferovic, Petar; Sztrymf, Benjamin; Vieillard-Baron, Antoine; Yilmaz, Mehmet Birhan; Konstantinides, Stavros

    2016-03-01

    Acute right ventricular (RV) failure is a complex clinical syndrome that results from many causes. Research efforts have disproportionately focused on the failing left ventricle, but recently the need has been recognized to achieve a more comprehensive understanding of RV anatomy, physiology, and pathophysiology, and of management approaches. Right ventricular mechanics and function are altered in the setting of either pressure overload or volume overload. Failure may also result from a primary reduction of myocardial contractility owing to ischaemia, cardiomyopathy, or arrhythmia. Dysfunction leads to impaired RV filling and increased right atrial pressures. As dysfunction progresses to overt RV failure, the RV chamber becomes more spherical and tricuspid regurgitation is aggravated, a cascade leading to increasing venous congestion. Ventricular interdependence results in impaired left ventricular filling, a decrease in left ventricular stroke volume, and ultimately low cardiac output and cardiogenic shock. Identification and treatment of the underlying cause of RV failure, such as acute pulmonary embolism, acute respiratory distress syndrome, acute decompensation of chronic pulmonary hypertension, RV infarction, or arrhythmia, is the primary management strategy. Judicious fluid management, use of inotropes and vasopressors, assist devices, and a strategy focusing on RV protection for mechanical ventilation if required all play a role in the clinical care of these patients. Future research should aim to address the remaining areas of uncertainty which result from the complexity of RV haemodynamics and lack of conclusive evidence regarding RV-specific treatment approaches.

  14. Assessment of the right ventricular ischemia by means of stress T1-201 myocardial imaging

    International Nuclear Information System (INIS)

    In order to evaluate the clinical significance of thallium (Tl)-201 myocardial imaging for diagnosing the right ventricular (RV) ischemia, relationship of right ventricular free wall (RVFW) appearance on myocardial images to coronary arteriographic findings was studied. Patients were divided into 3 groups as follows: 1) normal control (NC) group (19 cases) without angiographically documented coronary artery disease; non-RCA group (18 cases) with significant coronary artery lesion restricted to the left coronary artery (LCA); and 3) RCA group (41 cases) with significant right coronary artery (RCA) stenosis regardless of underlying LCA disease. On the immediate images, all patients except one in the NC group and all except 4 in the non-RCA group demonstrated ''continuous visualization'' of the RVFW in both views. In the RCA group, 6 showed ''non-visualization'' and 13 ''defective visualization'' of the RVFW in 300 LAO view. In 600 LAO view, 6 presented ''non-visualization'' and 7 ''defective visualization'' of the RVFW. On the delayed images, although none of the patients in the groups NC and non-RCA demonstrated redistribution phenomenon of the RVFW, 5 patients in the RCA group showed redistribution of Tl-201 into the RVFW. When abnormal RVFW findings were defined as ''non-visualization'' or ''defective visualization'' of the RVFW on immediate images and/or positive redistribution phenomenon of the RVFW, sensitivity and specificity of the RVFW findings on stress Tl-201 myocardial images for detection of the RCA disease were 48.8% and 94.8%, respectively. Non- and defective visualization of the RVFW on the immediate images were related to the proximally located RCA lesion, previous history of inferior MI and high grade RCA stenosis. Collateral vessels seemed to protect the RVFW against the development of exercise induced ischemia and affect the occurrence of redistibution of Tl-201 into the RVFW. (J.P.N.)

  15. Pulmonary endarterectomy normalizes interventricular dyssynchrony and right ventricular systolic wall stress

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    Mauritz Gert-Jan

    2012-01-01

    Full Text Available Abstract Background Interventricular mechanical dyssynchrony is a characteristic of pulmonary hypertension. We studied the role of right ventricular (RV wall stress in the recovery of interventricular dyssynchrony, after pulmonary endarterectomy (PEA in chronic thromboembolic pulmonary hypertension (CTEPH. Methods In 13 consecutive patients with CTEPH, before and 6 months after pulmonary endarterectomy, cardiovascular magnetic resonance myocardial tagging was applied. For the left ventricular (LV and RV free walls, the time to peak (Tpeak of circumferential shortening (strain was calculated. Pulmonary Artery Pressure (PAP was measured by right heart catheterization within 48 hours of PEA. Then the RV free wall systolic wall stress was calculated by the Laplace law. Results After PEA, the left to right free wall delay (L-R delay in Tpeak strain decreased from 97 ± 49 ms to -4 ± 51 ms (P P = 0.18. The RV wall stress decreased significantly from 15.2 ± 6.4 kPa to 5.7 ± 3.4 kPa (P P = 0.78. The reduction of L-R delay in Tpeak was more strongly associated with the reduction in RV wall stress (r = 0.69,P = 0.007 than with the reduction in systolic PAP (r = 0.53, P = 0.07. The reduction of L-R delay in Tpeak was not associated with estimates of the reduction in RV radius (r = 0.37,P = 0.21 or increase in RV systolic wall thickness (r = 0.19,P = 0.53. Conclusion After PEA for CTEPH, the RV and LV peak strains are resynchronized. The reduction in systolic RV wall stress plays a key role in this resynchronization.

  16. Analysis of right ventricular areas to assess the severity of ascites syndrome in broiler chickens.

    Science.gov (United States)

    McGovern, R H; Feddes, J J; Robinson, F E; Hanson, J A

    1999-01-01

    Ascites syndrome in broiler chickens is defined as a condition associated with pulmonary hypertension leading to right heart failure, increased central venous pressure, passive congestion of the liver, and accumulations of serous fluids in body cavities. The syndrome is currently seen in fast-growing broiler chickens associated with an increase in the weight, volume, and area of the right ventricle of the heart. The ratio of the right ventricle weight to the total heart mass has been used to assess the consequences of increased blood pressure. The right ventricle area (RVA) can be quantified using image analysis technology. Hearts were removed from 719 male broilers at slaughter (42 d). All birds were visually scored for the incidence of ascites. A score of 0 or 1 represented slight hydropericardium, slight right heart hypertrophy, and slight edema. A score of 4 was assigned to birds with marked accumulation of ascitic fluid in one or more ceolomic cavities, pronounced dilation of the right heart, and prominent liver lesions. A cross-sectional image of each heart slice (a 4-mm-thick slice of the ventricles) was digitally recorded. Using image analysis software, the RVA, left ventricular area (LVA), and total heart area (HA) were determined. Because a slice of the heart was used in image analysis, the importance of maintaining the original shape was determined. Twenty hearts in five ranges of RVA size were scanned in four different positions, which have differing heart slice orientations and differing RVA shapes, for a comparison of positioning technique (placement) relating to the RVA. The shape of the heart slice for image analysis was observed not to be critical for the small RVA. For heart slices with large RVA values, it was found to be critical to analyze the heart slice in a standardized placement. PMID:10023748

  17. Effect of pericardiocentesis on right and left ventricular function and volumes in pericardial effusion.

    Science.gov (United States)

    Manyari, D E; Kostuk, W J; Purves, P

    1983-07-01

    To assess the effects of pericardial effusion on ventricular performance and volumes, electrocardiographically gated blood pool cardiac scintigraphy was performed immediately before and after 14 pericardiocenteses in 10 patients, 7 men and 3 women, aged 28 to 73 years (mean 50). Cardiac tamponade was present in 5 patients. After removal of 140 to 1,100 ml of pericardial fluid (527 +/- 305 ml [mean +/- standard deviation]), left ventricular (LV) ejection fraction increased from 63 +/- 5 to 64 +/- 4% (p greater than 0.05) and right ventricular (RV) ejection fraction decreased from 47 +/- 4 to 46 +/- 2% (p greater than 0.05). LV end-diastolic and end-systolic volumes increased (p less than 0.01) by 28 and 33%, and RV volumes by 40 and 43%, respectively. There were 8 patients with normal LV function (ejection fraction greater than 60%) and 6 patients with subnormal LV function. Changes in ejection fraction were nonsignificant in the 4 subgroups. LV end-diastolic volume changes were more marked (p less than 0.01) in patients with cardiac tamponade (+ 56%) than in those without tamponade (+ 17%), and in those with normal LV function (+ 36%) than in those with subnormal LV function (+ 21%). RV end-diastolic volume increased more markedly (p less than 0.05) in patients with tamponade (+ 72%) than in those without tamponade (+ 23%), but were similar in patients with normal (+ 38%) and abnormal (+ 43%) LV function. After pericardiocentesis, RV volume increased more markedly than did LV volume. Thus, hemodynamic and clinical improvement after pericardiocentesis may be related only to an increase in stroke volume. RV and LV ejection fraction, a measure of myocardial contractility, was not affected significantly by the presence of pericardial effusion, even in those patients who had cardiac tamponade.

  18. Mitogen-activated protein kinase signal pathways play an important role in right ventricular hypertrophy of tetralogy of Fallot

    Institute of Scientific and Technical Information of China (English)

    ZHANG Hong-shan; WU Qing-yu; XU Ming; ZHOU Yu-xiang; SHUI Chao-xiang

    2012-01-01

    Background Tetralogy of Fallot (TOF) is the most common malformation of children with an incidence of approximately 10% of congenital heart disease patients.There can be a wide spectrum to the severity of the anatomic defects,which include ventricular septal defect,aortic override,right ventricular outflow tract obstruction,and right ventricular hypertrophy.We examined the relationship between right ventricular hypertrophy in patients with TOF and the gene expression of factors in the mitogen-activated protein kinase (MAPK) signal pathway.Methods To gain insight into the characteristic gene(s) involved in molecular mechanisms of right ventricular hypertrophy in TOF,differential mRNA and micro RNA expression profiles were assessed using expression-based micro array technology on right ventricular biopsies from young TOF patients who underwent primary correction and on normal heart tissue.We then analyzed the gene expression of the MAPK signal pathway using reverse transcription-polymerase chain reaction (RT-PCR) in normals and TOF patients.Results Using the micro RNA chip V3.0 and human whole genome oligonucleotide microarray V1.0 to detect the gene expression,we found 1068 genes showing altered expression of at least two-fold in TOF patients compared to the normal hearts,and 47 micro RNAs that showed a significant difference of at least two-fold in TOF patients.We then analyzed these mRNAs and micro RNAs by target gene predicting software Microcosm Targets version 5.0,and determined those mRNA highly relevant to the right ventricular hypertrophy by RT-PCR method.There were obvious differences in the gene expression of factors in the MAPK signal pathway when using RT-PCR,which was consistent to the results of the cDNA microarray.Conclusion The upregulation of genes in the MAPK signal pathway may be the key events that contribute to right ventricular hypertroohv and stunted angiogenesis in patients with TOF.

  19. Deformation of the left and right ventricular longitudinal myocardium in fetuses with umbilical cord around neck

    Institute of Scientific and Technical Information of China (English)

    ZUO Dong-mei; WANG Chao-hong; WANG Yue-heng

    2012-01-01

    Background Umbilical cord around neck,a common obstetric complication,affects fetal hemodynamics.Does it influence fetal cardiac functions? The purpose of this study was to investigate the left and right ventricular systolic and diastolic functions of fetuses with umbilical cord around neck in the third trimester by applying velocity vector imaging (VVI).Methods Thirty-five cases of fetuses with umbilical cord around neck whose gestational ages from 35 to 40 weeks were selected,including 20 cases of umbilical artery ratio of the highest systolic velocity (S) to the lowest diastolic velocity (D) (S/D) <3.0 and 15 cases of umbilical artery S/D ≥3.0,while 20 cases of normal fetuses of 35-40 gestational weeks were selected as the control group.The changes in longitudinal velocity,strain,and strain rate of fetal left and right ventricle in systole and diastole in two groups,and the changes in fetal cardiac function under the situation of umbilical cord around neck were analyzed.Results Longitudinal strain and strain rate overall of fetal left and right ventricle in systole and diastole were less in fetuses with umbilical artery S/D ≥3.0 and umbilical cord around neck than those in fetuses with umbilical artery S/D <3.0and those in control group (P <0.05); there was no significant difference (P >0.05) in longitudinal strain and strain rate overall of fetal left and right ventricle in systole and diastole between fetuses with umbilical artery S/D <3.0 and those in control group.Conclusions Left and right ventricular systolic and diastolic dysfunction was detected in fetuses with umbilical cord around neck and umbilical artery S/D ≥3.0.WI could sensitively respond to cardiac function changes in fetuses with umbilical cord around neck,which provides another valuable method in the evaluation of fetal cardiac function.

  20. Fatal right ventricular failure and pulmonary hypertension after protamine administration during cardiac transplantation

    Directory of Open Access Journals (Sweden)

    Bibek S Pannu

    2016-01-01

    Full Text Available Protamine sulfate is the only Food and Drug administration approved medication for reversal of intraoperative heparin-induced anticoagulation during cardiac and vascular surgeries. One of the rare side effects of protamine sulfate is an idiosyncratic reaction resulting in acute pulmonary hypertension (APH and right ventricular (RV failure occurring after protamine administration. These reactions are rare but catastrophic with high mortality. A 36-year-old female with severe congestive heart failure was undergoing cardiac transplant surgery. After successful implantation of the donor heart, the patient was weaned off cardiopulmonary bypass. Protamine was then administered to reverse the heparin anticoagulation. She immediately developed APH and RV failure immediately after protamine infusion. The patient required immediate administration of inotropic agents, nitric oxide (NO, and subsequently required a number of mechanical support devices including an RV assist device (RVAD and ultimately full veno-arterial extracorporeal membrane oxygenation (VA-ECMO. Despite heroic efforts, the patient developed refractory multi-organ failure in the Intensive Care Unit and died after family requested discontinuation of resuscitative efforts. This case probably represents the first reported occurrence of fatal protamine-induced APH and ventricular failure in the setting of cardiac transplantation surgery. A number of interventions including inhaled NO, systemic vasopressors, RVAD, and ultimately VA-ECMO failed to reverse the situation, and the patient died of multi-organ failure.

  1. Acute Effects of Hemodialysis on Left and Right Ventricular Function: A Doppler Tissue Imaging Study

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    Tansel Erol

    2012-08-01

    Full Text Available Purpose: Doppler tissue imaging (DTI allows noninvasive assessment of both left ventricular (LV and right ventricular (RV function. The aim of this study was to evaluate the effect of hemodialysis (HD on LV and RV function using DTI. Method: Our study group included 30 patients on chronic HD program (mean age 45 15 years. Myocardial (Sm, Em, Am and annular velocities (Ea, Aa were measured in several cardiac territories before and after HD. Results: After HD, Ea significantly reduced from 10.8 3.4 cm/s to 9.6 2.4 cm/s (p = 0.029. Patients exhibited a lower Em following HD in all measured territories. Em/Am ratio was also reduced for each LV wall investigated after HD in all measured territories. At the RV segments, Sm, Em, and Am decreased significantly in all measured territories. Em of the anterior wall was positively related to ultrafiltration volume (r = 0.25, p = 0.006, whereas the decrease of Sm of RV basal segment correlated with a decrease of diastolic blood pressure (r = 0.23, p < 0.01. Conclusion: Our data indicate that a single HD session is associated with acute changes of systolic and diastolic parameters of LV and RV. [Cukurova Med J 2012; 37(4.000: 215-222

  2. Mitochondrial integrity in a neonatal bovine model of right ventricular dysfunction.

    Science.gov (United States)

    Bruns, Danielle R; Brown, R Dale; Stenmark, Kurt R; Buttrick, Peter M; Walker, Lori A

    2015-01-15

    Right ventricular (RV) function is a key determinant of survival in patients with both RV and left ventricular (LV) failure, yet the mechanisms of RV failure are poorly understood. Recent studies suggest cardiac metabolism is altered in RV failure in pulmonary hypertension (PH). Accordingly, we assessed mitochondrial content, dynamics, and function in hearts from neonatal calves exposed to hypobaric hypoxia (HH). This model develops severe PH with concomitant RV hypertrophy, dilation, and dysfunction. After 2 wk of HH, pieces of RV and LV were obtained along with samples from age-matched controls. Comparison with control assesses the effect of hypoxia, whereas comparison between the LV and RV in HH assesses the additional impact of RV overload. Mitochondrial DNA was unchanged in HH, as was mitochondrial content as assessed by electron microscopy. Immunoblotting for electron transport chain subunits revealed a small increase in mitochondrial content in HH in both ventricles. Mitochondrial dynamics were largely unchanged. Activity of individual respiratory chain complexes was reduced (complex I) or unchanged (complex V) in HH. Key enzymes in the glycolysis pathway were upregulated in both HH ventricles, alongside upregulation of hypoxia-inducible factor-1α protein. Importantly, none of the changes in expression or activity were different between ventricles, suggesting the changes are in response to HH and not RV overload. Upregulation of glycolytic modulators without chamber-specific mitochondrial dysfunction suggests that mitochondrial capacity and activity are maintained at the onset of PH, and the early RV dysfunction in this model results from mechanisms independent of the mitochondria.

  3. Right Ventricular Thrombus in a 36-Year-Old Man with Factor V Leiden

    Science.gov (United States)

    Hajsadeghi, Shokoufeh; Naghshin, Roozbeh; Hejrati, Maral; Kerman, Scott Reza Jafarian

    2015-01-01

    Abstract Factor V Leiden deficiency is the most common hereditary hypercoagulable disease in the United States and involves 5% of the Caucasian population. Up to 30% of patients who present with deep vein thrombosis (DVT) or pulmonary thromboembolism present with this condition. This is a case report of a 36-year-old man who experienced one episode of DVT within the previous year and was admitted to our hospital due to productive coughs and hemoptysis. Paraclinical studies demonstrated a right ventricular thrombus. Additional investigation was done to find the underlying cause. Laboratory tests were positive for Factor V Leiden mutation. Other factors for hypercoagulability states were normal. Given that Factor V Leiden mutation is a life-threatening condition with a relatively high prevalence and considering its thrombogenesis, screening tests are necessary in young patients without obvious reasons for recurrent thrombus formation. It seems that medical noninvasive treatments can be an alternative therapy to surgery when a ventricular thrombus is suspected in these patients. PMID:26157463

  4. Right Ventricular Thrombus in a 36-Year-Old Man with Factor V Leiden

    Directory of Open Access Journals (Sweden)

    Shokoufeh Hajsadeghi

    2015-10-01

    Full Text Available Factor V Leiden deficiency is the most common hereditary hypercoagulable disease in the United States and involves 5% of the Caucasian population. Up to 30% of patients who present with deep vein thrombosis (DVT or pulmonary thromboembolism present with this condition. This is a case report of a 36-year-old man who experienced one episode of DVT within the previous year and was admitted to our hospital due to productive coughs and hemoptysis. Paraclinical studies demonstrated a right ventricular thrombus. Additional investigation was done to find the underlying cause. Laboratory tests were positive for Factor V Leiden mutation. Other factors for hypercoagulability states were normal. Given that Factor V Leiden mutation is a life-threatening condition with a relatively high prevalence and considering its thrombogenesis, screening tests are necessary in young patients without obvious reasons for recurrent thrombus formation. It seems that medical noninvasive treatments can be an alternative therapy to surgery when a ventricular thrombus is suspected in these patients.

  5. Reduced Right Ventricular Function Predicts Long-Term Cardiac Re-Hospitalization after Cardiac Surgery.

    Directory of Open Access Journals (Sweden)

    Leela K Lella

    Full Text Available The significance of right ventricular ejection fraction (RVEF, independent of left ventricular ejection fraction (LVEF, following isolated coronary artery bypass grafting (CABG and valve procedures remains unknown. The aim of this study is to examine the significance of abnormal RVEF by cardiac magnetic resonance (CMR, independent of LVEF in predicting outcomes of patients undergoing isolated CABG and valve surgery.From 2007 to 2009, 109 consecutive patients (mean age, 66 years; 38% female were referred for pre-operative CMR. Abnormal RVEF and LVEF were considered 30 days outcomes included, cardiac re-hospitalization, worsening congestive heart failure and mortality. Mean clinical follow up was 14 months.Forty-eight patients had reduced RVEF (mean 25% and 61 patients had normal RVEF (mean 50% (p<0.001. Fifty-four patients had reduced LVEF (mean 30% and 55 patients had normal LVEF (mean 59% (p<0.001. Patients with reduced RVEF had a higher incidence of long-term cardiac re-hospitalization vs. patients with normal RVEF (31% vs.13%, p<0.05. Abnormal RVEF was a predictor for long-term cardiac re-hospitalization (HR 3.01 [CI 1.5-7.9], p<0.03. Reduced LVEF did not influence long-term cardiac re-hospitalization.Abnormal RVEF is a stronger predictor for long-term cardiac re-hospitalization than abnormal LVEF in patients undergoing isolated CABG and valve procedures.

  6. Improved Right Ventricular Performance with Increased Tricuspid Annular Excursion in Athlete’s Heart

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    Himanshu eGupta

    2015-04-01

    Full Text Available Background: Marathon runners (MTH and patients with mitral regurgitation (MR exhibit left ventricular (LV overload, and LV geometric changes in these groups have been reported. In this study, right ventricular (RV adaptation to chronic volume overload was evaluated in MTH and MR and normal controls together with interventricular septal remodeling and tricuspid annulus (TA motion. Methods: A total of 60 age-matched subjects (including 19 MTH, 17 isolated chronic compensated MR patients and 24 normal subjects underwent conventional cine and tagged cardiac magnetic resonance imaging. Myocardial strain and curvature were computed on the interventricular septum and RV free wall. A dual-propagation technique was applied to construct RV volume-time curves for a single cardiac cycle. Similarly, the tricuspid annulus was tracked throughout the cardiac cycle to create displacement over time curve.Results: Septal curvature was significantly lower in MTH and MR compared to controls. No significant differences in RV free wall strain or RV ejection fraction were noted amongst the 3 groups. However, longitudinal TA excursion was significantly higher in MTH compared to controls (p=0.0061. The peak late diastolic TA velocity in MR was significantly faster than MTH (p=0.0031 and controls (p=0.020. Conclusions: Increased TA kinetics allows for improved RV performance in MTH. Septal remodeling was observed in both MR and MTH, therefore a direct relationship of septal remodeling to TA kinetics in athlete’s heart could not be elucidated in this study.

  7. Right ventricular failure due to chronic pressure load : What have we learned in animal models since the NIH working group statement?

    NARCIS (Netherlands)

    Borgdorff, Marinus A J; Dickinson, Michael G; Berger, Rolf M F; Bartelds, Beatrijs

    2015-01-01

    Right ventricular (RV) failure determines outcome in patients with pulmonary hypertension, congenital heart diseases and in left ventricular failure. In 2006, the Working Group on Cellular and Molecular Mechanisms of Right Heart Failure of the NIH advocated the development of preclinical models to s

  8. Accuracy of a new method for semi-quantitative assessment of right ventricular ejection fraction by cardiovascular magnetic resonance: Right ventricular fractional diameter changes

    International Nuclear Information System (INIS)

    Objective: Longitudinal shortening is traditionally considered the predominant part of global right ventricular (RV) systolic function. Less attention has been paid to transverse contraction. The aim of this study was to evaluate RV transverse motion by cardiovascular magnetic resonance (CMR) in a large cohort of patients and to assess its relationship with RV ejection fraction (RVEF). Study design: We retrospectively analyzed the CMR scans of 300 patients referred to our center in 2010. RVEF was determined from short axis sequences using the volumetric method. Transverse parameters called RV fractional diameter changes were calculated after measuring RV diastolic and systolic diameters at basal and mid-level in short axis view (respectively FBDC and FMDC). We also measured the tricuspid annular plane systolic excursion (TAPSE) as a longitudinal reference. Results: Our population was divided into 2 groups according to RVEF. 250 patients had a preserved RVEF (>40%) and 50 had a RV dysfunction (RVEF ≤40%). Transverse and longitudinal motions were significantly reduced in the group with RV dysfunction (p < .0001). After ROC analysis, areas under the curve for FBDC, FMDC and TAPSE, were respectively 0.79, 0.82 and 0.72, with the highest specificity and sensitivity respectively of 88% and 68% for FMDC (threshold at 20%) for predicting RV dysfunction. FMDC had an excellent negative predictive value of 93%. Conclusion: RV fractional diameter changes, especially at the mid-level, appear to be accurate for semi-quantitative assessment of RV function by CMR. A cut-off of 20% for FMDC differentiates patients with a low (EF ≤ 40%) or a preserved RVEF

  9. Automated Assessment of Right Ventricular Volumes and Function Using Three-Dimensional Transesophageal Echocardiography.

    Science.gov (United States)

    Nillesen, Maartje M; van Dijk, Arie P J; Duijnhouwer, Anthonie L; Thijssen, Johan M; de Korte, Chris L

    2016-02-01

    Assessment of right ventricular (RV) function is known to be of diagnostic value in patients with RV dysfunction. Because of its complex anatomic shape, automated determination of the RV volume is difficult and strong reliance on geometric assumptions is not desired. A method for automated RV assessment was developed using three-dimensional (3-D) echocardiography without relying on a priori knowledge of the cardiac anatomy. A 3-D adaptive filtering technique that optimizes the discrimination between blood and myocardium was applied to facilitate endocardial border detection. Filtered image data were incorporated in a segmentation model to automatically detect the endocardial RV border. End-systolic and end-diastolic RV volumes, as well as ejection fraction, were computed from the automatically segmented endocardial surfaces and compared against reference volumes manually delineated by two expert cardiologists. The results reported good performance in terms of correlation and agreement with the results from the reference volumes.

  10. Transcatheter Pulmonary Valve Replacement for Right Ventricular Outflow Tract Conduit Dysfunction After the Ross Procedure

    DEFF Research Database (Denmark)

    Gillespie, Matthew J; McElhinney, Doff B; Kreutzer, Jacqueline;

    2015-01-01

    BACKGROUND: Right ventricular outflow tract (RVOT) conduit dysfunction is a limitation of the Ross procedure. Transcatheter pulmonary valve replacement (TPVR) could alter the impact of conduit dysfunction and the risk-benefit balance for the Ross procedure. METHODS: Retrospective review...... of databases from 3 prospective Melody TPV (Medtronic Inc, Minneapolis, MN) trials. RESULTS: Among 358 patients who were catheterized with the intent to implant a Melody TPV for RVOT conduit stenosis or regurgitation (PR) as part of 3 prospective multicenter studies, 67 (19%) had a prior Ross procedure...... early outcomes and durable valve function in the majority of Ross patients. Recurrent RVOT obstruction associated with stent fracture was the main reason for reintervention. Coronary compression is not uncommon in Ross patients and should be assessed prior to TPVR....

  11. Quantitative assessment of pulmonary regurgitation in patients with and without right ventricular tract obstruction

    Energy Technology Data Exchange (ETDEWEB)

    Spiewak, Mateusz, E-mail: mspiewak@ikard.pl [Department of Coronary Artery Disease and Structural Heart Diseases, Institute of Cardiology, ul. Alpejska 42, 04-628 Warsaw (Poland); Cardiovascular Magnetic Resonance Unit, Institute of Cardiology, ul. Alpejska 42, 04-628 Warsaw (Poland); Biernacka, Elzbieta K., E-mail: kbiernacka@ikard.pl [Department of Congenital Heart Diseases, Institute of Cardiology, ul. Alpejska 42, 04-628 Warsaw (Poland); Malek, Lukasz A., E-mail: lmalek@ikard.pl [Cardiovascular Magnetic Resonance Unit, Institute of Cardiology, ul. Alpejska 42, 04-628 Warsaw (Poland); Department of Interventional Cardiology and Angiology, Institute of Cardiology, ul. Alpejska 42, 04-628 Warsaw (Poland); Misko, Jolanta, E-mail: jmisko@wp.pl [Cardiovascular Magnetic Resonance Unit, Institute of Cardiology, ul. Alpejska 42, 04-628 Warsaw (Poland); Department of Radiology, Institute of Cardiology, ul. Alpejska 42, 04-628 Warsaw (Poland); Kowalski, Miroslaw, E-mail: mkowalski@ikard.pl [Department of Congenital Heart Diseases, Institute of Cardiology, ul. Alpejska 42, 04-628 Warsaw (Poland); Milosz, Barbara, E-mail: barbara-milosz@o2.pl [Cardiovascular Magnetic Resonance Unit, Institute of Cardiology, ul. Alpejska 42, 04-628 Warsaw (Poland); Department of Radiology, Institute of Cardiology, ul. Alpejska 42, 04-628 Warsaw (Poland); Petryka, Joanna, E-mail: joannapetryka@hotmail.com [Department of Coronary Artery Disease and Structural Heart Diseases, Institute of Cardiology, ul. Alpejska 42, 04-628 Warsaw (Poland); Cardiovascular Magnetic Resonance Unit, Institute of Cardiology, ul. Alpejska 42, 04-628 Warsaw (Poland); Zabicka, Magdalena, E-mail: mzabicka@onet.eu [Cardiovascular Magnetic Resonance Unit, Institute of Cardiology, ul. Alpejska 42, 04-628 Warsaw (Poland); Dept. of Radiology, Inst. of Cardiology, ul. Alpejska 42, 04-628 Warsaw (Poland); Ruzyllo, Witold, E-mail: wruzyllo@ikard.pl [Inst. of Cardiology, ul. Alpejska 42, 04-628 Warsaw (Poland)

    2011-11-15

    Background: There are concerns whether there is a difference in clinical utility of pulmonary regurgitation (PR) fraction (PRF) and PR volume (PRV) in subgroups of patients with isolated PR and individuals with combined PR and right ventricular outflow tract obstruction (RVOTO). The aim of the study was to compare PRF and PRV in patients with or without RVOTO. Methods and results: 82 consecutive patients after repair of tetralogy of Fallot (TOF) who underwent cardiovascular magnetic resonance and echocardiography were studied. There was no difference in PRF between patients with moderate and severe right ventricular (RV) dilatation (32 {+-} 13% vs. 37 {+-} 12%; p = 0.18). Significant difference in PRV was observed between these groups (23 {+-} 10 ml/m{sup 2} vs. 31 {+-} 12 ml/m{sup 2}, respectively; p = 0.02). PRV had better ability than PRF in identification of severe RV dilatation, both in group with RVOTO [area under the curve (AUC) 0.82 vs. 0.72, p = 0.005] and in patients without RVOTO (AUC 0.83 vs. 0.77, p = 0.04). A strong correlation was seen between PRF and PRV both in patients with and without RVOTO [r = 0.93, p < 0.0001 and r = 0.92, p < 0.0001, respectively]. In both subgroups high variability of PRF was found in subjects with similar degree of PRV. Conclusions: PRV shows better ability than PRF in evaluating influence of PR on RV in patients after TOF repair, both in population with and without concomitant RVOTO.

  12. Left and right ventricular diastolic dysfunction and diastolic heart failure: does one lead to the other?

    Institute of Scientific and Technical Information of China (English)

    Faramarz Tehrani; Anita Phan; Ernst R. Schwarz

    2009-01-01

    Background and Objective Diastolic dysfunction of the left ventricle is a mechanical abnormality diagnosed primarily by echocardiogram, and can be distinguished into three separate degrees based on the severity of reduction in passive compliance and active myocardial relaxation. Methods A literature search was performed for basic science studies, clinical studies and major practice guidelines on the subject of diastolic dysfunction and diastolic heart failure. Important findings were analyzed and correlated with regard to clinical relevance. Results Left ventricular diastolic dysfunction appears to compromise exercise tolerance and is believed to contribute to the pathophysiology in patients with diastolic heart failure. In the clinical setting, however, oftentimes no clear distinction is made between echocardiographically diagnosed diastolic dysfunction and diastolic heart failure, and adequate treatment recommendations are sparse and aimed to prevent worsening and progression of clinical symptoms. To date, there is a lack of high powered trials assessing the possible progression rate from echocardiographically diagnosed diastolic dysfunction to the clinical diagnosis of diastolic heart failure. Furthermore, there are no solid indices to assess the degree of severity of diastolic dysfunction or its progression. Pure right ventricular diastolic dysfunction appears to be even less understood and under-recognized, although it may play a role in the development of both right and left heart failure. Currently there are few but interesting data on the possible interaction between ventricles with diastolic dysfunction and the overall affect on the development of heart failure. Conclusions The timeline and progression of diastolic dysfunction to diastolic heart failure have not been well established and warrant further investigation.

  13. Impacts of acute severe pulmonary regurgitation on right ventricular geometry and contractility assessed by tissue-Doppler echocardiography

    DEFF Research Database (Denmark)

    Kjaergaard, Jesper; Iversen, Kasper K; Vejlstrup, Niels G;

    2010-01-01

    Little is known of the impact of acute right ventricular (RV) volume overload on RV function. We assessed the impact of acute severe pulmonary regurgitation (PR) on global and regional RV function by applying novel quantitative echocardiographic markers of myocardial performance in an animal model....

  14. Impacts of acute severe pulmonary regurgitation on right ventricular geometry and contractility assessed by tissue-Doppler echocardiography

    DEFF Research Database (Denmark)

    Kjaergaard, Jesper; K. Iversen, Kasper; G Vejlstrup, Niels;

    2010-01-01

    AIMS: Little is known of the impact of acute right ventricular (RV) volume overload on RV function. We assessed the impact of acute severe pulmonary regurgitation (PR) on global and regional RV function by applying novel quantitative echocardiographic markers of myocardial performance in an animal...

  15. Clinical symptoms of right ventricular failure in experimental chronic pressure load are associated with progressive diastolic dysfunction

    NARCIS (Netherlands)

    Borgdorff, Marinus A. J.; Koop, Anne Marie C.; Bloks, Vincent W.; Dickinson, Michael G.; Steendijk, Paul; Sillje, Herman H. W.; van Wiechen, Maarten P. H.; Berger, Rolf M. F.; Bartelds, Beatrijs

    2015-01-01

    Background: Right ventricular failure (RVF) due to pressure load is a major cause of death in congenital heart diseases and pulmonary hypertension. The mechanisms of RVF are unknown. We used an experimental approach based upon clinical signs of RVF to delineate functional and biological processes as

  16. Prognostic value of right ventricular function in patients after acute myocardial infarction treated with primary percutaneous coronary intervention

    NARCIS (Netherlands)

    M.L. Antoni (Louisa); R.W.C. Scherptong (Roderick); J.Z. Atary (Jael); H. Boersma (Eric); E.R. Holman (Eduard); E.E. van der Wall (Ernst); M.J. Schalij (Martin Jan); J.J. Bax (Jeroen)

    2010-01-01

    textabstractBackground-Data on the association between right ventricular (RV) function and adverse events after acute myocardial infarction (AMI) are scarce. The purpose of the current study was to evaluate the relation between RV function and adverse events in patients treated with primary percutan

  17. Acetyl-lysine erasers and readers in the control of pulmonary hypertension and right ventricular hypertrophy

    Science.gov (United States)

    Stratton, Matthew S.; McKinsey, Timothy A.

    2016-01-01

    Acetylation of lysine residues within nucleosomal histone tails provides a crucial mechanism for epigenetic control of gene expression. Acetyl groups are coupled to lysine residues by histone acetyltransferases (HATs) and removed by histone deacetylases (HDACs), which are also commonly referred to as “writers” and “erasers”, respectively. In addition to altering the electrostatic properties of histones, lysine acetylation often creates docking sites for bromodomain-containing “reader” proteins. This review focuses on epigenetic control of pulmonary hypertension (PH) and associated right ventricular (RV) cardiac hypertrophy and failure. Effects of small molecule HDAC inhibitors in pre-clinical models of PH are highlighted. Furthermore, we describe the recently discovered role of bromodomain and extraterminal (BET) reader proteins in the control of cardiac hypertrophy, and provide evidence suggesting that one member of this family, BRD4, contributes to the pathogenesis of RV failure. Together, the data suggest intriguing potential for pharmacological epigenetic therapies for the treatment of PH and right-sided heart failure. PMID:25707943

  18. Ventricular fibrillation during right coronary arteriography with ioxaglate, iohexol and iopamidol in dogs.

    Science.gov (United States)

    Morris, T W

    1988-03-01

    Radiograph contrast media (CM) are known to produce myocardial disturbances during cardiac angiography. The most severe electrical disturbance is ventricular fibrillation (VF). Previous studies using prolonged right coronary exposures have demonstrated a higher incidence of VF with dilute low sodium CM than with dilute CM containing more physiologic levels of sodium. In this study the incidence of VF was examined for more conventional concentrations of iopamidol, iohexol and ioxaglate and for sodium supplemented iohexol. The incidence of VF was determined during 25-second injections of contrast media into the canine right coronary artery at a rate of 0.4 mL/sec. Injections of iohexol and iopamidol at concentrations of 160, 240 and 320 mgI/mL produced significantly more VF (P less than .005, Fisher Exact Test) than meglumine/sodium ioxaglate or iohexol supplemented with 20 mM sodium chloride. The time required to produce a 50% incidence of VF with iohexol and iopamidol was significantly related to sodium concentration (r = .92, P less than .01).

  19. Rapamycin attenuates hypoxia-induced pulmonary vascular remodeling and right ventricular hypertrophy in mice

    Directory of Open Access Journals (Sweden)

    Tillmanns Harald H

    2007-02-01

    Full Text Available Abstract Background Chronic hypoxia induces pulmonary arterial hypertension (PAH. Smooth muscle cell (SMC proliferation and hypertrophy are important contributors to the remodeling that occurs in chronic hypoxic pulmonary vasculature. We hypothesized that rapamycin (RAPA, a potent cell cycle inhibitor, prevents pulmonary hypertension in chronic hypoxic mice. Methods Mice were held either at normoxia (N; 21% O2 or at hypobaric hypoxia (H; 0.5 atm; ~10% O2. RAPA-treated animals (3 mg/kg*d, i.p. were compared to animals injected with vehicle alone. Proliferative activity within the pulmonary arteries was quantified by staining for Ki67 (positive nuclei/vessel and media area was quantified by computer-aided planimetry after immune-labeling for α-smooth muscle actin (pixel/vessel. The ratio of right ventricle to left ventricle plus septum (RV/[LV+S] was used to determine right ventricular hypertrophy. Results Proliferative activity increased by 34% at day 4 in mice held under H (median: 0.38 compared to N (median: 0.28, p = 0.028 which was completely blocked by RAPA (median HO+RAPA: 0.23, p = 0.003. H-induced proliferation had leveled off within 3 weeks. At this time point media area had, however, increased by 53% from 91 (N to 139 (H, p Conclusion Therapy with rapamycin may represent a new strategy for the treatment of pulmonary hypertension.

  20. Thymosin Beta 4 protects mice from monocrotaline-induced pulmonary hypertension and right ventricular hypertrophy.

    Directory of Open Access Journals (Sweden)

    Chuanyu Wei

    Full Text Available Pulmonary hypertension (PH is a progressive vascular disease of pulmonary arteries that impedes ejection of blood by the right ventricle. As a result there is an increase in pulmonary vascular resistance and pulmonary arterial pressure causing right ventricular hypertrophy (RVH and RV failure. The pathology of PAH involves vascular cell remodeling including pulmonary arterial endothelial cell (PAEC dysfunction and pulmonary arterial smooth muscle cell (PASMC proliferation. Current therapies are limited to reverse the vascular remodeling. Investigating a key molecule is required for development of new therapeutic intervention. Thymosin beta-4 (Tβ4 is a ubiquitous G-actin sequestering protein with diverse biological function and promotes wound healing and modulates inflammatory responses. However, it remains unknown whether Tβ4 has any protective role in PH. The purpose of this study is to evaluate the whether Tβ4 can be used as a vascular-protective agent. In monocrotaline (MCT-induced PH mouse model, we showed that mice treated with Tβ4 significantly attenuated the systolic pressure and RVH, compared to the MCT treated mice. Our data revealed for the first time that Tβ4 selectively targets Notch3-Col 3A-CTGF gene axis in preventing MCT-induced PH and RVH. Our study may provide pre-clinical evidence for Tβ4 and may consider as vasculo-protective agent for the treatment of PH induced RVH.

  1. The importance of trabecular hypertrophy in right ventricular adaptation to chronic pressure overload.

    Science.gov (United States)

    van de Veerdonk, Mariëlle C; Dusoswa, Sophie A; Marcus, J Tim; Bogaard, Harm-Jan; Spruijt, Onno; Kind, Taco; Westerhof, Nico; Vonk-Noordegraaf, Anton

    2014-02-01

    To assess the contribution of right ventricular (RV) trabeculae and papillary muscles (TPM) to RV mass and volumes in controls and patients with pulmonary arterial hypertension (PAH). Furthermore, to evaluate whether TPM shows a similar response as the RV free wall (RVFW) to changes in pulmonary artery pressure (PAP) during follow-up. 50 patients underwent cardiac magnetic resonance (CMR) and right heart catheterization at baseline and after one-year follow-up. Furthermore 20 controls underwent CMR. RV masses were assessed with and without TPM. TPM constituted a larger proportion of total RV mass and RV end-diastolic volume (RVEDV) in PAH than in controls (Mass: 35 ± 7 vs. 25 ± 5 %; p TPM mass was related to the RVFW mass in patients (baseline: R = 0.65; p TPM from the assessment resulted in altered RV mass, volumes and function than when included (all p TPM mass (β = 0.44; p = 0.004) but not the changes in RVFW mass (p = 0.095) were independently related to changes in PAP during follow-up. RV TPM showed a larger contribution to total RV mass in PAH (~35 %) compared to controls (~25 %). Inclusion of TPM in the analyses significantly influenced the magnitude of the RV volumes and mass. Furthermore, TPM mass was stronger related to changes in PAP than RVFW mass. Our results implicate that TPM are important contributors to RV adaptation during pressure overload and cannot be neglected from the RV assessment.

  2. Determination of right ventricular ejection fraction in children with cystic fibrosis, using krypton-81m

    International Nuclear Information System (INIS)

    The diagnosis of cor pulmonale and incipient heart failure remains difficult to assess in cystic fibrosis (CF) on the basis of the clinical as well as the biological parameters. The measurement of the right ventricular ejection fraction has been facilitated these last years by the introduction of the radionuclide methods. Methodological difficulties are however encountered when Tc-99m RBC are used, and are mainly related to heart chambers superposition (equilibrium method) or the low count density (first pass method). Few papers have been published on RVEF in cystic fibrosis and the results are somewhat contradictory. The authors have recently introduced a new method for the determination of RVEF, using equilibrium study during continuous injection of Kr-81m in glucose solution. This method offers several advantages related to an increased accuracy and a favorable dosimetry. In 25 patients aged 2 to 23 years with CF, one or more RVEF studies were performed. The severity of the disease was evaluated on the basis of the clinical Schwachman score, the lung function tests, the ventilation scan and the pa02. RVEF tended to decrease with the progression of the lung disease, although, owing to the spread of the results, no RVEF could be predicted on the basis of the other parameters. The decrease of RVEF in patients with advanced lung disease was moderate and terminal lung disease was sometimes associated with normal right heart contractility

  3. Endoscopic Observation of the Growth Process of a Right-Side Sessile Serrated Adenoma/Polyp with Cytological Dysplasia to an Invasive Submucosal Adenocarcinoma

    Science.gov (United States)

    Yoshida, Kanako; Daa, Tsutomu

    2016-01-01

    A sessile serrated adenoma/polyp (SSA/P) with cytological dysplasia in the right colon, which transformed to an invasive submucosal adenocarcinoma finally, was endoscopically observed in a 76-year-old woman. A whitish soft SSA/P (approximately 25 mm in diameter) was detected in the cecum. Biopsy samples were obtained from the small nodule, and the lesion was eventually diagnosed as an SSA/P with cytological dysplasia, considering endoscopic observations, among which the narrow-band imaging features suggested that the lesion was adenomatous, that is, a round-oval pattern, and hyperplastic, that is, comprising a circular pattern with dots and an invisible capillary vessel. After 11 months, an SSA/P had rapidly developed into a submucosal adenocarcinoma with lymphatic infiltrations, and the most aggressive deep invasion was observed in the central depression. This case suggests that right-side SSA/Ps with cytological dysplasia should be removed immediately, considering the potential for rapid progression to a larger size and eventually to deep and extensive cancer. PMID:27437153

  4. Angiotensin-(1-7) treatment mitigates right ventricular fibrosis as a distinctive feature of diabetic cardiomyopathy.

    Science.gov (United States)

    Hao, Pan-Pan; Yang, Jian-Min; Zhang, Ming-Xiang; Zhang, Kai; Chen, Yu-Guo; Zhang, Cheng; Zhang, Yun

    2015-05-01

    In diabetic patients, left ventricular (LV) remodeling is highly prevalent; however, little is known about the impact of diabetes on right ventricular (RV) structure and function. We recently found that overexpression of angiotensin (ANG)-converting enzyme 2 (ACE2), which metabolizes ANG-II to ANG-(1-7) and ANG-I to ANG-(1-9), may improve LV remodeling in diabetic cardiomyopathy (DCM). Here, we aimed to assess whether LV remodeling and dysfunction are paralleled by RV alterations and the effects of ANG-(1-7) on RV remodeling in DCM. After 12 wk of diabetes induced by a single intraperitoneal injection of streptozotocin, rats were treated with saline, ANG-(1-7), perindopril, ANG-(1-7) plus perindopril, ANG-(1-7) plus Mas receptor antagonist A779, or ANG-(1-7) plus ANG-II type 2 receptor antagonist PD123319 for 4 wk. RV remodeling in diabetic rats was indicated by fibrosis of the RV free wall in the absence of hypertrophy and apoptosis. Treatment with ANG-(1-7) prevented diabetes-induced RV fibrosis and dysfunction. ANG-(1-7) (800 ng·kg(-1)·min(-1)) was superior to perindopril in improving RV fibrosis. The major mechanisms involved a complex interaction of ANG-II type 2 and Mas receptors for subsequent downregulation of ACE expression and activity and ANG-II type 1 receptor expression, as well as upregulation of ACE2 expression and activity and the expression of ANG-II type 2 receptor and sarco(endo)plasmic reticulum Ca(2+)-ATPase. Thus RV fibrosis and dysfunction plays a central role in DCM, and ANG-(1-7) mitigates diabetes-induced RV alterations.

  5. Assessment of a single monomorphic ventricular ectopy from the right ventricular outflow tract in standard and high resolution electrocardiogram

    OpenAIRE

    Kozłowski, Dariusz; Kosiński, Adam; Dąbrowska-Kugacka, Alicja; Lewicka-Nowak, Ewa; Dudziak, Maria; Grzybiak, Marek; Raczak, Grzegorz

    2010-01-01

    Introduction High-resolution electrocardiography (ECG-CREM) is a method based on digital electrocardiography. In order to facilitate the interpretation of the Crem records the technique of vectorcardiography was used. In comparison the origin of the ventricular premature complexes (VPCs) could be estimated based on a standard 12-lead electrocardiogram. The aim of the study was to assess the point of origin of the VPCs in ECG-CREM and correlate it with standard electrocardiography (ECG-Stand)....

  6. Pulmonary Artery Dilation and Right Ventricular Function in Acute Kawasaki Disease.

    Science.gov (United States)

    Numano, Fujito; Shimizu, Chisato; Tremoulet, Adriana H; Dyar, Dan; Burns, Jane C; Printz, Beth F

    2016-03-01

    Coronary artery inflammation and aneurysm formation are the most common complications of Kawasaki disease (KD). Valvulitis and myocarditis are also well described and may lead to valvar regurgitation and left ventricular dysfunction. However, functional changes in the right heart have rarely been reported. We noted several acute KD patients with dilated pulmonary arteries (PA) and thus sought to systematically characterize PA size and right-heart function in an unselected cohort of KD patients cared for at a single clinical center. Clinical, laboratory, and echocardiographic data from 143 acute KD subjects were analyzed. PA dilation was documented in 23 subjects (16.1 %); these subjects had higher median right ventricle myocardial performance index (RV MPI), higher ratio of early tricuspid inflow velocity to tricuspid annular early diastolic velocity (TV E/e'), and lower median TV e' velocity compared to the non-PA dilation group (0.50 vs 0.38 p < 0.01, 4.2 vs 3.6 p < 0.05, and 13.5 vs 15.2 cm/s p < 0.01, respectively). Almost all subjects with PA dilation had improved PA Z-score, RV MPI, and TV E/e' in the subacute phase (p < 0.01). There were no significant differences in indices of left ventricle function between PA dilation group and non-PA dilation group. In summary, PA dilation was documented in 16 % of acute KD subjects. These subjects were more likely to have echocardiographic indices consistent with isolated RV dysfunction that improved in the subacute phase. The long-term consequence of these findings will require longitudinal studies of this patient population. PMID:26681305

  7. [Ventricular tachyarrhythmias. A retrospective analysis of etiology, demography and treatment

    DEFF Research Database (Denmark)

    Christensen, A.H.; Henningsen, K.; Svendsen, Jesper Hastrup

    2008-01-01

    INTRODUCTION: The aim of this study was to investigate the age, sex, etiology, frequency of implantable cardioverter-defibrillator (ICD) and previous cardiac arrest among patients discharged from the Department of Cardiology, Rigshospitalet (Copenhagen University Hospital), Denmark, due to...... average age of 59 years (ranging 15-95 years) with a majority of males (76%). Among the patients with known etiology ischemic heart disease (60%), dilated cardiomyopathy (6%) and arrhythmogenic right ventricular cardiomyopathy (6%) were the most frequent. A substantial number of the patients (15%) had...... unknown etiology; 492 (50%) of the patients overall had an ICD implanted, the majority of whom had been categorized as having ventricular tachycardia (92%); 168 patients had previous cardiac arrest, 127 of whom did not have a potential reversible cause. Of this group 75 (59%) had an ICD implanted...

  8. Effects of Cardiac Rehabilitation Program on Right Ventricular Function After Coronary Artery Bypass Graft Surgery

    Directory of Open Access Journals (Sweden)

    Akram Sardari

    2012-03-01

    Full Text Available Background: Cardiac rehabilitation has been recognized as one of the most effective strategies for managing cardiovascular indices as well as controlling the cardiovascular risk profile, in particular after coronary artery bypass graft surgery (CABG. However, the effect of this program on right ventricular function following CABG is unclear. The aim of this study was to evaluate the impact of cardiac rehabilitation on the right ventricular (RV function in a cohort of patients who underwent CABG. Methods: A total of 28 patients who underwent CABG and participated consecutively in an 8-week cardiac rehabilitation program at Tehran Heart Center were studied. The control group consisted of 39 patients who refused to attend cardiac rehabilitation and only received postoperative medical treatment after registration in the Cardiac Rehabilitation Clinic. Two-dimensional and Doppler echocardiography was performed to assess the RV function in both groups at the three time points of before surgery, at the end of surgery, and at the end of the rehabilitation program. Results: Significant increase of RV function parameters were observed in both rehabilitation group (RG and control group (CG at the end of the rehabilitation program compared with post-CABG evaluation in terms of tricuspid annular plane systolic execution (RG: 12.50 mm to 14.18 mm; CG: 13.41 mm to 14.56 mm, tricuspid annular peak systolic velocity (RG: 8.55 cm/s to 9.14 cm/s; CG: 9.03 cm/s to 9.26 cm/s, and tricuspid annular late diastolic velocity (RG: 8.93 cm/s to 9.39 cm/s; CG: 9.26 cm/s to 9.60 cm/s.The parameters of the RV function did improve in both groups, but this improvement was not associated with participation in the complete cardiac rehabilitation program. Conclusion: The RV function parameters gradually improved after CABG; this progress, however, was independent of the exercise-based cardiac rehabilitation program.

  9. Genetic influences on right ventricular systolic pressure (RVSP in chronic obstructive pulmonary disease (COPD

    Directory of Open Access Journals (Sweden)

    Shaw Janet G

    2012-06-01

    Full Text Available Abstract Background Pulmonary hypertension (PH is a complication of chronic obstructive pulmonary disease (COPD. This study examined genetic variations in mediators of vascular remodelling and their association with PH in patients with COPD. In patients with COPD, we genotyped 7 SNPs in 6 candidate PH genes (NOS3, ACE, EDN1, PTGIS, SLC6A4, VEGFA. We tested for association with right ventricular systolic pressure (RVSP, spirometry and gas transfer, and hypoxemia. Methods In patients with COPD, we genotyped 7 SNPs in 6 candidate PH genes (NOS3, ACE, EDN1, PTGIS, SLC6A4, VEGFA. We tested for association with right ventricular systolic pressure (RVSP, spirometry and gas transfer, and hypoxemia. Results 580 COPD patients were recruited, 341 patients had a transthoracic echocardiogram, with RVSP measurable in 278 patients (mean age 69 years, mean FEV1 50% predicted, mean RVSP 44 mmHg, median history of 50 pack-years. Of the 7 tested SNPs, the NOS3-VNTR polymorphism was significantly associated with RVSP in a dose-dependent fashion for the risk allele: mean RVSP for a/a and a/b genotypes were 52.0 and 46.6 mmHg respectively, compared to 43.2 mmHg for b/b genotypes (P = 0.032. No associations were found between RVSP and other polymorphisms. ACE II or ID genotypes were associated with a lower FEV1% predicted than the ACE DD genotype (P = 0.028. The NOS3-298 TT genotype was associated with lower KCO % predicted than the NOS3-298 GG or GT genotype (P = 0.031. Conclusions The NOS3-VNTR polymorphism was associated with RVSP in patients with COPD, supporting its involvement in the pathogenesis of PH in COPD. ACE and NOS3 genotypes were associated with COPD disease severity, but not with the presence of PH. Further study of these genes could lead to the development of prognostic and screening tools for PH in COPD.

  10. Related research between right ventricular dysfunction and pulmonary embolism range of the patients with acute pulmonary thromboembolism

    International Nuclear Information System (INIS)

    Objective: The presence of right ventrieular dysfunction (RVD) increases morbidity and mortality of the patient with pulmonary thromboembolism (PTE). The aims of this study were to evaluate the relation between RVD on echocardiography and pulmonary embolism range on radionuclide palmonary ventilation-perfusion (V/Q) scan of the patients with acute PTE, and to discuss the diagnostic feasibility of RVD by pulmonary embolism range. Methods: All 348 patients with proven PTE were classified as two groups according to the echocardiography diagnosis. Two hundreds and twelve were with RVD and 136 were with normal right ventricular function (N-RVF). All underwent pulmonary V/Q imping.Statistical analysis was performed with SPSS 11.5, and the relation between RVD and pulmonary embolism range was performed with χ2 analysis, correlation analysis, receiver operating characteristic (ROC) curve analysis. Results: Signiticant relations between RVD (right/left ventricular end-diastolic diameter ratio (RVD/LVD)=0.52 ± 0.22. right/left ventricular transverse diameter ratio (RVTD/LVTD) =0.88 ± 0.26, tricuspid regurgitant pressure gradient (TRPG) = (31.93 ± 21.79) nun Hg (1 mm Hg = 0.133 kPa) and right ventricular anterior wall moilon (RVAWM) = (5.77 ± 1.99) mm) and pulmonary embolism range (1 ∼ 36, 11.4 ± 7.1) RVF and RVD and larger embolism range in RVD than in N-RVF (χ2=445.93, P2.58, P<0.01. Conclusion: The pulmonary embolism area waft negatively correlated with the RVD and had potential of being one of the references for the impression of RVD in PTE patients. (authors)

  11. Current status of percutaneous right ventricular assist devices: First-in-man use of a novel dual lumen cannula.

    Science.gov (United States)

    Aggarwal, Vikas; Einhorn, Bryce N; Cohen, Howard A

    2016-09-01

    Ventricular assist devices have become an accepted therapeutic solution for patients with severe left ventricular dysfunction when pharmacology fails to maintain sufficient cardiac output. Despite various technologies that have allowed left ventricular assist devices to become more reliable and versatile in the past decade, comparatively little attention has been applied to right heart assistance which is still in the early stage of its development. The extracorporeal devices developed thus far have been associated with mobility issues and complications common to ventricular assist devices in general, such as infection, bleeding, and thromboembolism. Designed to obviate the problems previously experienced by other right ventricle (RV)-focused devices, the Protek Duo (CardiacAssist, Pittsburgh, PA) is a novel, fully percutaneous, dual lumen cannula for RV support used in conjunction with the paracorporeal TandemHeart(®) (CardiacAssist, Pittsburgh, PA) pump. We describe our initial experience with the Protek Duo cannula in two different clinical scenarios. In addition, we summarize the current percutaneous mechanical support technology for RV assistance and propose modification of current technology to facilitate its application. © 2016 Wiley Periodicals, Inc.

  12. Changes in Right Ventricular Dysfunction After Balloon Pulmonary Angioplasty in Patients With Chronic Thromboembolic Pulmonary Hypertension.

    Science.gov (United States)

    Tsugu, Toshimitsu; Murata, Mitsushige; Kawakami, Takashi; Minakata, Yugo; Kanazawa, Hideaki; Kataoka, Masaharu; Endoh, Jin; Tsuruta, Hikaru; Itabashi, Yuji; Maekawa, Yuichiro; Abe, Takayuki; Fukuda, Keiichi

    2016-10-01

    The aim was to investigate the effect of balloon pulmonary angioplasty (BPA) on right ventricular (RV) function in chronic thromboembolic pulmonary hypertension. Twenty-six patients with chronic thromboembolic pulmonary hypertension were enrolled and were divided into 2 groups, group H with high (>30 mm Hg) mean pulmonary arterial pressure and group L with low (25 to 30 mm Hg) mean pulmonary arterial pressure. RV function was assessed using 2-dimensional speckle-tracking echocardiography as well as 3-dimensional echocardiography, and RV dyssynchrony was assessed by the RV strain curves. Exercise capacity was evaluated by the 6-minute walk distance. RV dilatation was significantly reduced after BPA. In group H, RV ejection fraction, RV free wall longitudinal strain and RV dyssynchrony were all impaired before BPA and were ameliorated after BPA. In group L, RV ejection fraction as well as RV dyssynchrony were impaired without the reduction of RV free wall longitudinal strain and were improved after BPA, indicating that RV dysfunction may be attributable to the RV dyssynchrony in group L. Furthermore, RV dyssynchrony at baseline was the only parameter that was correlated with improvement in the 6-minute walk distance after BPA. RV dyssynchrony may affect RV function and could be the useful parameter for clinical outcome after BPA. PMID:27530827

  13. Repeatability of cardiac-MRI-measured right ventricular size and function in congenital heart disease

    Energy Technology Data Exchange (ETDEWEB)

    Walsh, Rowan; Salem, Yishay [Mount Sinai School of Medicine, Division of Pediatric Cardiology, New York, NY (United States); Shah, Amee; Lai, Wyman W. [Morgan Stanley Children' s Hospital of New York Presbyterian, New York, NY (United States); Nielsen, James C. [Mount Sinai School of Medicine, Division of Pediatric Cardiology, New York, NY (United States); Mount Sinai Children' s Heart Center, Box 1201, New York, NY (United States)

    2011-08-15

    The measurement error for right ventricular (RV) size and function assessed by cardiac MRI (CMRI) in congenital heart disease has not been fully characterized. As CMRI parameters are being increasingly utilized to make clinical decisions, defining error in the clinical setting is critical. This investigation examines the repeatability of CMRI for RV size and function. Forty consecutive people with congenital heart disease involving the RV were retrospectively identified. Contouring of RV volumes was performed by two expert CMRI clinicians. The coefficient of variability and repeatability coefficients were calculated. Repeatability coefficients were multiplied by the mean value for each group studied to define a threshold beyond which measurement error was unlikely to be responsible. The variability for indexed RV end-diastolic volume = 3.2% and 3.3% for intra- and interobserver comparisons, respectively. The repeatability coefficients were 13.2% and 14.9% for intra- and interobserver comparisons, which yielded threshold values of 15.1 ml/m{sup 2} and 20.2 ml/m{sup 2}, respectively. For RV ejection fraction (EF), the repeatability coefficients for intra- and interobserver comparisons were 5.0% and 6.0%, which resulted in threshold values of 2.6 EF% and 3.0 EF%. The threshold values generated can be used during serial assessment of RV size and function. (orig.)

  14. Pacing the right ventricular outflow tract septum: time to embrace the future.

    Science.gov (United States)

    Hillock, Richard J; Mond, Harry G

    2012-01-01

    Transvenous pacing has revolutionized the management of patients with potentially life-threatening bradycardias and at its most basic level ensures rate support to maintain cardiac output. However, we have known for at least a decade that pacing from the right ventricle (RV) apex can induce left ventricle (LV) dysfunction, atrial fibrillation, heart failure, and maybe an increased mortality. Although pacemaker manufacturers have developed successful pacing algorithms designed to minimize unnecessary ventricular pacing, it cannot be avoided in a substantial proportion of pacemaker-dependent patients. Just as there is undoubted evidence that RV apical pacing is injurious, there is emerging evidence that pacing from the RV septum is associated with a shorter duration of activation, improved haemodynamics, and less LV remodelling. The move from traditional RV apical pacing to RV septal pacing requires a change in mindset for many practitioners. The anatomical landmarks and electrocardiograph features of RV septal pacing are well described and easily recognized. While active fixation is required to place the lead on the septum, shaped stylets are now available to assist the implanter. In addition, concerns about the stability and longevity of steroid-eluting active fixation leads have proven to be unfounded. We therefore encourage all implanters to adopt RV septal pacing to minimize the potential of harm to their patients. PMID:21846639

  15. Label-free quantitative proteomic analysis of right ventricular remodeling in infant Tetralogy of Fallot patients.

    Science.gov (United States)

    Xia, Yu; Hong, Haifa; Ye, Lincai; Wang, Yanlin; Chen, Huiwen; Liu, Jinfen

    2013-06-12

    Tetralogy of Fallot (TOF) results in chronic progressive right ventricular (RV) pressure overload and shunt hypoxemia. We investigated the global changes in the proteome of RV among infant patients with and without TOF to gain an insight into early RV remodeling. One hundred and thirty-six differentially expressed proteins were identified using label-free LC-ESI-MS/MS analysis. Western blot results revealed that the expression of 6-phosphofructo-2-kinase/fructose-2,6-biphosphatase 2 (PFKFB2) increased significantly in TOF patients; and levels of lysocardiolipin acyltransferase 1 (LCLAT1), lumican (LUM), and versican (VCAN) decreased significantly. QRT-PCR analysis showed that levels of PFKFB2 mRNA were markedly increased, but those of LCLAT1 and LUM were significantly decreased. VCAN mRNA showed no significant change in response to pathophysiology of TOF. The results of immunohistochemical staining were similar to those of Western blot analysis. Results of the proteomic analysis indicated that the level of glycolysis-related proteins had increased and levels of lipid-metabolism-related proteins had decreased. ECM proteins were found to be more down-regulated in TOF in the present study than in previous reports. Taken together, our findings may provide clues to both the metabolic inflexibility and ECM remodeling during the early RV remodeling, which occur in response to chronic hypoxia and long-term pressure overload in TOF patients. PMID:23571024

  16. Clinical Profile and Prognosis of Patients with Right Ventricular Dilated Cardiomyopathy: Results of a Prospective Study

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    Ya.R. Akhmatov

    2015-12-01

    Full Text Available The aim of our study was to investigate the clinical prevalence of dilated cardiomyopathy (DCM with predominantly failure of the right-side heart (right ventricular DCM, RV-DCM, and features of the clinical course and prognosis of the disease compared to DCM with biventricular heart failure (BV-HF. The study design suggests a prospective observation of 300 patients with idiopathic DCM between 2000 and 2012. Herewith, we followed the criteria of the WHO/ISFC Task Force (1995 on the Definationa and Classification of Cardiomyopathies. All patients underwent a comprehensive examination. Two groups were formed for further comparative analysis. Group 1 included 22 patients (mean age 42.9±14.3 years, male/female 5/17 with RV-DCM. Group 2 included 38 patients (mean age 43.6±13.8, male/female 29/9 with DCM and BV-HF. The groups were matched for age, sex, NYHA class II-III, and disease duration. According to our aim, we studied 5-year survival prognosis and analyzed the incidence and causes of deaths, as well as the occurrence of nonfatal complications of the disease. Medical therapy for DCM patients was performed according to the CHF therapy guidelines (ACC/AHA 2001, 2005. The results of our investigations during many years of research have shown that the clinical incidence of RV-DCM was 7.3% among all forms of DCM. The study of life prognosis in patients with 2 forms of DCM showed that 5-year mortality of patients was about 50%. Herewith, we detected the differences in causes of death depending on the type of heart damage, primarily development of fatal pulmonary embolism.

  17. QUANTIFICATION OF RIGHT VENTRICULAR FUNCTION IN ATRIAL SEPTAL DEFECT USING ULTRASOUND-BASED STRAIN RATE IMAGING

    Institute of Scientific and Technical Information of China (English)

    MENG Xiang-chun; SUN Kun; ZHANG Yu-qi; HUANG Mei-rong; GAO Wei; ZHANG Zhi-fang; SHEN Rong; CHEN Shu-bao

    2005-01-01

    Objective To study the validation of ultrasound-based strain rate imaging in the quantitative assessment of right ventricular (RV) function in atrial septal defect (ASD). Methods Tissue Doppler images (TDI) of RV longitudinal and short axes were recorded from the apical 4-chamber view and the subcostal short-axis view in 18 normal controls, 28 children with ASD and 14 children after Amplazter closure of ASD respectively. Peak systolic velocities (V), peak systolic strain rates (SR), peak systolic strains (S) at the basal segment, middle segment of RV lateral wall and the basal septum from the longitudinal axis, the middle segment of RV free wall from the short axis were quantitatively measured using QLAB TM tissue velocity quantification software system respectively. Peak dp/dt from the RV isovolumic contraction determined during the right cardiac catheterization in 28 ASD patients was used as the gold standard of RV contractility. Peak systolic indices were compared against max dp/dt by linear correlation. Results Peak systolic indices at the basal and middle segments of RV lateral wall from the longitudinal axis increased significantly in 28 ASD patients.Peak systolic indices at the basal septum also increased in patient group, but not significantly. Significant decreases in peak systolic indices at the basal and middle segments of RV lateral wall were observed after the Amplatzer closure in 14 ASD patients. There was no significant difference at the middle segment of RV free wall from the short axis between patient group and normal control. A strong correlation was found between max dp/dt and peak systolic indices at the basal and middle segments of RV lateral wall (P<0.05). Conclusion Ultrasound-based strain rate imaging can assess quantitatively RV function in CHD. Peak systolic strains determined at the basal and middle segments of RV lateral wall are strong noninvasive indices of RV contractility.

  18. Interstudy repeatability of left and right ventricular volume estimations by serial-gated tomographic radionuclide angiographies using a cadmium-zinc-telluride detector gamma camera

    DEFF Research Database (Denmark)

    Jensen, Maria M; Haase, Christine; Zerahn, Bo

    2015-01-01

    PURPOSE: Estimation of left ventricular ejection fraction (LVEF) with 99MTc-HSA equilibrium radionuclide angiography (RA) is frequently used for assessing cardiac function. The purpose of this study was to investigate the interstudy repeatability of left (LV) and right (RV) ventricular volume...

  19. Right ventricular ejection fraction in patients with acute myocardial infarction assessed by 81m-krypton perfusion. Correlations with left ventricular ejection fraction as a function of myocardial infarction localization

    International Nuclear Information System (INIS)

    The right ventricular ejection fraction has been measured from right anterior oblique (R.A.O. 300). Immediatly after this measurement, the left ventricular ejection fraction (L.V.E.F.) has been determined from left anterior oblique (L.A.O.) with 99m-technetium labelled red cells. In 16 normal controls, R.V.E.F. averaged 38+-6,7%. In 24 anterior M.I., R.V.E.F. was normal (43,4+-9,5%). In 33 acute inferior M.I., R.V.E.F. was 35+-8,4%. Among 5 of 33 inferior M.I. patients with right ventricular infarction, R.V.E.F. was reduced (14,6+-4,7%; p-3 V.S. normal and V.S. inferior M.I. without right ventricular involvement). In the latter group, R.V.E.F. averaged 38,6+-8,9% (N.S.V.S. normals). To conclude, this study shows: (1) The use of intraveinous 81 m-krypton allows measuring R.V.E.F. from R.A.O.: this angle brings out the best separation between the right atrium and the right ventricular with no intrusion of a superimposed left ventricle, since 81 m-krypton is expelled at the first lung wash out. (2) R.V.E.F. is well preserved except when inferior infarction involves the right ventricle

  20. Right ventricular electrical and mechanical synchronization by properly timed septal pacing in a patient with right bundle branch block and first degree AV block--a case report.

    Science.gov (United States)

    Siliste, Calin; Suran, Maria-Claudia-Berenice; Margulescu, Andrei-Dumitru; Vinereanu, Dragos

    2015-03-01

    We present a case of near-normalization of the QRS by septal pacing in a patient with dual-chamber pacemaker and underlying complete right bundle branch block and first degree atrioventricular block. The right ventricular mechanical synchronization suggested by the ECG was validated as such by strain echo. To the best of our knowledge, this is the first time it has been shown that the narrowing of the QRS corresponds to mechanical synchronization in a case of this seldom-recognized phenomenon.

  1. Right ventricular function quantification in Takotsubo cardiomyopathy using two-dimensional strain echocardiography.

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    Felix Heggemann

    Full Text Available AIMS: This study sought to characterize global and regional right ventricular (RV myocardial function in patients with Takotsubo cardiomyopathy (TC using 2D strain imaging. METHODS: We compared various parameters of RV and left ventricular (LV systolic function between 2 groups of consecutive patients with TC at initial presentation and upon follow-up. Group 1 had RV involvement and group 2 did not have RV involvement. RESULTS: At initial presentation, RV peak systolic longitudinal strain (RVPSS and RV fractional area change (RVFAC were significantly lower in group 1 (-13.2±8.6% vs. -21.8±5.4%, p = 0.001; 30.7±9.3% vs. 43.5±6.3%, p = 0.001 and improved significantly upon follow-up. Tricuspid annular plane systolic excursion (TAPSE did not differ significantly at initial presentation between both groups (14.8±4.1 mm vs. 17.9±3.5 mm, p = 0.050. Differences in regional systolic RV strain were only observed in the mid and apical segments. LV ejection fraction (LVEF and LV global strain were significantly lower in group 1 (36±8% vs. 46±10%, p = 0.006 and -5.5±4.8% vs. -10.2±6.2%, p = 0.040 at initial presentation. None of the parameters were significantly different between the 2 groups upon follow-up. A RVPSS cut-off value of >-19.1% had a sensitivity of 85% and a specificity of 71% to discriminate between the 2 groups. CONCLUSION: In TC, RVFAC, RVPSS, LVEF and LV global strain differed significantly between patients with and without RV dysfunction, whereas TAPSE did not. 2 D strain imaging was feasible for the assessment of RV dysfunction in TC and could discriminate between patients with and without RV involvement in a clinically meaningful way.

  2. Efeitos hemodinâmicos da sobrecarga ventricular direita aguda experimental Efectos hemodinámicos de la sobrecarga ventricular derecha aguda experimental Hemodynamic effects of experimental acute right ventricular overload

    Directory of Open Access Journals (Sweden)

    Flávio Brito Filho

    2011-04-01

    el estudio, siendo divididos en 4 grupos: uno control, no sometido a la oclusión vascular pulmonar, y tres de sobrecarga ventricular derecha sometidos a la oclusión de las siguientes arterias pulmonares: SVD1 (arteria pulmonar izquierda; SVD2 (arteria pulmonar izquierda y del lóbulo inferior derecho y SVD3 (arteria pulmonar izquierda, del lóbulo inferior derecho y del lóbulo mediastinal, obstruyendo la vasculatura pulmonar en 42, 76 y 82,0% respectivamente. Variables de hemodinámica fueron medidas cada 15 minutos durante una hora del estudio. En el análisis estadístico, fueron utilizados ajustes de modelos lineares mixtos con estructura de variancias y covariancias. RESULTADOS:En las comparaciones intergrupales, hubo aumento significativo de la frecuencia cardíaca (p = 0,004, presión arterial pulmonar media (p = 0,001 y presión capilar pulmonar (p BACKGROUND: Acute right ventricular overload is associated with high morbidity and mortality clinical situations such as: extensive lung resection, pulmonary thromboembolism, lung transplantation and high altitude pulmonary edema. Some points of its pathophysiology remain unclear. OBJECTIVE: To assess the hemodynamic effects of experimental acute right ventricular overload in pigs. METHODS: Right ventricular overload was induced through the occlusion of the pulmonary arteries using ligationss. Twenty pigs were used in the study, divided into 04 groups: one control group not subject to pulmonary vascular occlusion, and three right ventricular overload groups subject to occlusion of the following pulmonary arteries: SVD1 (left pulmonary artery; SVD2 (left pulmonary artery and right lower lobe and SVD3 (left pulmonary artery, right lower lobe and mediastinal lobe, obstructing the pulmonary vasculature in 42, 76 and 82.0% respectively. Hemodynamic variables were measured every 15 minutes during one hour of study. The statistical analysis employed mixed linear models with variance and covariance structures. RESULTS

  3. Impact of untreated obstructive sleep apnea on left and right ventricular myocardial function and effects of CPAP therapy.

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    Christoph Hammerstingl

    Full Text Available BACKGROUND: Obstructive sleep apnea (OSA has deteriorating effect on LV function, whereas its impact on RV function is controversial. We aimed to determine the effect of OSA and continuous positive airway pressure (CPAP treatment on left and right ventricular (LV, RV function using transthoracic echocardiography (TTE and 2 dimensional speckle tracking (2D ST analysis of RV deformation capability. METHODS AND RESULTS: 82 patients with OSA and need for CPAP therapy were prospectively enrolled and underwent TTE at study inclusion and after 6 months of follow up (FU. Multivariate regression analysis revealed an independent association between baseline apical right ventricular longitudinal strain (RV-Sl, BMI and the severity of OSA (apical RV-Sl: P = 0.0002, BMI: P = 0.02. After CPAP therapy, LV functional parameters (LVEF: P30:54.1 ± 12.4%, 68.2 ± 13.6%[P30: -6.3 ± 5.7%, -17.9 ± 11.2% [P<0.0001]. CONCLUSIONS: OSA seems to have deteriorating effect on LV and RV function. We found a beneficial effect of CPAP on LV and RV functional parameters predominately in patients with severe OSA. 2D speckle tracking might be of value to determine early changes in global and regional right ventricular function.

  4. Effects of chronic severe pulmonary regurgitation and percutaneous valve repair on right ventricular geometry and contractility assessed by tissue Doppler echocardiography

    DEFF Research Database (Denmark)

    Kjaergaard, Jesper; Iversen, Kasper K; Vejlstrup, Niels G;

    2010-01-01

    Pulmonary regurgitation (PR) following repair of right ventricular (RV) outflow obstruction is related to slowly progressive RV dilatation and heart failure and will eventually require surgical intervention, but optimal timing of pulmonary valve replacement is challenging. Tissue Doppler based...

  5. Temporary epicardial cardiac resynchronisation versus conventional right ventricular pacing after cardiac surgery: study protocol for a randomised control trial

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    Russell Stuart J

    2012-02-01

    Full Text Available Abstract Background Heart failure patients with stable angina, acute coronary syndromes and valvular heart disease may benefit from revascularisation and/or valve surgery. However, the mortality rate is increased- 5-30%. Biventricular pacing using temporary epicardial wires after surgery is a potential mechanism to improve cardiac function and clinical endpoints. Method/design A multi-centred, prospective, randomised, single-blinded, intervention-control trial of temporary biventricular pacing versus standard pacing. Patients with ischaemic cardiomyopathy, valvular heart disease or both, an ejection fraction ≤ 35% and a conventional indication for cardiac surgery will be recruited from 2 cardiac centres. Baseline investigations will include: an electrocardiogram to confirm sinus rhythm and measure QRS duration; echocardiogram to evaluate left ventricular function and markers of mechanical dyssynchrony; dobutamine echocardiogram for viability and blood tests for renal function and biomarkers of myocardial injury- troponin T and brain naturetic peptide. Blood tests will be repeated at 18, 48 and 72 hours. The principal exclusions will be subjects with permanent atrial arrhythmias, permanent pacemakers, infective endocarditis or end-stage renal disease. After surgery, temporary pacing wires will be attached to the postero-lateral wall of the left ventricle, the right atrium and right ventricle and connected to a triple chamber temporary pacemaker. Subjects will be randomised to receive either temporary biventricular pacing or standard pacing (atrial inhibited pacing or atrial-synchronous right ventricular pacing for 48 hours. The primary endpoint will be the duration of level 3 care. In brief, this is the requirement for invasive ventilation, multi-organ support or more than one inotrope/vasoconstrictor. Haemodynamic studies will be performed at baseline, 6, 18 and 24 hours after surgery using a pulmonary arterial catheter. Measurements will be

  6. Anatomical Closure of Left-to-Right Shunts in Premature Infants with Bronchopulmonary Dysplasia and Pulmonary Hypertension: A Cautionary Tale

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    Narendra R. Dereddy

    2015-10-01

    Full Text Available Closure of a systemic to pulmonary shunt in premature infants with bronchopulmonary dysplasia may be beneficial, but in the presence of pulmonary hypertension is controversial. Here, we discuss two premature infants with pulmonary hypertension who developed acute pulmonary hypertensive crisis after closure of these shunts and hence advise caution.

  7. Anatomical Closure of Left-to-Right Shunts in Premature Infants with Bronchopulmonary Dysplasia and Pulmonary Hypertension: A Cautionary Tale

    OpenAIRE

    Dereddy, Narendra R.; Chilakala, Sandeep R.; Divya Rana

    2015-01-01

    Closure of a systemic to pulmonary shunt in premature infants with bronchopulmonary dysplasia may be beneficial, but in the presence of pulmonary hypertension is controversial. Here, we discuss two premature infants with pulmonary hypertension who developed acute pulmonary hypertensive crisis after closure of these shunts and hence advise caution.

  8. Evaluation of Right Ventricular Volume and Systolic Function by Real-time Three-dimensional Echocardiography

    Institute of Scientific and Technical Information of China (English)

    WANG Jing; WANG Xinfang; XIE Mingxing; YANG Ya; LV Qing; YANG Ying; WANG Liangyu

    2005-01-01

    The optimal plane for measurement of the right ventricular (RV) volumes by real-time three-dimensional echocardiography (RT3DE) was determined and the feasibility and accuracy of RT3DE in studying RV systolic function was assessed. RV "Full volume" images were acquired by RT3DE in 22 healthy subjects. RV end-diastolic volumes (RVEDV) and end-systolic volumes (RVESV) were outlined using apical biplane, 4-plane, 8-plane, 16-plane offline separately. RVSV and RVEF were calculated. Meanwhile tricuspid annual systolic excursion (TASE) was measured by M-mode echo. LVSV was outlined by 2-D echo according to the biplane Simpsons rule. The results showed: (1) There was a good correlation between RVSV measured from series planes and LVSV from 2-D echo (r=0.73; r=0.69; r=0.63; r=0.66, P<0.25-0. 0025); (2) There were significant differences between RVEDV in biplane and those in 4-, 8-, 16-plane (P<0. 001). There was also difference between RV volume in 4-plane and that in 8-plane (P<0.05), but there was no significant difference between RV volume in 8-plane and that in 16-plane (P>0.05); (3) Inter-observers and intro-observers variability analysis showed that there were close agreements and relations for RV volumes (r=0. 986, P<0. 001; r=0.93, P<0. 001); (4) There was a significantly positive correlation of TASE to RVSV and RVEF from RT3DE (r=0.83; r=0.90). So RV volume measures with RT3DE are rapid, accurate and reproducible. In view of RVs complex shape,apical 8-plane method is better in clinical use. It may allow early detection of RV systolic function.

  9. Protein Changes Contributing to Right Ventricular Cardiomyocyte Diastolic Dysfunction in Pulmonary Arterial Hypertension

    Science.gov (United States)

    Rain, Silvia; Bos, Denielli da Silva Goncalves; Handoko, M. Louis; Westerhof, Nico; Stienen, Ger; Ottenheijm, Coen; Goebel, Max; Dorfmüller, Peter; Guignabert, Christophe; Humbert, Marc; Bogaard, Harm‐Jan; dos Remedios, Cris; Saripalli, Chandra; Hidalgo, Carlos G.; Granzier, Henk L.; Vonk‐Noordegraaf, Anton; van der Velden, Jolanda; de Man, Frances S.

    2014-01-01

    Background Right ventricular (RV) diastolic function is impaired in patients with pulmonary arterial hypertension (PAH). Our previous study showed that elevated cardiomyocyte stiffness and myofilament Ca2+ sensitivity underlie diastolic dysfunction in PAH. This study investigates protein modifications contributing to cellular diastolic dysfunction in PAH. Methods and Results RV samples from PAH patients undergoing heart‐lung transplantation were compared to non‐failing donors (Don). Titin stiffness contribution to RV diastolic dysfunction was determined by Western‐blot analyses using antibodies to protein‐kinase‐A (PKA), Cα (PKCα) and Ca2+/calmoduling‐dependent‐kinase (CamKIIδ) titin and phospholamban (PLN) phosphorylation sites: N2B (Ser469), PEVK (Ser170 and Ser26), and PLN (Thr17), respectively. PKA and PKCα sites were significantly less phosphorylated in PAH compared with donors (P<0.0001). To test the functional relevance of PKA‐, PKCα‐, and CamKIIδ‐mediated titin phosphorylation, we measured the stiffness of single RV cardiomyocytes before and after kinase incubation. PKA significantly decreased PAH RV cardiomyocyte diastolic stiffness, PKCα further increased stiffness while CamKIIδ had no major effect. CamKIIδ activation was determined indirectly by measuring PLN Thr17phosphorylation level. No significant changes were found between the groups. Myofilament Ca2+ sensitivity is mediated by sarcomeric troponin I (cTnI) phosphorylation. We observed increased unphosphorylated cTnI in PAH compared with donors (P<0.05) and reduced PKA‐mediated cTnI phosphorylation (Ser22/23) (P<0.001). Finally, alterations in Ca2+‐handling proteins contribute to RV diastolic dysfunction due to insufficient diastolic Ca2+ clearance. PAH SERCA2a levels and PLN phosphorylation were significantly reduced compared with donors (P<0.05). Conclusions Increased titin stiffness, reduced cTnI phosphorylation, and altered levels of phosphorylation of Ca2

  10. Impact of endoscopic lung volume reduction on right ventricular myocardial function.

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    Carmen Pizarro

    Full Text Available Endoscopic lung volume reduction (ELVR provides a minimally invasive therapy for patients with severe lung emphysema. As its impact on right ventricular (RtV function is undefined, we examined the extent of RtV functional changes following ELVR, as assessed by use of speckle tracking-based RtV deformation analysis.We enrolled 32 patients with severe emphysematous COPD scheduled for bronchoscopic LVR using endobronchial valves (Zephyr, PulmonX, Inc., comprising 16 matched clinical responders and 16 non-responders. Echocardiography was conducted one day prior to ELVR and at an eight-week postprocedural interval.Patients were predominantly of late middle-age (65.8 ± 8.7 yrs, male (62.5% and presented advanced COPD emphysema (means FEV1 and RV: 32.6% and 239.1% of predicted, respectively. After ELVR, RtV apical longitudinal strain improved significantly in the total study cohort (-7.96 ± 7.02% vs. -13.35 ± 11.48%, p = 0.04, whereas there were no significant changes in other parameters of RtV function such as RtV global longitudinal strain, TAPSE or pulmonary arterial systolic pressure. In responding patients, 6MWT-improvement correlated with a decrease in NT-proBNP (Pearson´s r: -0.53, p = 0.03. However, clinical non-responders did not exhibit any RtV functional improvement.ELVR beneficially impacts RtV functional parameters. Speckle tracking-based RtV apical longitudinal strain analysis allows early determination of RtV contractile gain and identification of clinical responsiveness.

  11. Effects of combined deferiprone with deferoxamine on right ventricular function in thalassaemia major

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    Alpendurada Francisco

    2012-01-01

    Full Text Available Abstract Background Combination therapy with deferoxamine and oral deferiprone is superior to deferoxamine alone in removing cardiac iron and improving left ventricular ejection fraction (LVEF. The right ventricle (RV is also affected by the toxic effects of iron and may cause additional cardiovascular perturbation. We assessed the effects of combination therapy on the RV in thalassaemia major (TM using cardiovascular magnetic resonance (CMR. Methods We retrieved imaging data from 2 treatment trials and re-analyzed the data for the RV responses: Trial 1 was a randomized controlled trial (RCT of 65 TM patients with mild-moderate cardiac siderosis receiving combination therapy or deferoxamine with placebo; Trial 2 was an open label longitudinal trial assessing combination therapy in 15 TM patients with severe iron loading. Results In the RCT, combination therapy with deferoxamine and deferiprone was superior to deferoxamine alone for improving RVEF (3.6 vs 0.7%, p = 0.02. The increase in RVEF was greater with lower baseline T2* 8-12 ms (4.7 vs 0.5%, p = 0.01 than with T2* 12-20 ms (2.2 vs 0.8%, p = 0.47. In patients with severe cardiac siderosis, substantial improvement in RVEF was seen with open-label combination therapy (10.5% ± 5.6%, p Conclusions In the RCT of mild to moderate cardiac iron loading, combination treatment improved RV function significantly more than deferoxamine alone. Combination treatment also improved RV function in severe cardiac siderosis. Therefore adding deferiprone to deferoxamine has beneficial effects on both RV and LV function in TM patients with cardiac siderosis.

  12. Patients' and physicians' needs, experiences and preferences in the treatment of right ventricular outflow tract dysfunction

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    Luciana Scalone

    2012-06-01

    Full Text Available

    Background: patients with congenital heart defects, developing right ventricular outflow tract (rVoT dysfunction, can face repeated open chest interventions over their lifetime. repeating surgery increases difficulties and procedural risks, and exposes patients to burdensome and long recovery times that may induce them to postpone the treatment, with possible severe and irreversible consequences for their health. The percutaneous procedure was introduced to delay the need for open chest surgery. uncertainties still exist regarding the lifelong consequences that may result from adopting different treatment strategies. current decisions on treatment depend on patients’ clinical needs, but also on physicians’ experience and opinion, patients’ preferences, and procedural costs. The objective is to identify which treatment characteristics influence decisions on how to treat patients with rVoT dysfunction.

    Methods: a literature review was conducted, followed by a discussion with a panel of experts. Ten treatment characteristics, potentially relevant for treatment, were identified and rated in a survey, according to the importance assigned to each characteristic by specialist physicians, patients and/or their caregivers.

    Results: while some characteristics appear to be more important (risk of severe complications associated with intervention delays or less important (scar to both physicians and patients/caregivers, other characteristics are rated differently in importance depending on subjects consulted, e.g., risk of complications during the months post intervention was among the most important characteristics for patients/caregivers, but the fifth most important characteristic for physicians.

    Conclusions: to optimize benefits and efficiency of the treatment strategies, perceptions and opinions from the different subjects involved, together with patients

  13. Lead reduces tension development and the myosin ATPase activity of the rat right ventricular myocardium

    Directory of Open Access Journals (Sweden)

    D.V. Vassallo

    2008-09-01

    Full Text Available Lead (Pb2+ poisoning causes hypertension, but little is known regarding its acute effects on cardiac contractility. To evaluate these effects, force was measured in right ventricular strips that were contracting isometrically in 45 male Wistar rats (250-300 g before and after the addition of increasing concentrations of lead acetate (3, 7, 10, 30, 70, 100, and 300 µM to the bath. Changes in rate of stimulation (0.1-1.5 Hz, relative potentiation after pauses of 15, 30, and 60 s, effect of Ca2+ concentration (0.62, 1.25, and 2.5 mM, and the effect of isoproterenol (20 ng/mL were determined before and after the addition of 100 µM Pb2+. Effects on contractile proteins were evaluated after caffeine treatment using tetanic stimulation (10 Hz and measuring the activity of the myosin ATPase. Pb2+ produced concentration-dependent force reduction, significant at concentrations greater than 30 µM. The force developed in response to increasing rates of stimulation became smaller at 0.5 and 0.8 Hz. Relative potentiation increased after 100 µM Pb2+ treatment. Extracellular Ca2+ increment and isoproterenol administration increased force development but after 100 µM Pb2+ treatment the force was significantly reduced suggesting an effect of the metal on the sarcolemmal Ca2+ influx. Concentration of 100 µM Pb2+ also reduced the peak and plateau force of tetanic contractions and reduced the activity of the myosin ATPase. Results showed that acute Pb2+ administration, although not affecting the sarcoplasmic reticulum activity, produces a concentration-dependent negative inotropic effect and reduces myosin ATPase activity. Results suggest that acute lead administration reduced myocardial contractility by reducing sarcolemmal calcium influx and the myosin ATPase activity. These results also suggest that lead exposure is hazardous and has toxicological consequences affecting cardiac muscle.

  14. Analysis of right ventricular kinesis by means of transesophageal echocardiography: present problems and perspectives.

    Science.gov (United States)

    Kozàkovà, M; Palombo, C; Benanti, C; L'Abbate, A; Distante, A

    1994-03-01

    The evaluation of right ventricular (RV) kinesis by two-dimensional echocardiography represents a difficult task. Transthoracic echocardiography can visualize the RV in several projections, but the image quality and the variability of imaging views usually do not allow quantitative analysis. We investigated the potential of transesophageal echocardiography (TEE) for evaluating RV global function and regional kinesis, in 32 controls and in 16 patients with inferior myocardial infarction (MI) and asynergy involving the inferior wall of both ventricles. Good-quality images of at least one horizontal section of the RV were obtained in 73% of subjects by conventional, 90 degrees sector and in 100% of subjects by wide-angle, "panoramic" sector. Images of the RV in short-axis view at medium level were acquired and evaluated in 93% of cases, but at basal and apical levels only in 67% and 39%, respectively. The low percentage of successful detection and evaluation of the RV at apical level can be explained by prominent motion and trabeculation of the apex. Global systolic area changes (SAC) in controls attained similar values at apical and medium levels (60% and 59%, respectively), but were significantly lower (48%, P less than 0.05) at basal level. In patients with previous inferior MI and inferoposterior asynergy, global SAC were significantly (P less than 0.01) lower at medium and basal levels (32% and 27%, respectively) compared with controls. Regional kinesis of RV was assessed as segmental SAC in 12 different segments, by fixed and float system of center of cavity.(ABSTRACT TRUNCATED AT 250 WORDS)

  15. Evaluation of right ventricular function using single-beat three-dimensional echocardiography in neonate.

    Science.gov (United States)

    Watanabe, Kazuhiro; Hashimoto, Ikuo; Ibuki, Keijiro; Okabe, Mako; Kaneda, Hisashi; Ichida, Fukiko

    2015-06-01

    Aim of our study was to evaluate right ventricular (RV) systolic function in neonate using newly developed single-beat three-dimensional echocardiography (sb3DE). We enrolled 15 healthy or premature neonates (0-53 days after birth). We scanned one beat full volume using Siemens ACUSON SC2000 (Siemens AG) echocardiography with 4Z1c full-volume transducer without ECG gating. RV end-diastolic volume (RVEDV) and RV end-systolic volume (RVESV) were computed with special software dedicated to analysis for RV volume. RV ejection fraction (RVEF) and RV stroke volume (3D-RVSV) were calculated. And RV stroke volume was also determined from the recordings of ejection blood flow velocity and diameter at the level of the pulmonary orifice in RV outflow tract (Doppler-RVSV). Tricuspid annular plane systolic excursion (TAPSE) was also measured by 2D echocardiography. RVEDV ranged from 5.1 to 10.7 ml (average 7.5 ml), RVESV ranged from 2.3 to 5.8 ml (average 3.9 ml). There was a good correlation between 3D-RVSV and Doppler-RVSV (r = 0.77). Bland-Altman plot revealed that 3D-RVSV became underestimation of an average of 1.78 ml compared to Doppler-RVSV. And TAPSE positively correlated with 3D-RVEF (r = 0.58, P = 0.038). Newly developed sb3DE enables us to perform three-dimensional acquisition of RV volume without ECG gating even in neonate. However, 3D-RVSV currently tends to be underestimated in neonatal measurement. PMID:25588573

  16. Effects of short-term nutritional interventions on right ventricular function in healthy men.

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    Ralph L Widya

    Full Text Available BACKGROUND: A physiological model of increased plasma nonesterified fatty acid (NEFA levels result in myocardial triglyceride (TG accumulation, which is related to cardiac dysfunction. A pathophysiological model of increased plasma NEFA levels result in hepatic steatosis, which has been linked to abnormal myocardial energy metabolism. Hepatic steatosis is accompanied by hepatic inflammation, reflected by plasma cholesteryl ester transfer protein (CETP levels. The current study aimed to investigate effects of these models via different nutritional interventions on right ventricular (RV function. METHODS: Fifteen men (age 25.0±6.6 years were included and underwent magnetic resonance imaging and spectroscopy in this prospective crossover intervention study. RV function, myocardial and hepatic TG content, and CETP levels were assessed on three occasions: after normal diet, very low-calorie diet (VLCD, physiological model and high-fat high-energy (HFHE, pathophysiological model diet (all 3-days diets, randomly ordered, washout phase at least 14 days. RESULTS: VLCD induced a decrease in mean E deceleration by 27%. Myocardial TG content increased by 55%, whereas hepatic TG content decreased by 32%. Plasma CETP levels decreased by 14% (all P<0.05. HFHE diet induced a decrease in E/A by 19% (P<0.05. Myocardial TG content did not change, whereas hepatic TG content increased by 112% (P<0.01. Plasma CETP levels increased by 14% (P<0.05. CONCLUSIONS: These findings show that RV diastolic function is impaired after short-term VLCD and HFHE diet in healthy men, respectively a physiological and a pathophysiological model of increased plasma NEFA levels. After short-term VLCD, myocardial lipotoxicity may be of importance in decreased RV diastolic function. RV diastolic dysfunction is accompanied by increased hepatic TG content and plasma CETP levels after short-term HFHE diet, suggesting that systemic inflammation reflecting local macrophage infiltration in the

  17. Right Ventricular Dysfunction in Patients Experiencing Cardiotoxicity during Breast Cancer Therapy

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    Anna Calleja

    2015-01-01

    Full Text Available Background. Right ventricular (RV dysfunction during cancer therapy related cardiotoxicity and its prognostic implications have not been examined. Aim. We sought to determine the incidence and prognostic value of RV dysfunction at time of LV defined cardiotoxicity. Methods. We retrospectively identified 30 HER2+ female patients with breast cancer treated with trastuzumab (± anthracycline who developed cardiotoxicity and had a diagnostic quality transthoracic echocardiography. LV ejection fraction (LVEF, RV fractional area change (RV FAC, and peak systolic longitudinal strain (for both LV and RV were measured on echocardiograms at the time of cardiotoxicity and during follow-up. Thirty age balanced precancer therapy and HER2+ breast cancer patients were used as controls. Results. In the 30 patients with cardiotoxicity (mean ± SD age 54 ± 12 years RV FAC was significantly lower (42 ± 7 versus 47 ± 6%, P=0.01 compared to controls. RV dysfunction defined by global longitudinal strain (GLS < −20.3% was seen in 40% (n=12. During follow-up in 16 out of 30 patients (23 ± 15 months, there was persistent LV dysfunction (EF < 55% in 69% (n=11. Concomitant RV dysfunction at the time of LV cardiotoxicity was associated with reduced recovery of LVEF during follow-up although this was not statistically significant. Conclusion. RV dysfunction at the time of LV cardiotoxicity is frequent in patients with breast cancer receiving trastuzumab therapy. Despite appropriate management, LV dysfunction persisted in the majority at follow-up. The prognostic value of RV dysfunction at the time of cardiotoxicity warrants further investigation.

  18. Taquicardia ventricular del tracto de salida del ventrículo derecho durante el embarazo Right ventricular outflow tachycardia during pregnancy

    Directory of Open Access Journals (Sweden)

    Ariel K. Saad

    2012-06-01

    Full Text Available Durante el embarazo aumentan el metabolismo basal, el consumo de O2, la frecuencia cardíaca, el volumen sistólico, el volumen minuto y la volemia y disminuyen la tensión arterial y la resistencia periférica. Diferentes estudios han demostrado que durante este período la posibilidad de que ocurra una arritmia cardíaca o se produzca la exacerbación de una arritmia preexistente es mayor. No obstante, en su enorme mayoría carecen de importancia pronóstica tanto para la madre como para el feto. La taquicardia ventricular del tracto de salida del ventrículo derecho es una arritmia poco frecuente y su aparición se ha correlacionado con el aumento del tono adrenérgico. Se presentan los casos de dos pacientes que mostraron en el curso de la gestación reiterados episodios de taquicardia ventricular del tracto de salida del ventrículo derecho. Se analiza la asociación del embarazo con la ocurrencia de trastornos del ritmo cardíaco.During pregnancy, there is an increase in metabolism, oxygen consumption, heart rate, stroke volume, cardiac output, blood volume and a decrease in blood pressure and peripheral resistance. Studies have shown that during this period the occurrence of cardiac arrhythmias is not uncommon. Fortunately, malignant arrhythmias are rare. Herein we report two young patients who presented with symptomatic right ventricular outflow tachycardia during pregnancy that required antiarrhythmic therapy. Possible pathophysiologic mechanisms are discussed.

  19. A meta-analysis for the echocardiographic assessment of right ventricular structure and function in ARVC: a Study by the Research and Audit Committee of the British Society of Echocardiography

    Science.gov (United States)

    Qasem, Mohammad; Utomi, Victor; George, Keith; Somauroo, John; Zaidi, Abbas; Forsythe, Lynsey; Bhattacharrya, Sanjeev; Lloyd, Guy; Rana, Bushra; Ring, Liam; Robinson, Shaun; Senior, Roxy; Sheikh, Nabeel; Sitali, Mushemi; Sandoval, Julie; Steeds, Richard; Stout, Martin; Willis, James

    2016-01-01

    Introduction Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an inherited pathology that can increase the risk of sudden death. Current task force criteria for echocardiographic diagnosis do not include new, regional assessment tools which may be relevant in a phenotypically diverse disease. We adopted a systematic review and meta-analysis approach to highlight echocardiographic indices that differentiated ARVC patients and healthy controls. Methods Data was extracted and analysed from prospective trials that employed a case–control design meeting strict inclusion and exclusion as well as a priori quality criteria. Structural indices included proximal RV outflow tract (RVOT1) and RV diastolic area (RVDarea). Functional indices included RV fractional area change (RVFAC), tricuspid annular systolic excursion (TAPSE), peak systolic and early diastolic myocardial velocities (S′ and E′, respectively) and myocardial strain. Results Patients with ARVC had larger RVOT1 (mean ± s.d.; 34 vs 28 mm, P < 0.001) and RVDarea (23 vs 18 cm2, P < 0.001) compared with healthy controls. ARVC patients also had lower RVFAC (38 vs 46%, P < 0.001), TAPSE (17 vs 23 mm, P < 0.001), S′ (9 vs 12 cm/s, P < 0.001), E′ (9 vs 13 cm/s, P < 0.001) and myocardial strain (−17 vs −30%, P < 0.001). Conclusion The data from this meta-analysis support current task force criteria for the diagnosis of ARVC. In addition, other RV measures that reflect the complex geometry and function in ARVC clearly differentiated between ARVC and healthy controls and may provide additional diagnostic and management value. We recommend that future working groups consider this data when proposing new/revised criteria for the echocardiographic diagnosis of ARVC. PMID:27686556

  20. A meta-analysis for the echocardiographic assessment of right ventricular structure and function in ARVC: a Study by the Research and Audit Committee of the British Society of Echocardiography

    Directory of Open Access Journals (Sweden)

    Mohammad Qasem

    2016-10-01

    Full Text Available Introduction: Arrhythmogenic right ventricular cardiomyopathy ARVC is an inherited pathology that can increase the risk of sudden death. Current task force criteria for echocardiographic diagnosis do not include new, regional assessment tools which may be relevant in a phenotypically diverse disease. We adopted a systematic review and meta-analysis approach to highlight echocardiographic indices that differentiated ARVC patients and healthy controls. Methods: Data was extracted and analysed from prospective trials that employed a case–control design meeting strict inclusion and exclusion as well as a priori quality criteria. Structural indices included proximal RV outflow tract (RVOT1 and RV diastolic area (RVDarea. Functional indices included RV fractional area change (RVFAC, tricuspid annular systolic excursion (TAPSE, peak systolic and early diastolic myocardial velocities (S′ and E′, respectively and myocardial strain. Results: Patients with ARVC had larger RVOT1 (mean ± s.d.; 34 vs 28 mm, P < 0.001 and RVDarea (23 vs 18 cm2, P < 0.001 compared with healthy controls. ARVC patients also had lower RVFAC (38 vs 46%, P < 0.001, TAPSE (17 vs 23 mm, P < 0.001, S′ (9 vs 12 cm/s, P < 0.001, E′ (9 vs 13 cm/s, P < 0.001 and myocardial strain (−17 vs −30%, P < 0.001. Conclusion: The data from this meta-analysis support current task force criteria for the diagnosis of ARVC. In addition, other RV measures that reflect the complex geometry and function in ARVC clearly differentiated between ARVC and healthy controls and may provide additional diagnostic and management value. We recommend that future working groups consider this data when proposing new/revised criteria for the echocardiographic diagnosis of ARVC.

  1. Reverse left ventricular remodeling is more likely in non ischemic cardiomyopathy patients upgraded to biventricular stimulation after chronic right ventricular pacing

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    Morales Maria-Aurora

    2011-12-01

    Full Text Available Abstract Background Chronic right ventricular (RV apical pacing may lead to left ventricular (LV dyssynchrony and LV dysfunction. In heart failure due to RV pacing, upgrading to biventricular stimulation (CRT can improve NYHA Class and LV function. A proportion of patients do not respond to upgrading. Aim was to assess whether etiology of LV dysfunction accounts for responses to CRT in RV-paced patients. Methods Sixty-two patients treated by CRT, under RV pacing from 50.2 ± 5.4 months, were studied. Cause of LV dysfunction was non-ischemic (NIC in 28 and ischemic cardiomyopathy (IC in 34 patients. Clinical and conventional echocardiographic parameters were available within 1 month before RV pacing, within 1 month before CRT and at 12 ± 2 months of follow-up (FU. Results Decreased LVEF (from 37.0 ± 8.8 to 25.6 ± 6.1%, p 10% decrease in LVESD was observed in 24 patients: 5 with IC, 19 with NIC (p 10% decrease in LVESD remained highly significant (p Conclusions CRT improves functional class even after long-lasting pacing. Reverse remodeling is evident in a small population, more likely with NIC.

  2. A comparative study of right ventricular outflow tract pacing and right ventricular apical pacing in children%儿童右室流出道起搏与右室心尖起搏的对比研究

    Institute of Scientific and Technical Information of China (English)

    陈晶; 曾国洪; 曾少颖; 王树水

    2014-01-01

    目的:回顾性对比研究儿童行VVI起搏治疗的右室流出道起搏与右室心尖部起搏对近期心功能、QRS波时限及起搏参数的影响。方法:回顾2006年7月至2013年11月,在我科行VVI起搏治疗的38例患儿病例资料,根据术中记录螺旋电极植入的部位分为右室流出道组(n=22)和右室心尖部组(n=16)。记录术前和术后的心脏彩超心功能指标及QRS波时限,术中与术后起搏参数指标进行比较。结果:右室流出道组与右室心尖组在术前及术后心功能指标、术中及术后的起搏阈值差值、导线阻抗差值、R波幅度差值差异无统计学意义。右室流出道起搏组与右室心尖起搏组术后QRS波时限增宽,差异有统计学意义。术前与术后的QRS波时限差值[(134.95±12.86)ms vs(147.44±22.35)ms,t=1.35,P=0.01],差异有统计学意义。结论:儿童右室流出道起搏安全可行,两者起搏术后QRS波时限增宽,但右室心尖起搏组QRS波时限增宽更明显。%Objective To compare the impacts of right ventricular outflow tract pacing and right ventricular apical pacing on short-term cardiac function, QRS duration and pacing parameters in children undergoing VVI pacemaker therapy. Methods The clinical data of 38 children undergoing VVI pacemaker treatment in our department from July 2006 to November 2013 were retrospectively reviewed and analyzed to make grouping: 22 with right ventricular outflow tract pacing based on the operational records were assigned in one group and 16 with right ventricular apical pacing as the other group. The two groups were compared in terms of cardiac function indexes , QRS complex width and intra- and post- operative parameters of the implanted pacemakers. Results There were no significant differences between the two groups in pre-and post-operative cardiac function indexes , intra- and post-operative difference in pacing thresholds

  3. The accuracy and optimal slice thickness of multislice helical computed tomography for right and left ventricular volume measurement

    Institute of Scientific and Technical Information of China (English)

    崔炜; 近藤武; 安野泰史; 郭玉印; 佐藤贵久; 皿井正義; 篠崎仁史; 柿澤聡士; 杉浦厚司; 大岛慶太; 片田和廣; 菱田仁

    2004-01-01

    Background Multislice helical computed tomography (MSCT) has been used to depict coronary anatomy noninvasively, and proved useful for evaluating ventricular function. The aim of our study was to assess the accuracy of ventricular volume as measured by MSCT. Methods Fourteen human left ventricular (LV) and 15 right ventricular (RV) casts were scanned by MSCT. A series of LV and RV short-axis images were reconstructed later with slice thickness of 2.0 mm, 3.5 mm, 5.0 mm, 7.0 mm, and 10.0 mm. Ventricular volume was calculated by the multislice tomographic Simpson's method. True LV and RV cast volumes were determined by water displacement. Results Both calculated LV and RV volumes correlated highly with the corresponding true volumes (all r>0.95, P<0.01). But with slice thickness from 2.0 mm to 10.0 mm, MSCT scanning overestimated the corresponding true volume by (3.21±5.95) ml to (12.58±8.56) ml for LV and (10.22±8.45) ml to (23.91±12.24) ml for RV (all P<0.01). There was a very high correlation between the overestimation and the selected slice thickness for both LV and RV volume measurements (r=0.998 and 0.996, P<0.01, respectively). However, when slice thickness was reduced to 5.0 mm, the overestimation for both LV and RV volume measurements became nonsignificant for slice thickness from 2.0 mm to 5.0 mm. Conclusions Both LV and RV volumes can be accurately estimated by MSCT. Thinner slice has more accurate calculated volume. However, 5.0 mm slice thickness is thin enough for an accurate measurement of LV or RV volume.

  4. Right ventricular volumes and function in thalassemia major patients in the absence of myocardial iron overload

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    Porter John B

    2010-04-01

    Full Text Available Abstract Aim We aimed to define reference ranges for right ventricular (RV volumes, ejection fraction (EF in thalassemia major patients (TM without myocardial iron overload. Methods and results RV volumes, EF and mass were measured in 80 TM patients who had no myocardial iron overload (myocardial T2* > 20 ms by cardiovascular magnetic resonance. All patients were receiving deferoxamine chelation and none had evidence of pulmonary hypertension or other cardiovascular comorbidity. Forty age and sex matched healthy non-anemic volunteers acted as controls. The mean RV EF was higher in TM patients than controls (males 66.2 ± 4.1% vs 61.6 ± 6%, p = 0.0009; females 66.3 ± 5.1% vs 62.6 ± 6.4%, p = 0.017, which yielded a raised lower threshold of normality for RV EF in TM patients (males 58.0% vs 50.0% and females 56.4% vs 50.1%. RV end-diastolic volume index was higher in male TM patients (mean 98.1 ± 17.3 mL vs 88.4 ± 11.2 mL/m2, p = 0.027, with a higher upper limit (132 vs 110 mL/m2 but this difference was of borderline significance for females (mean 86.5 ± 13.6 mL vs 80.3 ± 12.8 mL/m2, p = 0.09, with upper limit of 113 vs 105 mL/m2. The cardiac index was raised in TM patients (males 4.8 ± 1.0 L/min vs 3.4 ± 0.7 L/min, p Conclusion The normal ranges for functional RV parameters in TM patients with no evidence of myocardial iron overload differ from healthy non-anemic controls. The new reference RV ranges are important for determining the functional effects of myocardial iron overload in TM patients.

  5. Logistic regression model for identification of right ventricular dysfunction in patients with acute pulmonary embolism by means of computed tomography

    International Nuclear Information System (INIS)

    Purpose: Diagnosis of right ventricular dysfunction in patients with acute pulmonary embolism (PE) is known to be associated with increased risk of mortality. The aim of the study was to calculate a logistic regression model for reliable identification of right ventricular dysfunction (RVD) in patients diagnosed with computed tomography pulmonary angiography. Material and methods: Ninety-seven consecutive patients with acute pulmonary embolism were divided into groups with and without RVD basing upon echocardiographic measurement of pulmonary artery systolic pressure (PASP). PE severity was graded with the pulmonary obstruction score. CT measurements of heart chambers and mediastinal vessels were performed; position of interventricular septum and presence of contrast reflux into the inferior vena cava were also recorded. The logistic regression model was prepared by means of stepwise logistic regression. Results: Among the used parameters, the final model consisted of pulmonary obstruction score, short axis diameter of right ventricle and diameter of inferior vena cava. The calculated model is characterized by 79% sensitivity and 81% specificity, and its performance was significantly better than single CT-based measurements. Conclusion: Logistic regression model identifies RVD significantly better, than single CT-based measurements

  6. PKC translocation and ERK1/2 activation in compensated right ventricular hypertrophy secondary to chronic emphysema.

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    Litwin Sheldon E

    2005-05-01

    Full Text Available Abstract Background Right ventricular hypertrophy (RVH is an important complication of chronic lung disease. However, the signal transduction pathways involved as well as the physiological changes to the right ventricle have not been investigated. Emphysema was produced in male, Syrian Golden hamsters by intra-tracheal instillation of 250 IU/kg elastase (Emp, n = 17. Saline treated animals served as controls (Con, n = 15. Results Nine months later, Emp hamsters had 75% greater lung volume, and evidence of RVH at the gross and myocyte level (RV:tibia length Emp 6.84 ± 1.18 vs. Con 5.14 ± 1.11 mg/mm; myocyte cross sectional area Emp 3737 vs. Con 2695 μm2, but not left ventricular hypertrophy. Serial echocardiographic analysis from baseline to nine months after induction of emphysema revealed increasing right ventricular internal dimension and decreased pulmonary artery acceleration time only in Emp hamsters. There was an increase in translocation of PKC βI and PKC ε from cytosolic to membranous cell fractions in RV of Emp hamsters. Phosphorylation of PKC ε was unchanged. Translocation of PKC α and βII were unchanged. Emp animals had a 22% increase in phospho-ERK 1/2, but no change in levels of total ERK 1/2 compared to Con. Conclusion These data suggest that PKC βI, ε and ERK 1/2 may play a role in mediating compensated RVH secondary to emphysema and may have clinical relevance in the pathogenesis of RVH.

  7. Sustained pulmonary hypertension and right ventricular hypertrophy after chronic hypoxia in mice with congenital deficiency of nitric oxide synthase 3.

    OpenAIRE

    Steudel, W.; Scherrer-Crosbie, M; Bloch, K D; Weimann, J.; Huang, P L; Jones, R. C.; Picard, M H; Zapol, W M

    1998-01-01

    Chronic hypoxia induces pulmonary hypertension and right ventricular (RV) hypertrophy. Nitric oxide (NO) has been proposed to modulate the pulmonary vascular response to hypoxia. We investigated the effects of congenital deficiency of endothelial NO synthase (NOS3) on the pulmonary vascular responses to breathing 11% oxygen for 3-6 wk. After 3 wk of hypoxia, RV systolic pressure was greater in NOS3-deficient than in wild-type mice (35+/-2 vs 28+/-1 mmHg, x+/-SE, P < 0.001). Pulmonary artery p...

  8. Evaluation of right ventricular function by NuSMUGA software : gated blood-pool SPECT vs. first-pass radionuclide angiography

    NARCIS (Netherlands)

    Slart, RHJA; Poot, L; Piers, DA; van Veldhuisen, DJ; Jager, PL

    2003-01-01

    Background: In comparison with planar imaging gated blood-pool single photon emission computed tomography (GBPS) has the advantage of separating left and right ventricle. The purpose of this investigation was to evaluate the right ventricular ejection fraction (RVEF) calculations by GBPS software ('

  9. Noninvasive model including right ventricular speckle tracking for the evaluation of pulmonary hypertension

    Science.gov (United States)

    Mahran, Yossra; Schueler, Robert; Weber, Marcel; Pizarro, Carmen; Nickenig, Georg; Skowasch, Dirk; Hammerstingl, Christoph

    2016-01-01

    AIM To find parameters from transthorathic echocardiography (TTE) including speckle-tracking (ST) analysis of the right ventricle (RV) to identify precapillary pulmonary hypertension (PH). METHODS Forty-four patients with suspected PH undergoing right heart catheterization (RHC) were consecutively included (mean age 63.1 ± 14 years, 61% male gender). All patients underwent standardized TTE including ST analysis of the RV. Based on the subsequent TTE-derived measurements, the presence of PH was assessed: Left ventricular ejection fraction (LVEF) was calculated by Simpsons rule from 4Ch. Systolic pulmonary artery pressure (sPAP) was assessed with continuous wave Doppler of systolic tricuspid regurgitant velocity and regarded raised with values ≥ 30 mmHg as a surrogate parameter for RA pressure. A concomitantly elevated PCWP was considered a means to discriminate between the precapillary and postcapillary form of PH. PCWP was considered elevated when the E/e’ ratio was > 12 as a surrogate for LV diastolic pressure. E/e’ ratio was measured by gauging systolic and diastolic velocities of the lateral and septal mitral valve annulus using TDI mode. The results were then averaged with conventional measurement of mitral valve inflow. Furthermore, functional testing with six minutes walking distance (6MWD), ECG-RV stress signs, NT pro-BNP and other laboratory values were assessed. RESULTS PH was confirmed in 34 patients (precapillary PH, n = 15, postcapillary PH, n = 19). TTE showed significant differences in E/e’ ratio (precapillary PH: 12.3 ± 4.4, postcapillary PH: 17.3 ± 10.3, no PH: 12.1 ± 4.5, P = 0.02), LV volumes (ESV: 25.0 ± 15.0 mL, 49.9 ± 29.5 mL, 32.2 ± 13.6 mL, P = 0.027; EDV: 73.6 ± 24.0 mL, 110.6 ± 31.8 mL, 87.8 ± 33.0 mL, P = 0.021) and systolic pulmonary arterial pressure (sPAP: 61.2 ± 22.3 mmHg, 53.6 ± 20.1 mmHg, 31.2 ± 24.6 mmHg, P = 0.001). STRV analysis showed significant differences for apical RV longitudinal strain (RVAS: -7.5% ± 5

  10. Use of myocardial tomo-scintigraphy by {sup 123}I - MIBG in right ventricle arrhythmia-gen dysplasia; Interet de la tomoscintigraphie myocardique a la {sup 123}I - MIBG dans la dysplasie arrythmogene du ventricule droit

    Energy Technology Data Exchange (ETDEWEB)

    Agostini, D.; Manrique, A.; Darlas, Y. [Service de Medecine Nucleaire, CHU Cote de Nacre, Caen (France); Loiselet, P.; Scanu, P.; Grollier, G.; Potier, J.C. [Service de Cardiologie, CHU Cote de Nacre, Caen (France); Bouvard, G. [Service de Medecine Nucleaire, CHU Cote de Nacre, Caen (France)

    1997-12-31

    The dysfunction of myocardial sympathetic system was implied in occurrence of ventricular arrhythmias in patients with a right ventricle arrhythmia-gen dysplasia (RVAD). The goal of this study is to evaluate the myocardial pre-synaptic adrenergic regional function by using the cardiac tomo-scintigraphy with {sup 123}I - meta-iodo-benzyl-guanidine (MIBG). Fourteen patients (12 M, 2 F, age: 46{+-} 13) in whom the disease`s diagnosis was done on the basis of the parameters of European Task Force (electric, angiographic, histologic), were studied. Six healthy subjects (32 {+-} 12 years) were at the same time studied as control group. Each patient benefited by an at-rest tomo-scintigraphy by {sup 201}Tl to eliminate any hypo-perfusion which could hinder the interpretation of MIBG fixation. A 48 h delay was necessary between the two isotopic examinations. After blocking the thyroid by Lugol fort, an at-rest tomo-scintigraphy by {sup 123}I - MIBG was effected 4 h after the injection IV of 259 MBq of tracer following a classical acquisition of a myocardial tomography with a tracer-adopted collimator (Elscint camera). Global and regional evaluations of the cardiac adrenergic neuronal function were effected by using the cardio-mediastinal ratio (CMR) and the circumferential profile, respectively, for the localization, extension and amplitude of regional adrenergic defects. The CMR is within the normal limits (236 {+-} 39% vs 234 {+-} 14% in healthy subjects). The adrenergic defects are present in 11/14 patients (a reduction of 50% of capture of MIBG as compared with the control group, < average - 2 ET) in the anterior and lateral regions of left ventricle. In conclusion, the tomo-scintigraphy by {sup 123}I - MIBG allows the detecting of presence of a sympathetic dys-innervation of left ventricle in patients afflicted with RVAD

  11. Effect of eight weeks of endurance exercise training on right and left ventricular volume and mass in untrained obese subjects: a longitudinal MRI study

    DEFF Research Database (Denmark)

    Vogelsang, T W; Hanel, B; Kristoffersen, U S;

    2008-01-01

    The aim of the present investigation was to examine how 8 weeks of intense endurance training influenced right and left ventricular volumes and mass in obese untrained subjects. Ten overweight subjects (19-47 years; body mass index of 34+/-5 kg/m(2)) underwent intensive endurance training (rowing......) and ventricular mass (VM) were measured by Magnetic resonance imaging (MRI). Submaximal heart rate decreased from 126+/-5 to 113+/-3 b.p.m. (10%; P...

  12. Non-ECG-gated CT pulmonary angiography and the prediction of right ventricular dysfunction in patients suspected of pulmonary embolism

    DEFF Research Database (Denmark)

    Gutte, Henrik; Mortensen, Jann; Mørk, Mette Louise;

    2016-01-01

    PURPOSE: Right ventricular dysfunction (RVD) is an important prognostic factor of 30-day mortality in patients with acute pulmonary embolism (PE). The aim of our study was to evaluate whether non-electrocardiogram (ECG)-gated cardiovascular parameters attained during computed tomography pulmonary...... angiography (CTPA) could predict RVD in patients suspected of PE using ECG-gated cardiac CT angiography as reference. METHODS: Consecutive patients suspected of PE were referred to a ventilation/perfusion single-photon emission tomography (V/Q-SPECT) as first-line imaging procedure. Patients had a V....../Q-SPECT/CT, a CTPA and an ECG-gated cardiac CT angiography performed the same day. RESULTS: A total of 71 patients were available for analysis. Seventeen patients (24%) had RVD. The non-ECG-gated dimensions of left and right ventricle and the major vessels were correlated with ECG-gated cardiac dimensions. The size...

  13. Right ventricular involvement with acute inferior wall myocardial infarction identifies high risk of developing atrioventricular nodal conduction disturbances

    Energy Technology Data Exchange (ETDEWEB)

    Braat, S.H.; de Zwaan, C.; Brugada, P.; Coenegracht, J.M.; Wellens, H.J.

    1984-06-01

    In 67 consecutive patients with inferior wall acute myocardial infarction (AMI), 99m-technetium pyrophosphate scintigraphy was performed 36 to 72 hours after the onset of chest pain to detect right ventricular (RV) involvement. All patients were continuously monitored during at least 3 days to detect rhythm and conduction disturbances. In 29 patients RV involvement was diagnosed by scintigraphy. None of these 29 patients showed clinical signs of right-sided heart failure. Fourteen of the 19 patients showing atrioventricular (AV) nodal condution disturbances in the setting of inferior AMI also had RV involvement. Therefore, the incidence of high-degree AV nodal block in patients with RV involvement (14 of 29 patients) was 48% compared to only 13% (5 of 38) in patients with inferior AMI without RV involvement.

  14. Right and left ventricular cardiac function in a developed world population with human immunodeficiency virus studied with radionuclide ventriculography

    DEFF Research Database (Denmark)

    Lebech, Anne-Mette; Gerstoft, Jan; Hesse, Birger;

    2004-01-01

    BACKGROUND: Cardiac dysfunction has been reported in a substantial part of patients infected with the human immunodeficiency virus (HIV). However, most studies are from a time before the introduction of highly active antiretroviral treatment (HAART), which has significantly reduced HIV-associated......BACKGROUND: Cardiac dysfunction has been reported in a substantial part of patients infected with the human immunodeficiency virus (HIV). However, most studies are from a time before the introduction of highly active antiretroviral treatment (HAART), which has significantly reduced HIV......-associated morbidity and mortality rates. Accordingly, the prevalence of HIV-associated cardiac dysfunction may also have changed. The aim of the study was to establish the prevalence of right- and left-sided cardiac dysfunction in a Danish HIV population, most of whom were undergoing HAART, with radionuclide......), and endothelin-1 (ET-1) were measured. Thirty age- and sex-matched healthy volunteer subjects were included to establish reference values of radionuclide measurements of left and right ventricular ejection fraction and of left ventricular volume. RESULTS: Of 95 patients with HIV, 1 (1%) had a reduced left...

  15. A comparison of right ventricular volume change during systole obtained using the monoplane Simpson’s method in two-dimensional echocardiographic apical four-chamber view with right ventricular volume change obtained using a prisma model reflecting the systolic long-axis shortening of the right ventricle of the heart: A pilot study

    OpenAIRE

    Loiske, K; Emilsson, K

    2008-01-01

    The right ventricle of the heart has a complex geometry, making it difficult to measure its function and volume. In the present study, right ventricular (RV) volume change during systole in two-dimensional echocardiographic apical four-chamber view was estimated using the monoplane Simpson’s method. Measurements of volume change using the monoplane Simpson’s method were compared with those obtained using a theoretical prisma model, which is believed to reflect RV systolic long-axis shortening...

  16. Thallium myocardial perfusion scans for the assessment of right ventricular hypertrophy in patients with cystic fibrosis. A comparison with other noninvasive techniques

    Energy Technology Data Exchange (ETDEWEB)

    Newth, C.J.; Corey, M.L.; Fowler, R.S.; Gilday, D.L.; Gross, D.; Mitchell, I.

    1981-01-01

    The incidence of right ventricular hypertrophy in 32 patients with cystic fibrosis was studied using thallium 201 (TI-201) myocardial perfusion scans, and compared with other noninvasive techniques including electrocardiography, vectorcardiography, and M-mode echocardiography. The patients (mean age, 17.3 yr; range, 7 to 33) had a wide range of clinical and pulmonary abnormalities (mean Shwachman-Kulczycki score, 66.6). In the total study group, TI-201 scans, like the vectorcardiograms and the M-mode echocardiograms, gave a surprisingly high proportion of positive predictions for right ventricular hypertrophy (RVH) (44%). The correlations with all other noninvasive methods were uniformly poor, so caution must be exercised in using this technique to predict early RVH in order to follow the natural history of cor pulmonale in cystic fibrosis. At the time of the study, 6 patients had clinical evidence of right ventricular failure, and in this disease setting must have had RVH. In 3 patients, RVH was confirmed at autopsy, and it was successfully predicted by TI-201 scans in 5 of the 6 patients. The false negative scan may have been due to regional myocardial ischemia secondary to severe right ventricular failure. In contrast, the vectorcardiogram, using Fowler's new criteria, made a successful prediction of RVH in all 6 patients, and the electro cardiogram in only 3. Although the M-mode echocardiogram was abnormal in all patients, it would have predicted RVH (with increased right ventricular anterior wall thickness) in only 1 patient. We concluded that TI-201 myocardial perfusion cans are good at confirming RVH in cases with established right ventricular failure, but have no advantage over vectorcardiographic assessments, which are logistically easier to perform and carry no radiation risks.

  17. Thallium myocardial perfusion scans for the assessment of right ventricular hypertrophy in patients with cystic fibrosis. A comparison with other noninvasive techniques

    International Nuclear Information System (INIS)

    The incidence of right ventricular hypertrophy in 32 patients with cystic fibrosis was studied using thallium 201 (TI-201) myocardial perfusion scans, and compared with other noninvasive techniques including electrocardiography, vectorcardiography, and M-mode echocardiography. The patients (mean age, 17.3 yr; range, 7 to 33) had a wide range of clinical and pulmonary abnormalities (mean Shwachman-Kulczycki score, 66.6). In the total study group, TI-201 scans, like the vectorcardiograms and the M-mode echocardiograms, gave a surprisingly high proportion of positive predictions for right ventricular hypertrophy (RVH) (44%). The correlations with all other noninvasive methods were uniformly poor, so caution must be exercised in using this technique to predict early RVH in order to follow the natural history of cor pulmonale in cystic fibrosis. At the time of the study, 6 patients had clinical evidence of right ventricular failure, and in this disease setting must have had RVH. In 3 patients, RVH was confirmed at autopsy, and it was successfully predicted by TI-201 scans in 5 of the 6 patients. The false negative scan may have been due to regional myocardial ischemia secondary to severe right ventricular failure. In contrast, the vectorcardiogram, using Fowler's new criteria, made a successful prediction of RVH in all 6 patients, and the electro cardiogram in only 3. Although the M-mode echocardiogram was abnormal in all patients, it would have predicted RVH (with increased right ventricular anterior wall thickness) in only 1 patient. We concluded that TI-201 myocardial perfusion cans are good at confirming RVH in cases with established right ventricular failure, but have no advantage over vectorcardiographic assessments, which are logistically easier to perform and carry no radiation risks

  18. Postpacing abnormal repolarization in catecholaminergic polymorphic ventricular tachycardia associated with a mutation in the cardiac ryanodine receptor gene

    NARCIS (Netherlands)

    E. Nof; B. Belhassen; M. Arad; Z.A. Bhuiyan; C. Antzelevitch; R. Rosso; R. Fogelman; D. Luria; D. El-Ani; M.M.A.M. Mannens; S. Viskin; M. Eldar; A.A.M. Wilde; M. Glikson

    2011-01-01

    Catecholaminergic polymorphic ventricular tachycardia (CPVT) is an arrhythmogenic disease for which electrophysiological studies (EPS) have shown to be of limited value. This study presents a CPVT family in which marked postpacing repolarization abnormalities during EPS were the only consistent phen

  19. First pass radionuclide studies in evaluation of left and right ventricular function in patients with bioprosthetic mitral valve replacement after 9-11 years

    International Nuclear Information System (INIS)

    The results presented here show that first pass scintigraphy is an effective diagnostic tool in evaluating tissue valves at long term risk. At 123.8 +-8 months postoperatively, 13 out of 15 patients with porcine valves in the mitral position showed normal PTT, RFR and clinical function. Two patients with bioprostheses proven to be stenotic had abnormal PTT and RFR. Valve replacement was required in these patients. In 14 patients, left and right ESV and EDV were normal at rest. Left and right ventricular responses to exercise were abnormal since ESV and EDV did not change, possibly due to decreased ventricular compliance

  20. Early teatment with hepatocyte growth factor improves pulmonary artery and right ventricular remodeling in rats with pulmonary artery hypertension by modulating cytokines expression

    Institute of Scientific and Technical Information of China (English)

    王晓林

    2014-01-01

    Objective To investigate the effect of early treatment with hepatocyte growth factor(HGF)on the cytokine expression and pulmonary artery,right ventricular(RV)remodeling in the rat model of pulmonary artery hypertension(PAH).Methods The rat model of PAH was produced by injecting monocrotaline,and the model rats were randomly divided into empty adenovirus transfection group(MCT group,n=10)and HGF gene transfection group(HGF group,n=10).Another group of rats served as the Sham operation group(Sham group n=10).After 4 weeks of HGF gene transfection,the histological sections of the lungs and right ventricular(RV)

  1. Prognostic value of echocardiographic right/left ventricular end-diastolic diameter ratio in idiopathic pulmonary arterial hypertension

    Institute of Scientific and Technical Information of China (English)

    ZENG Wei-jie; SUN Yun-juan; XIONG Chang-ming; GU Qing; HE Jian-guo

    2011-01-01

    Background An echocardiographic right/left ventricular end-diastolic diameter ratio (RV/LV ratio) ≥0.9 is an independent predictor of poor prognosis in patients with acute pulmonary embolism. Right ventricular dilation is a common characteristic of both acute pulmonary embolism and idiopathic pulmonary arterial hypertension (IPAH).However, the prognostic value of the RV/LV ratio in patients with IPAH is unknown.Methods Ninety-five consecutive patients with newly diagnosed IPAH were included, 17 were re-evaluated by echocardiography after 3-12 months of targeted therapy. Follow-up data were obtained by telephone interviews and review of the patients' records.Results Higher RV/LV ratios were associated with greater functional impairment and with a higher mean right atrial pressure.The RV/LV ratio was positively correlated with pulmonary vascular resistance (r=0.549, P <0.001) and plasma N-terminal pro-brain natriuretic peptide level (r=0.575, P <0.001), but negatively correlated with cardiac output (r= -0.517, P <0.001) and mixed venous oxygen saturation (r= -0.599, P <0.001). During a follow-up period of (21 ± 15) months, 27 patients died.Sensitivity and specificity of an RV/LV ratio ≥0.84 for predicting death were 85.2% and 51.5%, respectively. The RV/LV ratio and body mass index were independent predictors of death by multivariate Cox analysis (P <0.01). A baseline RV/LV ratio ≥0.84 or a further increase in the RV/LV ratio during targeted therapy indicated a poor prognosis (P <0.01).Conclusion The RV/LV ratio helps to assess the severity of IPAH and may serve as an independent predictor of prognosis in patients with IPAH.

  2. Ventricular septal defect (image)

    Science.gov (United States)

    Ventricular septal defect is a congenital defect of the heart, that occurs as an abnormal opening in ... wall that separates the right and left ventricles. Ventricular septal defect may also be associated with other ...

  3. A case report of the fibrous dysplasia

    International Nuclear Information System (INIS)

    The author observed a rare case of fibrous dysplasia in 12 year old female who came to the Infirmary of Dental College, Seoul National University, complaining of facial asymmetry of 3 years' duration in right maxillofacial region. The serial radiograms has been taken, and the nature of the lesion established as a typical fibrous dysplasia according to the interpreted findings in their images. The author has obtained the results as follows: 1. Fibrous dysplasia occurred at 3 years of age in this case. 2. On familial tendency, traumatic history and endocrine disturbances were not noted in this patient. 3. The serial radiograms revealed a typical fibrous dysplasia encroaching right zygomatic bone.

  4. Phenotyping of left and right ventricular function in mouse models of compensated hypertrophy and heart failure with cardiac MRI.

    Directory of Open Access Journals (Sweden)

    Bastiaan J van Nierop

    Full Text Available BACKGROUND: Left ventricular (LV and right ventricular (RV function have an important impact on symptom occurrence, disease progression and exercise tolerance in pressure overload-induced heart failure, but particularly RV functional changes are not well described in the relevant aortic banding mouse model. Therefore, we quantified time-dependent alterations in the ventricular morphology and function in two models of hypertrophy and heart failure and we studied the relationship between RV and LV function during the transition from hypertrophy to heart failure. METHODS: MRI was used to quantify RV and LV function and morphology in healthy (n = 4 and sham operated (n = 3 C57BL/6 mice, and animals with a mild (n = 5 and a severe aortic constriction (n = 10. RESULTS: Mice subjected to a mild constriction showed increased LV mass (P0.05. Animals with a severe constriction progressively developed LV hypertrophy (P<0.001, depressed LVEF (P<0.001, followed by a declining RVEF (P<0.001 and the development of pulmonary remodeling, as compared to controls during a 10-week follow-up. Myocardial strain, as a measure for local cardiac function, decreased in mice with a severe constriction compared to controls (P<0.05. CONCLUSIONS: Relevant changes in mouse RV and LV function following an aortic constriction could be quantified using MRI. The well-controlled models described here open opportunities to assess the added value of new MRI techniques for the diagnosis of heart failure and to study the impact of new therapeutic strategies on disease progression and symptom occurrence.

  5. Cervical dysplasia

    Science.gov (United States)

    ... by your provider. Make sure to get the HPV vaccine when it is offered to you. This vaccine prevents many cervical cancers. ... Early diagnosis and prompt treatment cures most cases of cervical ... severe cervical dysplasia may change into cervical cancer.

  6. Regional myocardial extraction of a radioiodinated branched chain fatty acid during right ventricular pressure overload due to acute pulmonary hypertension

    International Nuclear Information System (INIS)

    To determine whether branched chain fatty acid extraction is reduced during right ventricular (RV) dysfunction due to acute pulmonary artery hypertension, studies were done in 6 anesthetized dogs. Regional branched chain fatty acid extraction was measured by comparing the myocardial uptake of I-125 labeled 15-[p-(iodophenyl)]-3-methylpentadecanoic acid (I-PDA) to myocardial blood flow. Acute pulmonary hypertension was induced by incremental intravenous injection of 100 micron diameter glass beads into six pentobarbital anesthetized, mechanically ventilated dogs. Myocardial blood flow was measured by radiolabeled microspheres both under baseline conditions and during pulmonary hypertension. Mean RV pressure rose from 12 +- 2 (mean +- SEM) to 30 +-3mmHg resulting in a 225 +- 16% increase in RV stroke work. RV ejection fraction, as assessed by gated blood pool scans fell from 39 +- 2 to 18 +- 2%. Left ventricular (LV) pressures, stroke work and ejection fraction were unchanged. Myocardial blood flow increased 132 + 59% in the RV free wall and 67 +- 22% in the RV septum. LV blood flow was unchanged. Despite increased RV work and myocardial blood flow, no differences were noted in the branched chain fatty acid extraction ratios among LV or RV free walls or septum. The authors conclude that early RV dysfunction associated with pulmonary artery hypertension is not due to inadequate myocardial blood flow or branched chain fatty acid extraction

  7. Pre-implant right ventricular function might be an important predictor of the response to cardiac resynchronization therapy

    Directory of Open Access Journals (Sweden)

    Ring Margareta

    2011-10-01

    Full Text Available Abstract Objective Cardiac resynchronization therapy is proven efficacious in patients with heart failure (HF. Presence of biventricular HF is associated with a worse prognosis than having only left ventricular (LV HF and pacing might deteriorate heart function. The aim of the study was to assess a possible significance of right ventricular (RV pre-implant systolic function to predict response to CRT. Design We studied 22 HF-patients aged 72 ± 11 years, QRS-duration 155 ± 20 ms and with an LV ejection fraction (EF of 26 ± 6% before and four weeks after receiving a CRT-device. Results There were no changes in LV diameters or end systolic volume (ESV during the study. However, end diastolic volume (EDV decreased from 226 ± 71 to 211 ± 64 ml (p = 0.02 and systolic maximal velocities (SMV increased from 2.2 ± 0.4 to 2.6 ± 0.9 cm/s (p = 0.04. Pre-implant RV-SMV (6.2 ± 2.6 cm/s predicted postoperative increase in LV contractility, p = 0.032. Conclusions Pre-implant decreased RV systolic function might be an important way to predict a poor response to CRT implicating that other treatments should be considered. Furthermore we found that 3D- echocardiography and Tissue Doppler Imaging were feasible to detect short-term changes in LV function.

  8. Association of Right Ventricular Pressure and Volume Overload with Non-Ischemic Septal Fibrosis on Cardiac Magnetic Resonance.

    Directory of Open Access Journals (Sweden)

    Jiwon Kim

    Full Text Available Non-ischemic fibrosis (NIF on cardiac magnetic resonance (CMR has been linked to poor prognosis, but its association with adverse right ventricular (RV remodeling is unknown. This study examined a broad cohort of patients with RV dysfunction, so as to identify relationships between NIF and RV remodeling indices, including RV pressure load, volume and wall stress.The population comprised patients with RV dysfunction (EF 6-fold more common in the highest, vs. the lowest, common tertile of PASP and RV size (p<0.001.Among wall stress components, NIF was independently associated with RV chamber dilation and afterload, supporting the concept that NIF is linked to adverse RV chamber remodeling.

  9. Limiting collagen turnover via collagenase-resistance attenuates right ventricular dysfunction and fibrosis in pulmonary arterial hypertension.

    Science.gov (United States)

    Golob, Mark J; Wang, Zhijie; Prostrollo, Anthony J; Hacker, Timothy A; Chesler, Naomi C

    2016-06-01

    Pulmonary arterial hypertension (PAH) is a severe form of pulmonary hypertension in which right ventricular (RV) afterload is increased and death typically occurs due to decompensated RV hypertrophy and failure. Collagen accumulation has been implicated in pulmonary artery remodeling, but how it affects RV performance remains unclear. Here, we sought to identify the role of collagen turnover, defined as the balance between collagen synthesis and degradation, in RV structure and function in PAH To do so, we exposed mutant (Col1a1(R/R)) mice, in which collagen type I degradation is impaired such that collagen turnover is reduced, and wild-type (Col1a1(+/+)) littermates to 14 days of chronic hypoxia combined with SUGEN treatment (HySu) to recapitulate characteristics of clinical PAH RV structure and function were measured by echocardiography, RV catheterization, and histology. Despite comparable increases in RV systolic pressure (Col1a1(+/+): 46 ± 2 mmHg; Col1a1(R/R): 47 ± 3 mmHg), the impaired collagen degradation in Col1a1(R/R) mice resulted in no RV collagen accumulation, limited RV hypertrophy, and maintained right ventricular-pulmonary vascular coupling with HySu exposure. The preservation of cardiac function in the mutant mice indicates a beneficial role of limited collagen turnover via impaired degradation in RV remodeling in response to chronic pressure overload. Our results suggest novel treatments that reduce collagen turnover may offer a new therapeutic strategy for PAH patients. PMID:27252252

  10. Semi-quantitative assessment of right ventricular function in comparison to a 3D volumetric approach: A cardiovascular magnetic resonance study

    NARCIS (Netherlands)

    Nijveldt, Robin; Germans, Tjeerd; McCann, Gerald; Beek, Aernout; Rossum, van Albert

    2008-01-01

    Right ventricular (RV) volume measurements with cardiovascular magnetic resonance (CMR) is considered the gold standard, but acquisition and analysis remain timeconsuming. The aim of our study was therefore to investigate the accuracy and performance of a semi-quantitative assessment of RV function

  11. Clinical characteristics, left and right ventricular ejection fraction, and long-term prognosis in patients with non-insulin-dependent diabetes surviving an acute myocardial infarction

    DEFF Research Database (Denmark)

    Melchior, T; Gadsbøll, N; Hildebrandt, P;

    1996-01-01

    (with diabetes: median 46% vs without diabetes: median 43%; p = 0.89). Median right ventricular ejection fraction (62%) was within normal limits in both groups and did not differ statistically. Survival data were obtained for all patients. The 5-year mortality was increased in patients with diabetes...

  12. Acquired Aorto-Right Ventricular Fistula following Transcatheter Aortic Valve Replacement

    Directory of Open Access Journals (Sweden)

    Muhammad Tariq Shakoor

    2015-01-01

    Full Text Available Transcatheter aortic valve replacement (TAVR techniques are rapidly evolving, and results of published trials suggest that TAVR is emerging as the standard of care in certain patient subsets and a viable alternative to surgery in others. As TAVR is a relatively new procedure and continues to gain its acceptance, rare procedural complications will continue to appear. Our case is about an 89-year-old male with extensive past medical history who presented with progressive exertional dyspnea and angina secondary to severe aortic stenosis. Patient got TAVR and his postoperative course was complicated by complete heart block, aorto-RV fistula, and ventricular septal defect (VSD formation as a complication of TAVR. To the best of our knowledge, this is the third reported case of aorto-RV fistula following TAVR as a procedural complication but the first one to show three complications all together in one patient.

  13. Evaluation of Longitudinal Right Ventricular Mechanical Dyssynchrony before and Early after Cardiac Resynchronization Therapy: A Strain Imaging Study

    Directory of Open Access Journals (Sweden)

    Mozhgan Parsaee

    2011-02-01

    Full Text Available Background: The right ventricular (RV dyssynchrony has not been studied extensively and the existing literature has established the effect of cardiac resynchronization therapy (CRT on the left ventricular (LV dyssynchrony, but there is a dearth of data on the effect of CRT on the forgotten ventricle. We sought to evaluate the presence of mechanical right ventricular dyssynchrony in patients with systolic heart failure, selected for CRT, and track the changes early afterward utilizing the longitudinal strain analysis.Methods: Thirty-six patients with severe left ventricular systolic dysfunction, candidated for CRT, were enrolled in this study. Mechanical dyssynchrony was assessed using tissue Doppler echocardiography. The time interval between the onset of the QRS to the peak systolic longitudinal strain at the RV free wall and the septum was obtained. The RV mechanical delay was calculated as the absolute value of the difference in the time-to-peak measurements between the RV and septum. The RV dyssynchrony was defined as the calculated delay in strain imaging, which was ± 2 SD above the mean value for the control subjects (20 cases. The RV function was evaluated using the RV fractional area change (RVFAC, tricuspid annulus plane systolic excursion (TAPSE, and peak systolic strain values of the RV free wall. Four to 7 days after CRT implantation, echocardiographic reevaluations were done.Results: The calculated cut-off value for the RV dyssynchrony was 41.5 msec, according to which the pre-CRT analysis specified two patient groups: Group 1 (16 cases with RV dyssynchrony and Group 2 (20 patients without RV dyssynchrony. Significant improvement in the RV dyssynchrony was noted in Group 1 after CRT (30 ± 28.9 msec vs. 68.8 ± 21 msec; p value < 0.01 vs. 14 ± 10 msec vs. 19 ± 16.5 msec; p value = 0.18 respectively. A significant correlation was found between the severity of the RV dyssynchrony and peak systolic strain in the RV free wall (r = -0

  14. 右心室不同位点起搏对QRS时限的影响%Effect of different right ventricular pacing sites on QRS complex duration

    Institute of Scientific and Technical Information of China (English)

    任晓庆; 唐闽; 方丕华; 王方正; 张澍

    2013-01-01

    Objective To investigate the effect of right ventricular different pacing site on QRS complex width,and provide a reference for lead location.Methods Two hundred and sixteen patients[mean age,(69± 13) years] scheduled for a permanent pacemaker implantation,which met the class Ⅰ or Ⅱ a pacemaker installed indications,were enrolled for the study.Pacing and electrocardiography recording were underwent at right ventricular apex,right ventricular inflow tract (RVIT),mid septum,high septum and right ventricular outflow tract (RVOT),respectively.Then the duration and morphology of QRS complex paced in different right ventricular locations were analysed and compared.Results QRS durations at all different right ventricular pacing sites were significantly lengthened compared with baseline electrocardiography (P<0.001).QRS duration with right ventricular apex pacing was most broad (168± 16)ms,QRS duration with RVIT pacing was (166± 15) ms,and QRS duration with RVOT pacing was (165± 15)ins.There was no significant difference in QRS duration with apex,RVIT and RVOT (P> 0.05).QRS duration at septum pacing was significantly narrower (P<0.001),QRS morphology and electrical axis was normal compared with other right ventricular pacing sites.QRS duration with mid-septum pacing was most narrow (139±19) ms,and shorter than that with high septum (153± 14) ms.Conclusions QRS duration at mid-septum pacing was most narrow,QRS morphology and electrical axis was normal compared with any other right ventricular pacing sites.Mid-septum may be the best choice for right ventricular pacing site.%目的 观察右心室不同起搏位点的QRS时限,为临床导线放置提供参考依据.方法 选择216例符合Ⅰ类或Ⅱa类起搏器植入适应证的患者,在放置心室导线过程中,分别在右心室心尖部、流入道、中位间隔部、高位间隔部和流出道等不同位点起搏右心室,记录起搏时的体表心电图,比较不同位点QRS

  15. Arytmogen højre ventrikel kardiomyopati

    DEFF Research Database (Denmark)

    Benn, Marianne; Schiønning, J D; Baandrup, Ulrik

    1998-01-01

    Arrhythmogenic right ventricular dysplasia is a rare cardiomyopathy, but a frequent cause of ventricular tachyarrhythmia and sudden cardiac death among young otherwise healthy individuals. This article contains a review of the current knowledge on epidemiology, diagnosis, symptoms and signs as we...... as theories on etiology and pathogenesis, prognosis and treatment. The aim is to draw attention to the disease as a cause of syncope, ventricular tachycardia and sudden cardiac death....

  16. Value of posterior and right ventricular leads in comparison to the standard 12-lead electrocardiogram in evaluation of ST-segment elevation in suspected acute myocardial infarction.

    Science.gov (United States)

    Zalenski, R J; Rydman, R J; Sloan, E P; Hahn, K H; Cooke, D; Fagan, J; Fligner, D J; Hessions, W; Justis, D; Kampe, L M; Shah, S; Tucker, J; Zwicke, D

    1997-06-15

    In this multicenter prospective trial, we studied posterior (V7 to V9) and right ventricular (V4R to V6R) leads to assess their accuracy compared with standard 12-lead electrocardiograms (ECGs) for the diagnosis of acute myocardial infarction (AMI). Patients aged >34 years with suspected AMI received posterior and right ventricular leads immediately after the initial 12-lead ECG. ST elevation of 0.1 mV in 2 leads was blindly determined and inter-rater reliability estimated. AMI was diagnosed by World Health Organization criteria. The diagnostic value of nonstandard leads was determined when 12-lead ST elevation was absent and present and multivariate stepwise regression analysis was also performed. Of 533 study patients, 64.7% (345 of 533) had AMI and 24.8% received thrombolytic therapy. Posterior and right ventricular leads increased sensitivity for AMI by 8.4% (p = 0.03) but decreased specificity by 7.0% (p = 0.06). The likelihood ratios of a positive test for 12, 12 + posterior, and 12 + right ventricular ECGs were 6.4, 5.6, and 4.5, respectively. Increased AMI rates (positive predictive values) were found when ST elevation was present on 6 nonstandard leads (69.1%), on 12 leads only (88.4%), and on both 6 and 12 leads (96.8%; p <0.001). Treatment rates with thrombolytic therapy increased in parallel with this electrocardiographic gradient. Logistic regression analysis showed that 4 leads were independently predictive of AMI (p <0.001): leads I, II, V3, V5R; V9 approached statistical significance (p = 0.055). The standard ECG is not optimal for detecting ST-segment elevation in AMI, but its accuracy is only modestly improved by the addition of posterior and right ventricular leads. PMID:9202344

  17. [Fibromuscular dysplasia].

    Science.gov (United States)

    Desbois, A C; Koskas, F; Cacoub, P

    2015-04-01

    Fibromuscular dysplasia is a segmentary, non-atherosclerotic, non-inflammatory vascular disease that may result in stenosis, occlusion, aneurysms or dissection of medium arteries. Renal involvement is the most frequent location, described in 60-100% of patients. Renal stenosis can be asymptomatic or complicated with arterial hypertension or less frequently with renal insufficiency. Carotid and vertebral involvements are less frequent (10-35%). Surgical management of fibromuscular dysplasia is now less common because of the better efficacy of percutaneous transluminal angioplasty. Thus, histologic characteristics are no longer relevant prognostic criteria. Clinical features and outcome vary according to angiographic presentation (focal or multifocal disease), with an increased recovery rate of hypertension with focal lesions. In the presence of renal fibromuscular dysplasia, only symptomatic patients are revascularized (recent or resistant hypertension) or patients with asymmetric renal size or impaired renal function. Transluminal angioplasty is the first-line treatment except for patients with complex lesions or stenosis associated with aneurysm. PMID:25455952

  18. Evaluation of right ventricular function by 64-row CT in patients with chronic obstructive pulmonary disease and cor pulmonale

    International Nuclear Information System (INIS)

    Purpose: The aim of this study was to investigate the clinical application value of right ventricle (RV) function measured by 64 multi-detector row CT (MDCT) in patients with chronic obstructive pulmonary disease (COPD) and cor pulmonale. Materials and methods: Sixty-three consecutive patients with COPD and cor pulmonale were referred for electrocardiographically gated MDCT for evaluation of suspected or known coronary artery disease. Magnetic resonance imaging (MRI) for cardiac function analysis was performed on the same day. The MDCT and MRI examinations were successfully completed in 58 patients. Forty-six patients with COPD were divided into three groups according to the severity of disease by the pulmonary function test (PFT). Twelve patients diagnosed as cor pulmonale and 32 control subjects were also included. The RV function and myocardial mass (MM) were obtained by 64-MDCT and 1.5 T cardiac MRI in all of the groups. The results were compared among the groups using the Newman–Keuls method. Pearson's correlation was used to evaluate the relationship between the right ventricular ejection fraction (RVEF) and MM with the PFT results in COPD and cor pulmonale patients. Results: The RVEF was significantly lower in patients with severe COPD and cor pulmonale than it was in those patients with mild or moderate COPD (P < 0.01). There were strong correlations between MDCT and MRI (r = 0.826 for RV MM, r = 0.982 and 0.969 for RV EDV and RV ESV, r = 0.899 for RVEF) and between MDCT results and forced expiratory volume in 1 s (r = 0.787 for RVEF, r = −0.774 for RV MM) in all patients. Conclusion: MDCT can accurately quantify RV function and MM. The RVEF and RV MM measured by MDCT correlate well with the severity of disease as determined by PFT in patients with COPD and cor pulmonale. The assessment of right ventricular function is clinically important for evaluation of the severity of COPD, which may provide an objective basis for therapeutic strategy.

  19. Pulmonary Artery Stiffness Is Independently Associated with Right Ventricular Mass and Function: A Cardiac MR Imaging Study.

    Science.gov (United States)

    Dawes, Timothy J W; Gandhi, Ajay; de Marvao, Antonio; Buzaco, Rui; Tokarczuk, Paweł; Quinlan, Marina; Durighel, Giuliana; Diamond, Tamara; Monje Garcia, Laura; de Cesare, Alain; Cook, Stuart A; O'Regan, Declan P

    2016-08-01

    Purpose To determine the relationship between pulmonary artery (PA) stiffness and both right ventricular (RV) mass and function with cardiac magnetic resonance (MR) imaging. Materials and Methods The study was approved by the local research ethics committee, and all participants gave written informed consent. Cardiac MR imaging was performed at 1.5 T in 156 healthy volunteers (63% women; age range, 19-61 years; mean age, 36.1 years). High-temporal-resolution phase-contrast imaging was performed in the main and right PAs. Pulmonary pulse wave velocity (PWV) was determined by the interval between arterial systolic upslopes. RV function was assessed with feature tracking to derive peak systolic strain and strain rate, as well as peak early-diastolic strain rate. RV volumes, ejection fraction (RVEF), and mass were measured from the cine images. The association of pulmonary PWV with RV function and mass was quantified with univariate linear regression. Interstudy repeatability was assessed with intraclass correlation. Results The repeatability coefficient for pulmonary PWV was 0.96. Increases in pulmonary PWV and RVEF were associated with increases in age (r = 0.32, P Online supplemental material is available for this article. PMID:26909648

  20. Extent of late gadolinium enhancement at right ventricular insertion points in patients with hypertrophic cardiomyopathy: relation with diastolic dysfunction

    Energy Technology Data Exchange (ETDEWEB)

    Zhu, Yinsu [Seoul National University Hospital, Department of Radiology, Seoul (Korea, Republic of); The First Affiliated Hospital of Nanjing Medical University, Department of Radiology, Nanjing, Jiangsu (China); Park, Eun-Ah; Lee, Whal; Chu, Ajung; Chung, Jin Wook; Park, Jae Hyung [Seoul National University Hospital, Department of Radiology, Seoul (Korea, Republic of); Kim, Hyung-Kwan [Seoul National University Hospital, Division of Cardiology, Department of Internal Medicine, Seoul (Korea, Republic of)

    2015-04-01

    Our aim was to examine the association between the extent of late gadolinium enhancement (LGE) at right ventricular insertion points (RVIP) and left ventricular (LV) functional parameters in patients with hypertrophic cardiomyopathy (HCM). Sixty-one HCM patients underwent echocardiography and cardiovascular magnetic resonance (CMR) within one week. Mitral annular velocities (E/E') were obtained from echocardiography; LV ejection fraction (EF), LV mass index, LV wall maximal thickness, and left atrial volume index (LAVI) were obtained from MR. LGE extent was quantified (proportion of total LV myocardial mass) according to location: % RVIP-LGE and % non-RVIP-LGE. Although LGE was commonly present in both apical (74 %) and non-apical HCMs (88 %) (p = 0.163), RVIP-LGE was more frequent (86 % vs. 47 %, p = 0.002) in non-apical HCMs in which E/E' was significantly higher (19.23 ± 8.40 vs. 13.13 ± 5.06, p = 0.009). In addition, RVIP-LGE extent was associated with LV diastolic dysfunction (r = 0.45, p < 0.001 for E/E'; r = 0.53, p < 0.001 for LAVI) and lower LVEF (r = -0.42, p = 0.001). There was no correlation between non-RVIP-LGE extent and other parameters. Multiple linear regression analysis revealed RVIP-LGE extent as an independent predictor of E/E' (β = 0.45, p < 0.001) and LAVI in HCM patients (β = 0.53, p < 0.001). The extent of LGE at RVIPs in HCM patients is associated with increased estimated LV filling pressure and chronic diastolic burden. (orig.)

  1. The Early Predictive Value of Right Ventricular Strain in Epirubicin-Induced Cardiotoxicity in Patients with Breast Cancer

    Science.gov (United States)

    Chang, Wei-Ting; Shih, Jhih-Yuan; Feng, Yin-Hsun; Chiang, Chun-Yen; Kuo, Yu Hsuan; Chen, Wei-Yu; Wu, Hong-Chang; Cheng, Juei-Tang; Wang, Jhi-Joung; Chen, Zhih-Cherng

    2016-01-01

    Background As cancer therapies have improved, patient life spans have been extended but quality of life has been threatened by chemotherapy induced cardiotoxicity. Most cardiac complications remain unobserved until specific symptoms develop. Speckle-tracking echocardiography is a sensitive imaging modality in detecting early occult myocardial dysfunction. Methods A total number of 35 patients newly diagnosed with breast cancer and preparing for epirubicin therapy were prospectively recruited. Echocardiography, including speckle-tracking echocardiography, was performed sequentially at baseline (T1), after the first cycle (T2) and after the third cycle (T3) of epirubicin. At each visit, the severity of dyspnea was evaluated by the assessment scale. Results Compared with the baseline, right ventricular longitudinal strain (RVLS_FW) at T2 significantly declined (-22.49 ± 4.97 vs. -18.48 ± 4.46, p = 0.001), which was also positively associated with the development of dyspnea (R2 = 0.8, p = 0.01). At T3, both the left ventricular global longitudinal strain and RVLS_FW were significantly impaired (-21.4 ± 4.12 vs. -16.94 ± 6.81%; -22.49 ± 4.97 vs. -16.86 ± 7.27%, p = 0.01; 0.001, respectively). Also, the accumulating dose of epirubicin positively correlated with the development of dyspnea (R2 = 0.38, p = 0.04) and the decline of RVLS_FW (R2 = 0.53, p = 0.02). Notably, compared with the other echocardiographic parameters only RVLS_FW at the early stage (T2) significantly correlated with the development of dyspnea (odds ratio: 1.84, 95% confidence interval: 1.22-2.78, p = 0.04). Conclusions RVLS_FW sensitively predicts dyspnea development in breast cancer patients receiving epirubicin therapy. However, larger scale studies are required to validate its role in long-term patient survival. PMID:27713603

  2. Comparison of isoflurane and α-chloralose in an anesthetized swine model of acute pulmonary embolism producing right ventricular dysfunction.

    Science.gov (United States)

    Beam, Daren M; Neto-Neves, Evandro M; Stubblefield, William B; Alves, Nathan J; Tune, Johnathan D; Kline, Jeffrey A

    2015-02-01

    Pulmonary embolism (PE) is a leading cause of sudden cardiac death, and a model is needed for testing potential treatments. In developing a model, we compared the hemodynamic effects of isoflurane and α-chloralose in an acute swine model of PE because the choice of anesthesia will likely affect the cardiovascular responses of an animal to PE. At baseline, swine that received α-chloralose (n = 6) had a lower heart rate and cardiac output and higher SpO2, end-tidal CO2, and mean arterial pressure than did those given isoflurane (n = 9). After PE induction, swine given α-chloralose compared with isoflurane exhibited a lower heart rate (63 ± 10 compared with 116 ± 15 bpm) and peripheral arterial pressure (52 ± 12 compared with 61 ± 12 mm Hg); higher SpO2 (98% ± 3% compared with 95% ± 1%), end-tidal CO2 (35 ± 4 compared with 32 ± 5), and systolic blood pressure (121 ± 8 compared with 104 ± 20 mm Hg); and equivalent right ventricular:left ventricular ratios (1.32 ± 0.50 compared with 1.23 ± 0.19) and troponin I mean values (0.09 ± 0.07 ng/mL compared with 0.09 ± 0.06 ng/mL). Isoflurane was associated with widely variable fibrinogen and activated partial thromboplastin time. Intraexperiment mortality was 0 of 6 animals for α-chloralose and 2 of 9 swine for isoflurane. All swine anesthetized with α-chloralose survived with sustained pulmonary hypertension, RV-dilation-associated cardiac injury without the confounding vasodilatory or coagulatory effects of isoflurane. These data demonstrate the physiologic advantages of α-chloralose over isoflurane for anesthesia in a swine model of severe submassive PE. PMID:25730758

  3. Paced QRS duration and myocardial scar amount: predictors of long-term outcome of right ventricular apical pacing.

    Science.gov (United States)

    Lee, Seung-Ah; Cha, Myung-Jin; Cho, Youngjin; Oh, Il-Young; Choi, Eue-Keun; Oh, Seil

    2016-07-01

    Long-term right ventricular apical pacing (RVAP) is reportedly associated with heart failure (HF) development. However, the predictors of pacing-induced HF (PHF) remained unclear. We retrospectively enrolled 234 patients without structural heart disease who underwent a permanent pacemaker implantation with RVAP between 1982 and 2004. RVAP-induced HF was defined as left ventricular ejection fraction decrease >5 % with HF symptom without other HF development etiology. The QRS duration of a paced beat (pQRSd) and myocardial scar score were analyzed from each patient's 12-lead ECG. During a mean 15.6 years (range 3.3-30.0 years), 48 patients (20.5 %) patients developed RVAP-induced HF. The PHF group patients had a longer pQRSd (192.4 ± 13.5 vs. 175.7 ± 14.7 ms in non-PHF patients, p scar score (5.2 ± 1.9 vs. 2.7 ± 1.9, respectively p scar score (HR 1.23, 95 % CI 1.03-1.49, p = 0.037), and a higher percentage of ventricular pacing (HR 1.31, 95 % CI 1.01-1.49, p = 0.010) were independent predictors of PHF. Based on the results of the receiver-operating characteristic (ROC) curve, the pQRSd cutoff was 185 ms (AUC 0.79, sensitivity 66.7 %, specificity 76.3 %) and myocardial scar score cutoff value was 4 (AUC 0.81, sensitivity 81.3 %, specificity 66.1 %). The pQRSd was positively correlated with scar score (r = 0.70, p scar score ≥4 might be independent long-term prognostic markers of PHF.

  4. The ratio of right ventricular volume to left ventricular volume reflects the impact of pulmonary regurgitation independently of the method of pulmonary regurgitation quantification

    Energy Technology Data Exchange (ETDEWEB)

    Śpiewak, Mateusz, E-mail: mspiewak@ikard.pl [Department of Coronary Artery Disease and Structural Heart Diseases, Institute of Cardiology, Warsaw (Poland); Cardiac Magnetic Resonance Unit, Institute of Cardiology, Warsaw (Poland); Małek, Łukasz A., E-mail: lmalek@ikard.pl [Cardiac Magnetic Resonance Unit, Institute of Cardiology, Warsaw (Poland); Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw (Poland); Petryka, Joanna, E-mail: joannapetryka@hotmail.com [Department of Coronary Artery Disease and Structural Heart Diseases, Institute of Cardiology, Warsaw (Poland); Cardiac Magnetic Resonance Unit, Institute of Cardiology, Warsaw (Poland); Mazurkiewicz, Łukasz, E-mail: lmazurkiewicz@ikard.pl [Cardiac Magnetic Resonance Unit, Institute of Cardiology, Warsaw (Poland); Department of Cardiomyopathy, Institute of Cardiology, Warsaw (Poland); Miłosz, Barbara, E-mail: barbara-milosz@o2.pl [Cardiac Magnetic Resonance Unit, Institute of Cardiology, Warsaw (Poland); Department of Radiology, Institute of Cardiology, Warsaw (Poland); Biernacka, Elżbieta K., E-mail: kbiernacka@ikard.pl [Department of Congenital Heart Diseases, Institute of Cardiology, Warsaw (Poland); Kowalski, Mirosław, E-mail: mkowalski@ikard.pl [Department of Congenital Heart Diseases, Institute of Cardiology, Warsaw (Poland); Hoffman, Piotr, E-mail: phoffman@ikard.pl [Department of Congenital Heart Diseases, Institute of Cardiology, Warsaw (Poland); Demkow, Marcin, E-mail: mdemkow@ikard.pl [Department of Coronary Artery Disease and Structural Heart Diseases, Institute of Cardiology, Warsaw (Poland); Miśko, Jolanta, E-mail: jmisko@wp.pl [Cardiac Magnetic Resonance Unit, Institute of Cardiology, Warsaw (Poland); Department of Radiology, Institute of Cardiology, Warsaw (Poland); Rużyłło, Witold, E-mail: wruzyllo@ikard.pl [Institute of Cardiology, Warsaw (Poland)

    2012-10-15

    Background: Previous studies have advocated quantifying pulmonary regurgitation (PR) by using PR volume (PRV) instead of commonly used PR fraction (PRF). However, physicians are not familiar with the use of PRV in clinical practice. The ratio of right ventricle (RV) volume to left ventricle volume (RV/LV) may better reflect the impact of PR on the heart than RV end-diastolic volume (RVEDV) alone. We aimed to compare the impact of PRV and PRF on RV size expressed as either the RV/LV ratio or RVEDV (mL/m{sup 2}). Methods: Consecutive patients with repaired tetralogy of Fallot were included (n = 53). PRV, PRF and ventricular volumes were measured with the use of cardiac magnetic resonance. Results: RVEDV was more closely correlated with PRV when compared with PRF (r = 0.686, p < 0.0001, and r = 0.430, p = 0.0014, respectively). On the other hand, both PRV and PRF showed a good correlation with the RV/LV ratio (r = 0.691, p < 0.0001, and r = 0.685, p < 0.0001, respectively). Receiver operating characteristic analysis showed that both measures of PR had similar ability to predict severe RV dilatation when the RV/LV ratio-based criterion was used, namely the RV/LV ratio > 2.0 [area under the curve (AUC){sub PRV} = 0.770 vs AUC{sub PRF} = 0.777, p = 0.86]. Conversely, with the use of the RVEDV-based criterion (>170 mL/m{sup 2}), PRV proved to be superior over PRF (AUC{sub PRV} = 0.770 vs AUC{sub PRF} = 0.656, p = 0.0028]. Conclusions: PRV and PRF have similar significance as measures of PR when the RV/LV ratio is used instead of RVEDV. The RV/LV ratio is a universal marker of RV dilatation independent of the method of PR quantification applied (PRF vs PRV)

  5. Lower Lid Ectropion in Hypohidrotic Ectodermal Dysplasia

    Directory of Open Access Journals (Sweden)

    Xiaoyun Zhang

    2015-01-01

    Full Text Available We report a case of a lower lid ectropion with ectodermal dysplasia and ectropion blepharoplasty surgery experience. A 14-year-old Han nationality male patient with typical characteristics of hypohidrotic ectodermal dysplasia presented to our clinic for his right lower lid eversion. The patient was diagnosed as having hypohidrotic ectodermal dysplasia and underwent an uneventful blepharoplasty surgery. The lower lid maintained normal position during the 10-month follow-up period. Patients with ectodermal dysplasia could firstly visit ophthalmologist for their ectropion and blepharoplasty surgery could be useful for the disease.

  6. Role of hybrid operating room in surgery for the right atrial thrombus, pulmonary thrombi, and ventricular septal rupture after myocardial infarction

    Science.gov (United States)

    Singh, Ajmer; Mehta, Yatin; Parakh, Rajiv; Kohli, Vijay; Trehan, Naresh

    2016-01-01

    Free-floating right heart thrombi are uncommon and need emergency treatment in view of their tendency to dislodge and cause pulmonary embolism. We report a successful surgical management of a patient who had large mobile right atrial thrombus, bilateral pulmonary thrombi, coronary artery disease, and postmyocardial infarction ventricular septal rupture (VSR). The patient underwent coronary angiography, inferior vena cava filter placement, removal of thrombi from the right atrium and pulmonary arteries, repair of VSR, and coronary artery bypass graft surgery in a hybrid operating room. PMID:27716704

  7. Iloprost improves ventricular function in the hypertrophic and functionally impaired right heart by direct stimulation

    DEFF Research Database (Denmark)

    Holmboe, Sarah; Andersen, Asger; Vildbrad, Mads D;

    2013-01-01

    Right heart function is an important predictor of morbidity and mortality in patients suffering from pulmonary arterial hypertension and congenital heart diseases. We investigated whether the prostacyclin analog iloprost has a direct inotropic effect in the pressure-overloaded hypertrophic...... and dysfunctional right ventricle (RV). Rats were randomized to monocrotaline injection (60 mg/kg; [Formula: see text]), pulmonary trunk banding (PTB; [Formula: see text]), or a sham operation ([Formula: see text]). RV function was evaluated with magnetic resonance imaging, echocardiography, and invasive pressure......]) increase in RV systolic pressure were found in the PTB group. Iloprost caused a decrease in mean arterial blood pressure (MAP) in all groups of animals. An equal reduction in MAP induced by the arterial vasodilator nitroprusside did not improve any of the measured parameters of RV function. We conclude...

  8. Methods for measuring right ventricular function and hemodynamic coupling with the pulmonary vasculature

    OpenAIRE

    Bellofiore, Alessandro; Chesler, Naomi C

    2013-01-01

    The right ventricle (RV) is a pulsatile pump, the efficiency of which depends on proper hemodynamic coupling with the compliant pulmonary circulation. The RV and pulmonary circulation exhibit structural and functional differences with the more extensively investigated left ventricle (LV) and systemic circulation. In light of these differences, metrics of LV function and efficiency of coupling to the systemic circulation cannot be used without modification to characterize RV function and effic...

  9. Ablação de taquicardia ventricular idiopática com morfologia de bloqueio de ramo esquerdo localizada no tronco da artéria pulmonar Ablation of idiopathic ventricular tachycardia with left bundle-branch block morphology located in the pulmonary trunk

    Directory of Open Access Journals (Sweden)

    Luiz Roberto Leite

    2005-02-01

    Full Text Available Paciente de 26 anos, sem cardiopatia estrutural, apresentando palpitações e pré-síncopes devido à taquicardia ventricular não sustentada, foi submetida a estudo eletrofisiológico para tentativa de ablação do foco arritmogênico, usando-se como local, os critérios de mapeamento. Sem obter êxito com o mapeamento da via de saída do ventrículo direito, posicionou-se o cateter dentro da artéria pulmonar com mapeamento de foco satisfatório, eliminando a taquicardia tão logo iniciada a radiofreqüência. Durante seguimento de 14 meses, a paciente permanece assintomática, sem arritmia ao Holter e não nessecitando de drogas antiarrítmicas.We report the case of a 26-year-old female patient with palpitations and presyncopes due to nonsustained ventricular tachycardia, who had no structural heart disease. The patient underwent electrophysiological study in an attempt to ablate the arrhythmogenic focus, whose location was determined by using mapping criteria. Because mapping of the right ventricular outflow tract was not successful, the catheter was placed inside the pulmonary artery with satisfactory mapping of the arrhythmogenic focus, and tachycardia was eliminated as soon as radiofrequency was initiated. The patient has remained asymptomatic for 14 months, with no treatment with antiarrhythmic drugs, and no arrhythmias on serial 24-hour Holter.

  10. Evaluation of right ventricular systolic function in patients with right ventricular myocardial infarction by ultrasound tissue tracking and strain rate imaging%组织追踪和应变率显像技术评价右室心肌梗死患者右室收缩功能

    Institute of Scientific and Technical Information of China (English)

    卢永昭; 谭深; 闫丽娟; 赵君智; 张景峰; 麦兴盛; 左鹏飞; 张耀仁

    2011-01-01

    Objective To explore the clinical application value of ultrasound tissue tracking( TTI) and strain rate imaging( SRI) in diagnosis of right ventricular myocardial infarction and evaluating right ventricular systolic function. Methods Twenty patients with acute right ventricular myocardial infarction and 24 healthy controls were enrolled in this study, Their right ventricular apical two chamber view and apical four chamher view were examined by TTI and SRI. The peak systolic displacement( PDS) of right ventricular anterior, inferior wall, lateral wall and the maximum systolic strain rate ( SSR) were detected. Results The PDS and SSR in patients with right ventricular myocardial infarction were lower than those in control group (P <0. 05 ) , and the diagnostic sensitivity of SSR was higher than PDS( P <0. 05 ) . Conclusion TTI and SRI can accurately diagnose right ventricular myocardial infarction,and can quantitatively evaluate the right ventricular systolic function.%目的 探讨超声组织追踪(TTI)和应变率显像(SRI)技术在诊断右室壁心肌梗死和评价右室局部收缩功能中的临床应用价值.方法 采用TTI和SRI技术对20例急性右室梗死患者和24例健康对照者的右室心尖两腔心切面和四腔心切面进行扫查,检测分析右室前壁、下壁、侧壁收缩期峰值位移值(PDS)、收缩期最大应变率(SSR).结果 右室心肌梗死患者的PDS和SSR均较对照组降低(P<0.05),而SSR较PDS显示结果更敏感(P<0.01).结论 TTI和SRI技术能够准确地诊断右室壁心肌梗死,并能对右室局部收缩功能进行定量评价.

  11. ARRHYTHMOGENIC CALMODULIN MUTATIONS AFFECT THE ACTIVATION AND TERMINATION OF CARDIAC RYANODINE RECEPTOR MEDIATED CA2+ RELEASE

    DEFF Research Database (Denmark)

    Søndergaard, Mads Toft; Chazin, Walter J.; Chen, Wayne S.R.;

    We recently identified the first two human missense mutations in a calmodulin (CaM) gene (CALM1) and linked these to catecholaminergic polymorphic ventricular tachycardia (CPVT) and sudden cardiac death in young individuals1. More CaM mutations have since been identified in CALM1 and also...... in the other two CaM genes (CALM2 and CALM3). All CaM mutations are associated with severe ventricular arrhythmias. CaM regulates several key proteins governing cardiac excitation-contraction coupling (ECC), including the cardiac ryanodine receptor (RyR2) Ca2+ release channel. RyR2 mutations also dominantly...... cause CPVT, where the mutations increase the channel sensitivity to activation and enhance the propensity for pro-arrhythmogenic spontaneous Ca2+ release. Here we investigated the effect of CPVT-linked CaM mutations (N53I and N97S) and two CaM mutations identified in individuals with early onset severe...

  12. The response of right ventricular size, function, and pressure to supine exercise: A comparison of patients with chronic obstructive lung disease and normal subjects

    International Nuclear Information System (INIS)

    The response of right ventricular ejection fraction (RVEF) and right ventricular end-diastolic volume (RVEDV) to exercise was studied in 11 patients with severe (FEV25sub(%)sub(-)75sub(%)=0.32+-0.13, mean+-SD) chronic obstructive pulmonary disease (COPD). Using gated radionuclide cardiac blood pool imaging techniques, the response of the patients with COPD was compared with that of 15 control subjects. Arterial blood gases, pulmonary arterial pressures, wedge pressure, and right ventricular pressures also were monitored in patients with COPD. The resting RVEF was lower and the resting RVEDV was higher in patients with COPD than in normals (both, P2). With exercise this cardiac index rose to 5.52+-1.7/min/m2(P<0.01) due to the increase in heart rate (83+-18 to 125+-25 beats/min; P<0.01) while stroke volume did not significantly change. During exercise, normal subjects showed an increase in RVEF while RVEDV did not change; in patients with COPD, the RVEF fell and the RVEDV increased. In the patients with COPD, mild resting arterial hypoxemia and hypercapnia were both exaggerated during exercise; and mild resting pulmonary arterial hypertension (PAm=24.3+-7.65 mm Hg) also worsened with exercise (PAm=41+-19 mm Hg, P<0.01). Correlation between change in RVEF and PAm was -0.58, and between change in RVEDV and PAm was 0.63. We conclude that patients with severe COPD often have right ventricular dilation at rest and commonly respond to supine exercise with a fall in FV ejection fraction and further dilation of the right ventricle. (orig.)

  13. 超声心动图在右心功能评价中的应用%Echocardiography in Evaluation of Right Ventricular Function

    Institute of Scientific and Technical Information of China (English)

    彭玲

    2012-01-01

    右心功能不全或右心衰竭是一种复杂的临床综合征,常导致患者预后不良,病死率高.为早期发现右心功能障碍,及时指导治疗和评价治疗效果,对右心功能的监测越来越引起临床医生的关注.超声心动图具有无创、准确和重复性好等优点而广泛应用于心功能的评价.我们就如何运用超声心动图来简便有效、准确敏感地评价右心功能做一综述,为其能进一步推广应用于临床打下良好的基础.%Right ventricular dysfunction or right heart failure is a complex clinical syndrome and often leads to a poor prognosis and high mortality. In order to detect right ventricular dysfunction at an early stage, provide a therapy guidance and evaluate treatment outcomes, right ventricular function evaluation has aroused more and more concern in clinical physicians. With the advantages of being non-invasive, accuracy and repetitiveness, echocardiography is used extensively in the assessment of heart function. In this review, we focus on how to use echocardiography to evaluate right ventricular function easily, efficiently, accurately and sensitively, and provide a good foundation for its further clinical application.

  14. Echocardiographic assessment of global longitudinal right ventricular function in patients with an acute inferior ST elevation myocardial infarction and proximal right coronary artery occlusion.

    Science.gov (United States)

    Hutyra, Martin; Skála, Tomáš; Horák, David; Köcher, Martin; Tüdös, Zbyněk; Zapletalová, Jana; Přeček, Jan; Louis, Albert; Smékal, Aleš; Táborský, Miloš

    2015-03-01

    Right ventricular (RV) myocardial infarction (MI) is a frequent concomitant of an acute inferior MI. We set out to determine the diagnostic value of speckle tracking echocardiography in comparison with cardiac magnetic resonance (CMR) for RV stunning and scar prediction. 55 patients (66 ± 11 years) with an acute inferior ST elevation MI who underwent percutaneous coronary intervention (PCI) of an occlusion in the proximal right coronary artery were prospectively enrolled. An echocardiography was done on the day of presentation and on the 5th day thereafter. A CMR was subsequently performed 1 month after the MI. The CMR was used to differentiate between the group with RV scar (n = 26) and without RV scar (n = 29). RV peak systolic longitudinal strain (RV-LS) at presentation determined RV scar (-21.1 ± 5.1% vs. -9.9 ± 4.6%, p -15.8% had a sensitivity of 92% and a specificity of 83% in RV scar prediction (AUC 0.93). RV-LS was superior to TAPSE and TDI in determining the presence of RV scar. According to RV-LS values at presentation and on the 5th day, 3 subgroups were defined: G1-normal deformation (RV-LS -20%, 5th day RV-LS -20%). In G1, there was neither RV scar nor clinically relevant hypotension. In G2, 58% of patients developed RV scar and 36% had hypotension. In the G3, 83% developed RV scar and 55% had hypotension. The myocardial deformation analysis could provide an early prediction of RV scar. It allowed the patients to be divided into subgroups with normal RV function, stunning and persistent RV dysfunction.

  15. Effect of food intake on left and right ventricular systolic tissue Doppler measurements.

    Science.gov (United States)

    Dieden, Anna; Gårdinger, Ylva; Hlebowicz, Joanna; Björgell, Ola; Dencker, Magnus

    2016-09-01

    Systolic tissue Doppler measurements (s') have been used to measure the velocity in myocardial motion and are a valuable tool for evaluating the systolic function of the left and right ventricles. Digestion of food is known to significantly alter hemodynamics and may therefore affect s'. The effect of food intake on s' parameters has not yet been studied. We assessed whether s' is affected by food intake. Nineteen healthy subjects aged 26·2 ± 4·2 years were investigated. s' was measured with pulsed tissue Doppler imaging in the right and left ventricles before the subjects ate a standardized meal and also 30 and 110 min after the meal. Three measurements were taken in each projection, and a mean value was calculated for each. s' increased significantly (Pfasting to 30 min after food intake in every measured site except in the left inferolateral wall (P = 0·15, NS). Several, but not all, variables returned to base value 110 min after food intake. This study shows that food intake affects the tissue Doppler variables used to evaluate systolic heart function. Further studies are needed in older healthy subjects and older subjects with various cardiovascular diseases. PMID:25976703

  16. The Correlation between Left and Right Ventricular Ejection Fractions in Patients with Ischemic Heart Disease, Documented by Cardiac Magnetic Resonance Imaging

    Directory of Open Access Journals (Sweden)

    Ali Eshraghi

    2016-03-01

    Full Text Available Introduction: The correlation between right and left ventricular ejection fractions (RVEF and LVEF, respectively has been studied in only a small number of patients with a marked decrease in RVEF and LVEF. The aim of the present study was to compare LVEF and RVEF in patients with ischemic heart disease. RVEF and LVEF were measured by Cardiovascular Magnetic Resonance (CMR imaging. Materials and Methods: This observational study was done in Ghaem general hospital in 2014.  LVEF and RVEF were measured in a series of 33 patients with ischemic heart disease, undergoing CMR for the evaluation of myocardial viability. The correlation between RVEF and LVEF in patients with ischemic heart disease was studied, using Pearson product-moment correlation coefficient analysis.   This study was done in Ghaem general hospital in 2014 with simple sapling. Results: Right ventricular end diastolic volume (186.33±58.90 and left ventricular end diastolic volume (121.72±61.64 were significantly correlated (r=0.223, P=0.005. Moreover, there was a significant correlation between right ventricular end systolic volume (88.18±40.90 and left ventricular end systolic volume (140.96±35.33 (r=0.329, P=0.000. The most significant association was observed between RVEF and LVEF (r=0.913, P=0.000. Conclusion: Based on the findings, RVEF and LVEF were significantly correlated in patients with ischemic heart disease, although this association was not always present in all cardiac patients. The cause of this discrepancy is still unknown.

  17. Hemodynamic and radionuclide effects of acute captopril therapy for heart failure: changes in left and right ventricular volumes and function at rest and during exercise

    International Nuclear Information System (INIS)

    Although the resting hemodynamic effects of captopril in congestive heart failure are known, little information is available about the hemodynamic response to captopril during exercise or about changes in noninvasive measurements of the size and function of both ventricles. In this study, 14 stable New York Heart Association class III patients were given 25 mg of oral captopril. Rest and exercise hemodynamic measurements and blood pool scintigrams were performed simultaneously before and 90 minutes after captopril. The radionuclide studies were analyzed for left and right ventricular end-diastolic volumes, end-systolic volumes, ejection fractions and pulmonary blood volume. The primary beneficial responses at rest were decreases in left and right ventricular end-diastolic volumes from 388 + 81 to 350 + 77 ml (p < 0.01) and from 52 + 26 to 43 + 20 volume units (p < 0.01), respectively, and in their corresponding filling pressures, from 24 + 10 to 17 + 9 mm Hg and 10 + 5 to and + 5 mm Hg (both p < 0.01). Altough stroke volume did not increase significantly, both left and right ventricular ejection fractions increased slightly, from 19 + 6% to 22 + 5% and from 25 + 9% to 29 + 11%, respectively (both p < 0.01). During exercise, similar changes were noted in both hemodynamic and radionuclide indexes. Thus, in patients with moderate symptomatic limitation from chronic heart failure, captopril predominantly reduces ventricular volume and filling pressure, with a less significant effect on cardiac output. These effects persist during exercise, when systemic vascular resistance is already very low. Radionuclide techniques are valuable in assessing the drug effect in these subjects, particularly when ventricular volumes are also measured

  18. Right Ventricular Adaptation Is Associated with the Glu298Asp Variant of the NOS3 Gene in Elite Athletes.

    Science.gov (United States)

    Szelid, Zsolt; Lux, Árpád; Kolossváry, Márton; Tóth, Attila; Vágó, Hajnalka; Lendvai, Zsuzsanna; Kiss, Loretta; Maurovich-Horvat, Pál; Bagyura, Zsolt; Merkely, Béla

    2015-01-01

    Nitric oxide (NO), an important endogenous pulmonary vasodilator is synthetized by the endothelial NO synthase (NOS3). Reduced NO bioavailability and thus the Glu298Asp polymorphism of NOS3 may enhance right ventricular (RV) afterload and hypertrophic remodeling and influence athletic performance. To test this hypothesis world class level athletes (water polo players, kayakers, canoeists, rowers, swimmers, n = 126) with a VO2 maximum greater than 50ml/kg/min were compared with non-athletic volunteers (n = 155). Cardiopulmonary exercise tests and cardiac magnetic resonance imaging (cMRI) were performed to determine structural or functional changes. Genotype distribution of the NOS3 Glu298Asp polymorphism was not affected by gender or physical performance. Cardiac MRI showed increased stroke volume with eccentric hypertrophy in all athletes regardless of their genotype. However, the Asp allelic variant carriers had increased RV mass index (32±6g versus 27±6g, ppolymorphism and RV structure and dimension in elite athletes emphasizes the importance of NOS3 gene function and NO bioavailability in sport related cardiac adaptation. PMID:26517550

  19. Widening of coronary sinus in CT pulmonary angiography indicates right ventricular dysfunction in patients with acute pulmonary embolism

    International Nuclear Information System (INIS)

    Right ventricular dysfunction (RVD) may occur in the course of acute pulmonary embolism (PE). Patients with RVD need more intensive treatment, and the prognosis is more severe. The aim of this study was to evaluate the usefulness of the measurement of the coronary sinus in the assessment of RVD in patients with acute PE and to compare it with other indicators of RVD. Retrospective assessment of 55 CT pulmonary angiography examinations with signs of acute PE was performed. Pulmonary artery systolic pressure (PASP) was echocardiographically assessed in all patients, and RVD was defined as PASP values greater than 30 mmHg. CT measurements included the size of the heart ventricles, mediastinal vessels and the width of the coronary sinus. Median width of the coronary sinus was 16 mm (range 12-24 mm) in patients with increased PASP and 10 mm (range 7-22 mm) in patients with normal PASP (p = 0.001). Best cut-off value was assessed to be 12.5 mm, with sensitivity 94% and specificity 75%. It was characterised by the largest area under ROC curve (0.82) among analysed parameters. Width of the coronary sinus seems to be a promising parameter for identification of RVD in patients with acute PE. A prospective study should be undertaken to further assess its clinical and prognostic applicability. (orig.)

  20. Assessment of cardiac troponin I in patients with pulmonary emboli and its relationship with right ventricular dysfunction

    Directory of Open Access Journals (Sweden)

    Sasan Tavana

    2009-01-01

    Full Text Available (Received 16 December, 2008; Accepted 27 May, 2009AbstractBackground and purpose: Right ventricular dysfunction is common in major pulmonary embolisms. The purpose of this study was to evaluate the prevalence and diagnostic utility of cardiac troponin I and also to identify patients with RV dysfunction in pulmonary embolism.Materials and methods: This study was conducted on 42 patients with pulmonary embolism in Ekbatan Hospital, in Hamedan city. Data from history, echocardiogram, and lung perfusion scan was obtained from medical records. Blood samples were obtained immediately after pulmonary embolism was diagnosed. Cardiac troponin was measured using chromatographic assay.Results: Two patients (4.8% had positive troponin I (≥0.5µg/l, and 40 patients (95.2% had negative troponin I (0.05. Conclusion: Our data demonstrates that troponin I measurement is not able to distinguish specifically between coronary and non- coronary causes of chest pain.J Mazand Univ Med Sci 2009; 19(70: 72-75 (Persian

  1. Scintigraphic prediction of pulmonary arterial systolic pressure by regional right ventricular ejection fraction during the second half of systole

    Energy Technology Data Exchange (ETDEWEB)

    Friedman, B.J.; Holman, B.L.

    1982-11-01

    In 49 patients in whom gated equilibrium ventriculography and cardiac catheterization were performed within a 6 day interval, total and fractional portions of global and regional right ventricular ejection fraction (RVEF) were correlated with pulmonary arterial systolic pressure. Pulmonary arterial systolic pressure was normal (30 mm Hg or less) in 27 patients (Group I) and elevated (31 mm Hg or greater) in 22 patients (Group II). The second-half regional RVEF was 38 +/- 8% (mean +/- standard deviation) with a range of 30 to 54% for Group I and 22 +/- 6% with a range of 13 to 32% for Group II. The difference between the means was statistically significant (p less than 0.001). Use of a second-half regional RVEF of 30% as the criterion of elevated pulmonary arterial systolic pressure resulted in a sensitivity of 0.86 and a specificity of 1.00. A power curve fit in which pulmonary arterial systolic pressure . 10.91 (second-half regional RVEF)-0.87 allowed accurate estimation (r . -0.85) of pulmonary arterial systolic pressure from the second-half regional RVEF. It is concluded that second-half regional RVEF may be used to accurately detect pulmonary arterial hypertension and to estimate its extent.

  2. Plasma CCN2/connective tissue growth factor is associated with right ventricular dysfunction in patients with neuroendocrine tumors

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    Aakhus Svend

    2010-01-01

    Full Text Available Abstract Background Carcinoid heart disease, a known complication of neuroendocrine tumors, is characterized by right heart fibrotic lesions. Carcinoid heart disease has traditionally been defined by the degree of valvular involvement. Right ventricular (RV dysfunction due to mural involvement may also be a manifestation. Connective tissue growth factor (CCN2 is elevated in many fibrotic disorders. Its role in carcinoid heart disease is unknown. We sought to investigate the relationship between plasma CCN2 and valvular and mural involvement in carcinoid heart disease. Methods Echocardiography was performed in 69 patients with neuroendocrine tumors. RV function was assessed using tissue Doppler analysis of myocardial systolic strain. Plasma CCN2 was analyzed using an enzyme-linked immunosorbent assay. Mann-Whitney U, Kruskal-Wallis, Chi-squared and Fisher's exact tests were used to compare groups where appropriate. Linear regression was used to evaluate correlation. Results Mean strain was -21% ± 5. Thirty-three patients had reduced RV function (strain > -20%, mean -16% ± 3. Of these, 8 had no or minimal tricuspid and/or pulmonary regurgitation (TR/PR. Thirty-six patients had normal or mildly reduced RV function (strain ≤ -20%, mean -25% ± 3. There was a significant inverse correlation between RV function and plasma CCN2 levels (r = 0.47, p Conclusions Elevated plasma CCN2 levels are associated with RV dysfunction and valvular regurgitation in NET patients. CCN2 may play a role in neuroendocrine tumor-related cardiac fibrosis and may serve as a marker of its earliest stages.

  3. Right Ventricular Doppler Echocardiographic Study of Indeterminate Form of Chagas Disease

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    Rogério Gomes Furtado

    2015-03-01

    Full Text Available Background: Patients with indeterminate form of Chagas disease/cardiac normality (ICD/CN exhibited normal electrocardiograms and chest X-rays; however, more sophisticated tests detected some degree of morphological and functional changes in the heart. Objective: To assess the prevalence of systolic and diastolic dysfunction of the right ventricle (RV in patients with ICD/CN. Methods: This was a case–control and prevalence study. Using Doppler two-dimensional echocardiography (2D, 92 patients were assessed and divided into two groups: group I (normal, n = 31 and group II (ICD/CN, n = 61. Results: The prevalence of RV systolic dysfunction in patients in groups I and II was as follows: fractional area change (0.0% versus 0.6%, mobility of the tricuspid annulus (0.0% versus 0.0%, and S-wave tissue Doppler (6.4% versus 26.0%, p = 0.016. The prevalence of global disorders such as the right myocardial performance index using tissue Doppler (16.1% versus 27.8%, p = 0.099 and pulsed Doppler (61.3% versus 68%, p = 0.141 and diastolic disorders such as abnormal relaxation (0.0% versus 6.0%, pseudonormal pattern (0.0% versus 0.0%, and restrictive pattern (0.0% versus 0.0% was not statistically different between groups. Conclusion: The prevalence of RV systolic dysfunction was estimated to be 26% (S wave velocity compared with other variables, suggesting incipient changes in RV systolic function in the ICD/CN group.

  4. Early right ventricular systolic dysfunction in patients with systemic sclerosis without pulmonary hypertension: a Doppler Tissue and Speckle Tracking echocardiography study

    Directory of Open Access Journals (Sweden)

    Baumann Gert

    2010-01-01

    Full Text Available Abstract Background Isovolumetric acceleration (IVA is a novel tissue Doppler parameter for the assessment of systolic function. The aim of this study was to evaluate IVA as an early parameter for the detection of right ventricular (RV systolic dysfunction in patients with systemic sclerosis (SSc without pulmonary hypertension. Methods 22 patients and 22 gender- and age-matched healthy subjects underwent standard echocardiography with tissue Doppler imaging (TDI and speckle tracking strain to assess RV function. Results Tricuspid annular plane systolic excursion (TAPSE (23.2 ± 4.1 mm vs. 26.5 ± 2.9 mm, p 2 vs. 4.1 ± 0.8 m/s2, p Conclusion IVA is a useful tool with high-predictive power to detect early right ventricular systolic impairment in patients with SSc and without pulmonary hypertension.

  5. Septo-Optic Dysplasia

    Science.gov (United States)

    ... Enhancing Diversity Find People About NINDS NINDS Septo-Optic Dysplasia Information Page Synonym(s): De Morsier's Syndrome Table ... being done? Clinical Trials Organizations What is Septo-Optic Dysplasia? Septo-optic dysplasia (SOD) is a rare ...

  6. Right ventricular dysfunction as predictor of longer hospital stay in patients with acute decompensated heart failure: a prospective study in Indonesian population

    OpenAIRE

    Yamin, Paskariatne Probo Dewi; Raharjo, Sunu Budhi; Putri, Vebiona Kartini Prima; Hersunarti, Nani

    2016-01-01

    Background Hospital length of stay (LOS) is a key determinant of heart failure hospitalization costs. Longer LOS is associated with lower quality of care measures and higher rates of readmission and mortality. Right ventricular (RV) dysfunction predicted poor outcomes in patients with stable chronic heart failure (CHF), however, its prognostic value in the acute decompensated heart failure (ADHF) patients has not been sufficiently clarified. This study investigated the prognostic value of RV ...

  7. Right Ventricle-Sparing Left Ventricular Resection and Replacement with a Continuous-Flow Rotary Blood Pump: An In Vivo Experiment

    OpenAIRE

    Frazier, O H; Tuzun, Egemen; Narin, Cuneyt; Cohn, William E.

    2010-01-01

    Despite recent advances in left ventricular assist device and total artificial heart technologies, these devices are still so large that they pose a significant problem in small patients with refractory heart failure. Excising the left ventricle while preserving the right ventricle—and then replacing the left ventricle with a mechanical pump—has been proposed as an alternative approach to this problem. We conducted a pilot study to evaluate possible surgical techniques and the hemodynamic eff...

  8. Fibromuscular dysplasia

    OpenAIRE

    Jeunemaitre Xavier; Gimenez-Roqueplo Anne-Paule; Boutouyrie Pierre; Perdu Jérôme; La Batide-Alanore Agnès; Plouin Pierre-François

    2007-01-01

    Abstract Fibromuscular dysplasia (FMD), formerly called fibromuscular fibroplasia, is a group of nonatherosclerotic, noninflammatory arterial diseases that most commonly involve the renal and carotid arteries. The prevalence of symptomatic renal artery FMD is about 4/1000 and the prevalence of cervicocranial FMD is probably half that. Histological classification discriminates three main subtypes, intimal, medial and perimedial, which may be associated in a single patient. Angiographic classif...

  9. Right-To-Left Ventricular Differences in the Expression of Mitochondrial Hexokinase and Phosphorylation of Akt

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    Petra Waskova-Arnostova

    2013-01-01

    Full Text Available Background/Aims: Hexokinase (HK is a key glycolytic enzyme which promotes the maintenance of glucose homeostasis in cardiomyocytes. HK1 isoform is predominantly bound to the outer mitochondrial membrane and highly supports oxidative phosphorylation by increasing the availability of ADP for complex V of the respiratory chain. HK2 isoform is under physiological conditions predominantly localized in the cytosol and upon stimulation of PI3K/ Akt pathway associates with mitochondria and thus can prevent apoptosis. The purpose of this study was to investigate expression and subcellular localization of both HK isoforms in left (LV and right (RV heart ventricles of adult male Wistar rats. Methods: Real-Time RT-PCR, Western blotting, and quantitative immunofluorescence microscopy were used. Results: Our results showed a significantly higher expression of both HK1 and HK2 at mRNA and protein levels in the RV compared to the LV. These findings were corroborated by immunofluorescence staining which revealed substantially higher fluorescence signals of both HKs in the RV than in the LV. The ratios of phospho-Ser473-Akt/non-phospho-Akt and phospho-Thr308-Akt/non-phospho-Akt were also markedly higher in the RV than in the LV. Conclusion: These results suggest that the RV has a higher activity of aerobic glycolytic metabolism and may be able to respond faster and more powerfully to stressful stimuli than the LV.

  10. Fungal endocarditis with right ventricular candidal mycetoma in a premature neonate

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    Jayashree Purkayastha

    2015-09-01

    Full Text Available Fungal mycetoma or endocarditis is rare in premature neonates and it is often associated with high mortality. In the majority of the cases diagnosis is made postmortem. Here we report a 0-week-old preterm neonate who developed Candida albicans blood stream infection complicated by endocarditis and subsequent mycetoma. Initially, this neonate had Klebsiella sepsis requiring multiple antibiotic courses. A peripherally inserted central venous catheter was used to give total parenteral nutrition. On day 24 of life, he developed candidemia, treated with 14 day course of fluconazole and shown improvement. Further, on day 60 of life he developed cholestasis, deranged liver function tests and persistent thrombocytopenia along with apnea, bradycardia and desaturations. Blood culture again grew again C. albicansEchocardiography showed large fungal vegetation on tricuspid valve with a mycetoma filling the right ventricle. He was treated with intravenous amphotericin B, fluconazole and upportive measures, but he deteriorated and succumbed after two weeks. J Microbiol Infect Dis 2015;5(3: 142-145

  11. [Acquired Left Ventricular-right Atrial Communication due to Infective Endocarditis;Report of a Case].

    Science.gov (United States)

    Sakasai, Yoshie; Sasaki, Akinobu; Shigeta, Osamu; Tsumagari, Yasuaki; Tsuneoka, Hidekazu; Misaki, Masako; Takeyasu, Noriyuki

    2016-08-01

    A 77-year-old woman presented with a 3-week history of low grade fever, appetite loss and dizziness. An electrocardiogram showed complete heart block. Echocardiography demonstrated severe aortic valve stenosis and a mass of probable vegetation 2 cm in diameter on the atrioventricular septum in the right atrium (RA), but no obvious intra-cardiac fistula. There was no growth of organism in blood cul tures. In the 4th week after admission, a harsh and continuous cardiac murmur was detected for the 1st time. Portable echocardiography revealed disappearance of the mass in the RA, and showed an intra-cardiac shunt from the left ventricle( LV) to RA. The shunt was closed by autologous pericardial patch form LV side and directly with mattress suture form RA side during the emergency operation. The aortic valve was replaced with bio-prosthetic valve (SJM Trifecta 19 mm). No organism was detected in the excised tissue, but antibiotics were continued for 2 months until a permanent pacemaker was inserted. PMID:27476571

  12. Assessment of right ventricular oxidative metabolism by PET in patients with idiopathic dilated cardiomyopathy undergoing cardiac resynchronisation therapy

    Energy Technology Data Exchange (ETDEWEB)

    Knuuti, Juhani; Naum, Alexandru; Stolen, Kira Q.; Kalliokoski, Riikka [University of Turku, Turku PET Centre, P.O. Box 52, Turku (Finland); Sundell, Jan [University of Turku, Turku PET Centre, P.O. Box 52, Turku (Finland); University of Turku, Department of Medicine, Turku (Finland); Engblom, Erik; Koistinen, Juhani; Airaksinen, K.E. Juhani [University of Turku, Department of Medicine, Turku (Finland); Ylitalo, Antti [Satakunta Central Hospital, Department of Medicine, Pori (Finland); Nekolla, Stephan G. [Klinikum rechts der Isar der Technischen Universitaet Muenchen, Klinik und Poliklinik fuer Nuklearmedizin, Munich (Germany); Bax, K.E. Jeroen J. [Leiden University, Department of Cardiology, Leiden (Netherlands)

    2004-12-01

    Right ventricular (RV) performance is known to have prognostic value in patients with congestive heart failure (CHF). Cardiac resynchronisation therapy (CRT) has been found to enhance left ventricular (LV) energetics and metabolic reserve in patients with heart failure. The interplay between the LV and RV may play an important role in CRT response. The purpose of the study was to investigate RV oxidative metabolism, metabolic reserve and the effects of CRT in patients with CHF and left bundle brach block. In addition, the role of the RV in the response to CRT was evaluated. Ten patients with idiopathic dilated cardiomyopathy who had undergone implantation of a biventricular pacemaker 8{+-}5 months earlier were studied under two conditions: CRT ON and after CRT had been switched OFF for 24 h. Oxidative metabolism was measured using [{sup 11}C]acetate positron emission tomography (K{sub mono}). The measurements were performed at rest and during dobutamine-induced stress (5 {mu}g/kg per minute). LV performance and interventricular mechanical delay (interventricular asynchrony) were measured using echocardiography. CRT had no effect on RV K{sub mono} at rest (ON: 0.052{+-}0.014, OFF: 0.047{+-}0.018, NS). Dobutamine-induced stress increased RV K{sub mono} significantly under both conditions but oxidative metabolism was more enhanced when CRT was ON (0.076{+-}0.026 vs 0.065{+-}0.027, p=0.003). CRT shortened interventricular delay significantly (45{+-}33 vs 19{+-}35 ms, p=0.05). In five patients the response to CRT was striking (32% increase in mean LV stroke volume, range 18-36%), while in the other five patients no response was observed (mean change +2%, range -6% to +4%). RV K{sub mono} and LV stroke volume response to CRT correlated inversely (r=-0.66, p=0.034). None of the other measured parameters, including all LV parameters and electromechanical parameters, were associated with the response to CRT. In responders, RV K{sub mono} with CRT OFF was significantly lower

  13. Validation of real-time three-dimensional echocardiography for quantifying left and right ventricular volumes:an experimental study

    Institute of Scientific and Technical Information of China (English)

    费洪文; 王新房; 谢明星; 庄磊; 陈立新; 杨颖; 黄润青; 王静

    2004-01-01

    Background Assessment of the left ventricular (LV) and the right ventricular (RV) volumes and their functions is important for prognostic prediction and clinical decision making. We compared the accuracy for quantifying the LV and the RV volumes in vitro between conventional two-dimensional echocardiography (2DE) and real-time three-dimensional echocardiography (RT3DE). Methods The volumes of 37 rubber-models (10 regularly shaped to simulate normal LV, 7 shaped to simulate LV with symmetric aneurysm, 8 shaped to simulate LV with asymmetric aneurysm, and 12 irregularly shaped to simulate normal RV) and 10 excised canine hearts were measured by RT3DE and 2DE. On RT3DE "full volume" imaging, the inner-surfaces of the rubber-models and canine LV and RV were outlined and the volumes were measured using 2-, 4-, 8- and 16-plane methods with the RT3DE analysis software. On 2DE imaging, the volumes were measured by the Simpson method. The LV and RV volumes measured by drained water were served as reference values, with which we compared RT3DE and 2DE data.Results In rubber models mimicking normal LV and LV with symmetric aneurysms, RT3DE results were strongly correlated with reference values (r=0.795-0.998) and there was a good correlation between 2DE estimates and reference values (r=0.715-0.729). There were no significant differences between RT3DE estimates, 2DE results and reference values (P>0.05). In rubber models mimicking the RV and LV with asymmetric aneurysm, RT3DE strongly correlated with reference values (r=0.765-0.988), but 2DE weakly correlated with reference values (r=0.518-0.592). There were no differences between RT3DE and reference values (P>0.05), but a significant difference between 2DE and reference values occurred (P0.05), but there was a significant difference between 2DE and reference values (P<0.05).Conclusions RT3DE can accurately quantify LV and RV volumes and provides a new tool to evaluate LV and RV function. For LV and RV measurements by RT3DE

  14. Usefulness of color kinesis imaging for evaluation of regional right ventricular wall motion in patients with surgically repaired tetralogy of Fallot.

    Science.gov (United States)

    Hayabuchi, Y; Matsuoka, S; Kubo, M; Kuroda, Y

    1998-11-15

    We evaluated regional right ventricular wall motion during systole in patients with surgically repaired tetralogy of Fallot (TOF) using color kinesis imaging. Color kinesis images were obtained in a subcostal sagittal view from 19 patients with repaired TOF (TOF group), aged 3 to 5 years, and 20 age-matched normal subjects (control group). For regional wall motion analysis, the endocardial motion distance and the fractional area change (FAC) were calculated for 6 segments obtained from color kinesis images. The endocardial inward excursion distances and the FACs in the upper, middle, and lower posterior segments of the TOF group were significantly greater than those of the control group (p kinesis measurements was excellent (y = 1.14x - 1.30, r = 0.87 for the endocardial inward excursion, and y = 1.03x +/- 0.56, r = 0.91 for the FAC). In conclusion, color kinesis is a useful method for assessing regional right ventricular wall motion. Segmental analysis of color kinesis images provides accurate, automated, and quantitative diagnosis of regional right ventricular wall motion abnormalities in patients with surgically repaired TOF.

  15. Comparison of tricuspid inflow and superior vena caval Doppler velocities in acute simulated hypovolemia: new non-invasive indices for evaluating right ventricular preload

    Directory of Open Access Journals (Sweden)

    Duan Yun-You

    2006-05-01

    Full Text Available Abstract Background Assessment of cardiac preload is important for clinical management of some emergencies related to hypovolemia. Effects of acute simulated hypovolemia on Doppler blood flow velocity indices of tricuspid valve (TV and superior vena cava (SVC were investigated in order to find sensitive Doppler indices for predicting right ventricular preload. Methods Doppler flow patterns of SVC and TV in 12 healthy young men were examined by transthoracic echocardiography (TTE during graded lower body negative pressure (LBNP of up to -60 mm Hg which simulated acute hypovolemia. Peak velocities of all waves and their related ratios (SVC S/D and tricuspid E/A were measured, calculated and statistically analyzed. Results Except for the velocity of tricuspid A wave, velocities of all waves and their related ratios declined during volume decentralization. Of all indices measured, the peak velocities of S wave and AR wave in SVC correlated most strongly with levels of LBNP (r = -0.744 and -0.771, p Conclusion The S and AR velocities are of good values in assessing right ventricular preload. Monitoring SVC flow may provide a relatively noninvasive means to assess direct changes in right ventricular preload.

  16. The Frank-Starling mechanism involves deceleration of cross-bridge kinetics and is preserved in failing human right ventricular myocardium.

    Science.gov (United States)

    Milani-Nejad, Nima; Canan, Benjamin D; Elnakish, Mohammad T; Davis, Jonathan P; Chung, Jae-Hoon; Fedorov, Vadim V; Binkley, Philip F; Higgins, Robert S D; Kilic, Ahmet; Mohler, Peter J; Janssen, Paul M L

    2015-12-15

    Cross-bridge cycling rate is an important determinant of cardiac output, and its alteration can potentially contribute to reduced output in heart failure patients. Additionally, animal studies suggest that this rate can be regulated by muscle length. The purpose of this study was to investigate cross-bridge cycling rate and its regulation by muscle length under near-physiological conditions in intact right ventricular muscles of nonfailing and failing human hearts. We acquired freshly explanted nonfailing (n = 9) and failing (n = 10) human hearts. All experiments were performed on intact right ventricular cardiac trabeculae (n = 40) at physiological temperature and near the normal heart rate range. The failing myocardium showed the typical heart failure phenotype: a negative force-frequency relationship and β-adrenergic desensitization (P kinetics in human myocardium. Decreasing muscle length accelerated the rate of cross-bridge reattachment (ktr) in both nonfailing and failing myocardium (P 0.05), indicating that this regulatory mechanism is preserved in heart failure. Length-dependent assessment of twitch kinetics mirrored these findings; normalized dF/dt slowed down with increasing length of the muscle and was virtually identical in diseased tissue. This study shows for the first time that muscle length regulates cross-bridge kinetics in human myocardium under near-physiological conditions and that those kinetics are preserved in the right ventricular tissues of heart failure patients.

  17. Matrix metalloproteinase inhibition attenuates right ventricular dysfunction and improves responses to dobutamine during acute pulmonary thromboembolism

    Science.gov (United States)

    Neto-Neves, Evandro M; Sousa-Santos, Ozelia; Ferraz, Karina C; Rizzi, Elen; Ceron, Carla S; Romano, Minna M D; Gali, Luis G; Maciel, Benedito C; Schulz, Richard; Gerlach, Raquel F; Tanus-Santos, Jose E

    2013-01-01

    Activated matrix metalloproteinases (MMPs) cause cardiomyocyte injury during acute pulmonary thromboembolism (APT). However, the functional consequences of this alteration are not known. We examined whether doxycycline (a MMP inhibitor) improves right ventricle function and the cardiac responses to dobutamine during APT. APT was induced with autologous blood clots (350 mg/kg) in anaesthetized male lambs pre-treated with doxycycline (Doxy, 10 mg/kg/day, intravenously) or saline. Non-embolized control lambs received doxycycline pre-treatment or saline. The responses to intravenous dobutamine (Dob, 1, 5, 10 μg/kg/min.) or saline infusions at 30 and 120 min. after APT induction were evaluated by echocardiography. APT increased mean pulmonary artery pressure and pulmonary vascular resistance index by ∼185%. Doxycycline partially prevented APT-induced pulmonary hypertension (P  0.05). RV dysfunction on stress echocardiography was observed in embolized lambs (APT+Dob group) but not in embolized animals pre-treated with doxycycline (Doxy+APT+Dob). APT increased MMP-9 activity, oxidative stress and gelatinolytic activity in the RV. Although doxycycline had no effects on RV MMP-9 activity, it prevented the increases in RV oxidative stress and gelatinolytic activity (P < 0.05). APT increased serum cardiac troponin I concentrations (P < 0.05), doxycycline partially prevented this alteration (P < 0.05). We found evidence to support that doxycycline prevents RV dysfunction and improves the cardiac responses to dobutamine during APT. PMID:24199964

  18. Nicorandil prevents right ventricular remodeling by inhibiting apoptosis and lowering pressure overload in rats with pulmonary arterial hypertension.

    Directory of Open Access Journals (Sweden)

    Xiang-Rong Zuo

    Full Text Available BACKGROUND: Most of the deaths among patients with severe pulmonary arterial hypertension (PAH are caused by progressive right ventricular (RV pathological remodeling, dysfunction, and failure. Nicorandil can inhibit the development of PAH by reducing pulmonary artery pressure and RV hypertrophy. However, whether nicorandil can inhibit apoptosis in RV cardiomyocytes and prevent RV remodeling has been unclear. METHODOLOGY/PRINCIPAL FINDINGS: RV remodeling was induced in rats by intraperitoneal injection of monocrotaline (MCT. RV systolic pressure (RVSP was measured at the end of each week after MCT injection. Blood samples were drawn for brain natriuretic peptide (BNP ELISA analysis. The hearts were excised for histopathological, ultrastructural, immunohistochemical, and Western blotting analyses. The MCT-injected rats exhibited greater mortality and less weight gain and showed significantly increased RVSP and RV hypertrophy during the second week. These worsened during the third week. MCT injection for three weeks caused pathological RV remodeling, characterized by hypertrophy, fibrosis, dysfunction, and RV mitochondrial impairment, as indicated by increased levels of apoptosis. Nicorandil improved survival, weight gain, and RV function, ameliorated RV pressure overload, and prevented maladaptive RV remodeling in PAH rats. Nicorandil also reduced the number of apoptotic cardiomyocytes, with a concomitant increase in Bcl-2/Bax ratio. 5-hydroxydecanoate (5-HD reversed these beneficial effects of nicorandil in MCT-injected rats. CONCLUSIONS/SIGNIFICANCE: Nicorandil inhibits PAH-induced RV remodeling in rats not only by reducing RV pressure overload but also by inhibiting apoptosis in cardiomyocytes through the activation of mitochondrial ATP-sensitive K(+ (mitoK(ATP channels. The use of a mitoK(ATP channel opener such as nicorandil for PAH-associated RV remodeling and dysfunction may represent a new therapeutic strategy for the amelioration of RV

  19. Cardiac-specific genetic inhibition of nuclear factor-κB prevents right ventricular hypertrophy induced by monocrotaline.

    Science.gov (United States)

    Kumar, Sandeep; Wei, Chuanyu; Thomas, Candice M; Kim, Il-Kwon; Seqqat, Rachid; Kumar, Rajesh; Baker, Kenneth M; Jones, W Keith; Gupta, Sudhiranjan

    2012-04-15

    Uncontrolled pulmonary arterial hypertension (PAH) results in right ventricular (RV) hypertrophy (RVH), progressive RV failure, and low cardiac output leading to increased morbidity and mortality (McLaughlin VV, Archer SL, Badesch DB, Barst RJ, Farber HW, Lindner JR, Mathier MA, McGoon MD, Park MH, Rosenson RS, Rubin LJ, Tapson VF, Varga J. J Am Coll Cardiol 53: 1573-1619, 2009). Although the exact figures of its prevalence are difficult to obtain because of the diversity of identifiable causes, it is estimated that the incidence of pulmonary hypertension is seven to nine cases per million persons in the general population and is most prevalent in the age group of 20-40, occurring more commonly in women than in men (ratio: 1.7 to 1; Rubin LJ. N Engl J Med 336: 111-117, 1997). PAH is characterized by dyspnea, chest pain, and syncope. Unfortunately, there is no cure for this disease and medical regimens are limited (Simon MA. Curr Opin Crit Care 16: 237-243, 2010). PAH leads to adverse remodeling that results in RVH, progressive right heart failure, low cardiac output, and ultimately death if left untreated (Humbert M, Morrell NW, Archer SL, Stenmark KR, MacLean MR, Lang IM, Christman BW, Weir EK, Eickelberg O, Voelkel NF, Rabinovitch M. J Am Coll Cardiol 43: 13S-24S, 2004; Humbert M, Sitbon O, Simonneau G. N Engl J Med 351: 1425-1436, 2004. LaRaia AV, Waxman AB. South Med J 100: 393-399, 2007). As there are no direct tools to assess the onset and progression of PAH and RVH, the disease is often detected in later stages marked by full-blown RVH, with the outcome predominantly determined by the level of increased afterload (D'Alonzo GE, Barst RJ, Ayres SM, Bergofsky EH, Brundage BH, Detre KM, Fishman AP, Goldring RM, Groves BM, Kernis JT, et al. Ann Intern Med 115: 343-349, 1991; Sandoval J, Bauerle O, Palomar A, Gomez A, Martinez-Guerra ML, Beltran M, Guerrero ML. Validation of a prognostic equation Circulation 89: 1733-1744, 1994). Various studies have been

  20. Epicardial Ventricular Tachycardia Ablation: Clinical Practice and Recent Developments

    Directory of Open Access Journals (Sweden)

    Michalis Efremidis MD

    2011-08-01

    Full Text Available Mapping and radiofrequency (RF catheter ablation of ventricular tachycardia (VT is a demanding procedure, with variable success rates (1. The presence of deep subendocardial or epicardial re-entry circuits is regarded as one of the reasons of failure of endocardial ablation, and these circuits have been acknowledged in ischemic and non-ischemic dilated cardiomyopathy (CMP, other types of CMP and especially in arrhythmogenic right ventricular cardiomyopathy (ARVC.The significance of epicardial VT circuits was brought to light in Chagas’ disease, which characteristically results in epicardial involvement in approximately 70% of patients (2. A recent study found one third of VTs to be epicardial in origin among patients with nonischemic CMP, about double the incidence among those with ischemic heart disease(3. Mapping and ablation of these epicardial circuits is quite exigent. Although coronary veins can be used to perform epicardial mapping, the manipulation of the catheter is strictly limited to the anatomical distribution of these vessels. Thus, the subxiphoid percutaneous approach to the pericardial space is the only technique that allows extensive, unhampered mapping of the epicardial surface of both ventricles.

  1. Cardiac hypertrophy, arrhythmogenicity and the new myocardial phenotype. II. The cellular adaptational process.

    Science.gov (United States)

    Swynghedauw, B; Chevalier, B; Charlemagne, D; Mansier, P; Carré, F

    1997-07-01

    Ventricular fibrosis is not the only structural determinant of arrhythmias in left ventricular hypertrophy. In an experimental model of compensatory cardiac hypertrophy (CCH) the degree of cardiac hypertrophy is also independently linked to ventricular arrhythmias. Cardiac hypertrophy reflects the level of adaptation, and matches the adaptational modifications of the myocardial phenotype. We suggest that these modifications have detrimental aspects. The increased action potential (AP) and QT duration and the prolonged calcium transient both favour spontaneous calcium oscillations, and both are potentially arrhythmogenic and linked to phenotypic changes in membrane proteins. To date, only two ionic currents have been studied in detail: Ito is depressed (likely the main determinant in AP durations), and If, the pacemaker current, is induced in the overloaded ventricular myocytes. In rat CCH, the two components of the sarcoplasmic reticulum, namely Ca(2+)-ATPase and ryanodine receptors, are down-regulated in parallel. Nevertheless, while the inward calcium current is unchanged, the functionally linked duo composed of the Na+/Ca2+ exchanged and (Na+, K+)-ATPase, is less active. Such an imbalance may explain the prolonged calcium transient. The changes in heart rate variability provide information about the state of the autonomic nervous system and has prognostic value even in CCH. Transgenic studies have demonstrated that the myocardial adrenergic and muscarinic receptor content is also a determining factor. During CCH, several phenotypic membrane changes participate in the slowing of contraction velocity and are thus adaptational. They also have a detrimental counterpart and, together with fibrosis, favour arrhythmias. PMID:9302342

  2. Prevalence and determinants of anemia in adults with complex congenital heart disease and ventricular dysfunction (subaortic right ventricle and single ventricle physiology).

    Science.gov (United States)

    Collins, Nicholas; Piran, Sanaz; Harrison, Jeanine; Azevedo, Eduardo; Oechslin, Erwin; Silversides, Candice K

    2008-09-01

    Anemia is well recognized as a marker of poor prognosis in patients with acquired heart disease and heart failure. Adults with complex congenital heart disease and ventricular dysfunction (subaortic right ventricle or single-ventricle physiology) represent a different population, because they are typically much younger and have less co-morbidity compared with patients with acquired forms of heart disease. The purpose of this study was to evaluate the prevalence and determinants of anemia in this population. Baseline hemoglobin levels were recorded at the time of the initial clinic visit, and final hemoglobin levels were those recorded before death or transplantation or at study completion. Anemia was defined as hemoglobin complex congenital heart disease and ventricular dysfunction, in particular those with Fontan physiology.

  3. Tissue-resident Sca1+ PDGFRα+ mesenchymal progenitors are the cellular source of fibrofatty infiltration in arrhythmogenic cardiomyopathy [v1; ref status: indexed, http://f1000r.es/17s

    Directory of Open Access Journals (Sweden)

    Ben Paylor

    2013-06-01

    Full Text Available Arrhythmogenic cardiomyopathy (AC is a disease of the heart involving myocardial dystrophy leading to fibrofatty scarring of the myocardium and is associated with an increased risk of both ventricular arrhythmias and sudden cardiac death. It often affects the right ventricle but may also involve the left. Although there has been significant progress in understanding the role of underlying desmosomal genetic defects in AC, there is still a lack of data regarding the cellular processes involved in its progression. The development of cardiac fibrofatty scarring is known to be a principal pathological process associated with ventricular arrhythmias, and it is vital that we elucidate the role of various cell populations involved in the disease if targeted therapeutics are to be developed. The known role of mesenchymal progenitor cells in the reparative process of both the heart and skeletal muscle has provided inspiration for the identification of the cellular basis of fibrofatty infiltration in AC. Here we hypothesize that reparative processes triggered by myocardial degeneration lead to the differentiation of tissue-resident Sca1+ PDGFRα+ mesenchymal progenitors into adipocytes and fibroblasts, which compose the fibrofatty lesions characteristic of AC.

  4. Stable right ventricular size and function during short-term follow-up in patients with pulmonary regurgitation after tetralogy of Fallot repair

    International Nuclear Information System (INIS)

    Aim: To assess changes in ventricular size and function over time in conservatively treated adult patients with repaired tetralogy of Fallot (TOF) and significant pulmonary regurgitation (PR). Materials and methods: Patients with repaired TOF who had undergone more than one cardiac magnetic resonance study were identified. To confine the cause of ventricular size and function deviation to PR, patients with residual ventricular septal defect, more than mild regurgitation at a valve other than the pulmonary valve, and known coronary artery disease were excluded. Results: The final analysis included 27 adults with PR fraction >20%. During a follow-up of mean 2.1 ± 0.8 years, there was no change in right ventricular (RV) end-diastolic volume (EDV; 162.1 ± 27.6 versus 164 ± 29.6 ml/m2, p = 0.5). Left ventricular (LV) EDV showed a small decrease (85.1 ± 16.2 versus 81.5 ± 14.1 ml/m2, p = 0.02). The mean PR fraction, PR volume, and peak RV outflow tract gradient did not change. Additionally, both RV ejection fraction (EF) and LVEF remained stable over the follow-up period (48.1 ± 6.5 versus 48.4 ± 6.7%, p = 0.83, and 57.3 ± 5.4 versus 57.2 ± 5.1 %, p = 0.91, respectively). Only two asymptomatic patients (7.4% of the study group) developed symptoms and the remaining did not deteriorate. Conclusion: The RVEDV, RVEF, and LVEF remained stable over a mean follow-up of approximately 2 years in the majority of adult patients after TOF repair with significant PR and a wide range of RVEDV

  5. Relation of fragmented QRS complex to right ventricular fibrosis detected by late gadolinium enhancement cardiac magnetic resonance in adults with repaired tetralogy of fallot.

    Science.gov (United States)

    Park, Seung-Jung; On, Young Keun; Kim, June Soo; Park, Seung Woo; Yang, Ji-Hyuk; Jun, Tae-Gook; Kang, I-Seok; Lee, Heung Jae; Choe, Yeon Hyeon; Huh, June

    2012-01-01

    Fragmented QRS (fQRS) on 12-lead electrocardiography reflects conduction delay caused by myocardial fibrosis and dysfunction. Ventricular fibrosis detected by late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) is reportedly correlated with worse clinical outcomes in adults with repaired tetralogy of Fallot (TOF). The aim of this study was to assess whether the presence of fQRS is associated with right ventricular (RV) fibrosis or dysfunction in this patient group. In 37 consecutive patients (median age 30 years, median age at repair 6.6 years), the number of leads showing fQRS, defined as the presence of >2 notches on the R/S wave in ≥2 contiguous leads, was counted. RV systolic function, dilatation, and LGE score were measured using LGE CMR. Ventricular LGE was observed mainly at the previous surgical sites: the RV outflow tract (33 of 37), ventricular septal defect patch region (15 of 37), and RV anterior wall (11 of 37). Fragmented QRS was found mostly in the right and mid precordial leads. The fQRS group (n = 20) demonstrated higher RV LGE scores (p <0.001) and lower RV ejection fractions (p = 0.02) and a trend toward larger RV end-diastolic and end-systolic volumes (p = 0.12 and p = 0.06, respectively) compared to the non-fQRS group (n = 17). The number of electrocardiographic leads showing fQRS was positively correlated with RV LGE score (r = 0.75, p <0.001). The presence of fQRS remained independently associated with the presence of supramedian RV LGE score, even after adjusting for relevant parameters. In conclusion, fQRS was closely associated with more extensive RV fibrosis and dysfunction in adults with repaired tetralogy of Fallot.

  6. Truncating plakophilin-2 mutations in arrhythmogenic cardiomyopathy are associated with protein haploinsufficiency in both myocardium and epidermis

    DEFF Research Database (Denmark)

    Rasmussen, Torsten B; Nissen, Peter H; Palmfeldt, Johan;

    2014-01-01

    unrelated patients with AC identified 10 different PKP2 mutations in 12 index patients. One patient, heterozygous for a PKP2 nonsense mutation, developed severe heart failure and underwent cardiac transplantation. Western blotting and immunohistochemistry of the explanted heart showed a significant decrease......BACKGROUND: Arrhythmogenic cardiomyopathy (AC) is a hereditary cardiac condition associated with ventricular arrhythmias, heart failure, and sudden death. The disease is most often caused by mutations in the desmosomal gene for plakophilin-2 (PKP2), which is expressed in both myocardial and...

  7. Arrhythmogenic remodelling of activation and repolarization in the failing human heart.

    Science.gov (United States)

    Holzem, Katherine M; Efimov, Igor R

    2012-11-01

    Heart failure is a major cause of disability and death worldwide, and approximately half of heart failure-related deaths are sudden and presumably due to ventricular arrhythmias. Patients with heart failure have been shown to be at 6- to 9-fold increased risk of sudden cardiac death compared to the general population. (AHA. Heart Disease and Stroke Statistics-2003 Update. Heart and Stroke Facts. Dallas, TX: American Heart Association; 2002) Thus, electrophysiological remodelling associated with heart failure is a leading cause of disease mortality and has been a major investigational focus examined using many animal models of heart failure. While these studies have provided an important foundation for understanding the arrhythmogenic pathophysiology of heart failure, the need for corroborating studies conducted on human heart tissue has been increasingly recognized. Many human heart studies of conduction and repolarization remodelling have now been published and shed some light on important, potentially arrhythmogenic, changes in human heart failure. These studies are being conducted at multiple experimental scales from isolated cells to whole-tissue preparations and have provided insight into regulatory mechanisms such as decreased protein expression, alternative mRNA splicing of ion channel genes, and defective cellular trafficking. Further investigations of heart failure in the human myocardium will be essential for determining possible therapeutic targets to prevent arrhythmia in heart failure and for facilitating the translation of basic research findings to the clinical realm.

  8. Echocardiographic estimation of right ventricular function in patients with congenital heart disease%超声心动图对先天性心脏病右心室功能的评价

    Institute of Scientific and Technical Information of China (English)

    崔亚玲; 黄新胜; 黄奕高; 黄涛; 张曹进

    2012-01-01

    目的 以右心室造影为对照,使用超声心动图常规的四腔心切面和全新的右心室全显示切面定量评价右心室射血分数(right ventricular ejection fraction,RVEF),探讨右心室全显示切面在右心功能评价中的应用价值.方法 2011年4月至2011年11月通过临床和超声心动图检查选择伴有右心室形态或血流动力学改变的先天性心脏病患者22例(男13例,女9例,年龄16~67岁)为研究对象.除对入选患者行常规的超声心动图检查外,还使用四腔心切面和右心室全显示切面测量RVEF.在心导管实验室使用右心室造影测量RVEF.将四腔心和右心室全显示切面RVEF与右心室造影RVEF行随机区组设计方差分析及Pearson相关性分析,右心室全显示切面RVEF与其余右心功能指标行Pearson相关分析,并采用Bland -Altman法评价右心室全显示切面与右心室造影的一致性.结果 3种方法测得的RVEF分别为右心室全显示切面48.0%±11.3%、四腔心切面49.5%±13.1%、右心室造影48.7%±12.1%.3种方法测量结果比较,差异无统计学意义(F=0.327,P=0.723).右心室全显示切面RVEF与右心室造影RVEF呈高度相关(r=0.908,P<0.001),四腔心切面RVEF与右心室造影RVEF呈中度相关(r=0.659,P=0.001).右心室全显示切面RVEF与肺动脉收缩压及主肺动脉宽度负相关(P<0.05),与右心室每搏输出量正相关(P<0.05),与其他右心功能评价指标则无明显相关性.结论 与常规的四腔心测量方法相比,超声心动图右心室全显示切面测量的RVEF与右心室造影的相关性更好,可能是一种准确和可靠的评价右心室收缩功能的方法.%Objectives A novel method was developed for calculating right ventricular ejection fraction (RVEF) from total right ventricular view of two-dimensional echocardiography, and was compared with the conventional four chamber view and right anterior oblique view of right ventricular angiography. The

  9. Ventricular arrhythmias in Chagas disease

    Directory of Open Access Journals (Sweden)

    Marco Paulo Tomaz Barbosa

    2015-02-01

    Full Text Available Sudden death is one of the most characteristic phenomena of Chagas disease, and approximately one-third of infected patients develop life-threatening heart disease, including malignant ventricular arrhythmias. Fibrotic lesions secondary to chronic cardiomyopathy produce arrhythmogenic substrates that lead to the appearance and maintenance of ventricular arrhythmias. The objective of this study is to discuss the main clinical and epidemiological aspects of ventricular arrhythmias in Chagas disease, the specific workups and treatments for these abnormalities, and the breakthroughs needed to determine a more effective approach to these arrhythmias. A literature review was performed via a search of the PubMed database from 1965 to May 31, 2014 for studies of patients with Chagas disease. Clinical management of patients with chronic Chagas disease begins with proper clinical stratification and the identification of individuals at a higher risk of sudden cardiac death. Once a patient develops malignant ventricular arrhythmia, the therapeutic approach aims to prevent the recurrence of arrhythmias and sudden cardiac death by the use of implantable cardioverter defibrillators, antiarrhythmic drugs, or both. In select cases, invasive ablation of the reentrant circuit causing tachycardia may be useful. Ventricular arrhythmias are important manifestations of Chagas cardiomyopathy. This review highlights the absence of high-quality evidence regarding the treatment of ventricular arrhythmias in Chagas disease. Recognizing high-risk patients who require specific therapies, especially invasive procedures such as the implantation of cardioverter defibrillators and ablative approaches, is a major challenge in clinical practice.

  10. Diagnostic accuracy of cardiovascular magnetic resonance imaging of right ventricular morphology and function in the assessment of suspected pulmonary hypertension results from the ASPIRE registry

    Directory of Open Access Journals (Sweden)

    Swift Andrew J

    2012-06-01

    Full Text Available Abstract Background Cardiovascular Magnetic Resonance (CMR imaging is accurate and reproducible for the assessment of right ventricular (RV morphology and function. However, the diagnostic accuracy of CMR derived RV measurements for the detection of pulmonary hypertension (PH in the assessment of patients with suspected PH in the clinic setting is not well described. Methods We retrospectively studied 233 consecutive treatment naïve patients with suspected PH including 39 patients with no PH who underwent CMR and right heart catheterisation (RHC within 48hours. The diagnostic accuracy of multiple CMR measurements for the detection of mPAP ≥ 25 mmHg was assessed using Fisher’s exact test and receiver operating characteristic (ROC analysis. Results Ventricular mass index (VMI was the CMR measurement with the strongest correlation with mPAP (r = 0.78 and the highest diagnostic accuracy for the detection of PH (area under the ROC curve of 0.91 compared to an ROC of 0.88 for echocardiography calculated mPAP. Late gadolinium enhancement, VMI ≥ 0.4, retrograde flow ≥ 0.3 L/min/m2 and PA relative area change ≤ 15% predicted the presence of PH with a high degree of diagnostic certainty with a positive predictive value of 98%, 97%, 95% and 94% respectively. No single CMR parameter could confidently exclude the presence of PH. Conclusion CMR is a useful alternative to echocardiography in the evaluation of suspected PH. This study supports a role for the routine measurement of ventricular mass index, late gadolinium enhancement and the use of phase contrast imaging in addition to right heart functional indices in patients undergoing diagnostic CMR evaluation for suspected pulmonary hypertension.

  11. Quantification of Coupled Stiffness and Fiber Orientation Remodeling in Hypertensive Rat Right-Ventricular Myocardium Using 3D Ultrasound Speckle Tracking with Biaxial Testing

    Science.gov (United States)

    Park, Dae Woo; Sebastiani, Andrea; Yap, Choon Hwai; Simon, Marc A.; Kim, Kang

    2016-01-01

    Mechanical and structural changes of right ventricular (RV) in response to pulmonary hypertension (PH) are inadequately understood. While current standard biaxial testing provides information on the mechanical behavior of RV tissues using surface markers, it is unable to fully assess structural and mechanical properties across the full tissue thickness. In this study, the mechanical and structural properties of normotensive and pulmonary hypertension right ventricular (PHRV) myocardium through its full thickness were examined using mechanical testing combined with 3D ultrasound speckle tracking (3D-UST). RV pressure overload was induced in Sprague–Dawley rats by pulmonary artery (PA) banding. The second Piola–Kirchhoff stress tensors and Green-Lagrangian strain tensors were computed in the RV myocardium using the biaxial testing combined with 3D-UST. A previously established non-linear curve-fitting algorithm was applied to fit experimental data to a Strain Energy Function (SEF) for computation of myofiber orientation. The fiber orientations obtained by the biaxial testing with 3D-UST compared well with the fiber orientations computed from the histology. In addition, the re-orientation of myofiber in the right ventricular free wall (RVFW) along longitudinal direction (apex-to-outflow-tract direction) was noticeable in response to PH. For normotensive RVFW samples, the average fiber orientation angles obtained by 3D-UST with biaxial test spiraled from 20° at the endo-cardium to -42° at the epi-cardium (Δ = 62°). For PHRV samples, the average fiber orientation angles obtained by 3D-UST with biaxial test had much less spiral across tissue thickness: 3° at endo-cardium to -7° at epi-cardium (Δ = 10°, P<0.005 compared to normotensive). PMID:27780271

  12. Evaluation of right and left ventricular function by quantitative blood-pool SPECT (QBS): comparison with conventional methods and quantitative gated SPECT (QGS).

    Science.gov (United States)

    Odagiri, Keiichi; Wakabayashi, Yasushi; Tawarahara, Kei; Kurata, Chinori; Urushida, Tsuyoshi; Katoh, Hideki; Satoh, Hiroshi; Hayashi, Hideharu

    2006-10-01

    Though quantitative ECG-gated blood-pool SPECT (QBS) has become a popular tool in research settings, more verification is necessary for its utilization in clinical medicine. To evaluate the reliability of the measurements of left and right ventricular functions with QBS, we performed QBS, as well as first-pass pool (FPP) and ECG-gated blood-pool (GBP) studies on planar images in 41 patients and 8 healthy volunteers. Quantitative ECG-gated myocardial perfusion SPECT (QGS) was also performed in 30 of 49 subjects. First, we assessed the reproducibility of the measurements of left and right ventricular ejection fraction (LVEF, RVEF) and left and right ventricular end-diastolic volume (LVEDV, RVEDV) with QBS. Second, LVEF and RVEF obtained from QBS were compared with those from FPP and GBP, respectively. Third, LVEF and LVEDV obtained from QBS were compared with those from QGS, respectively. The intra- and inter-observer reproducibilities were excellent for LVEF, LVEDV, RVEF and RVEDV measured with QBS (r = 0.88 to 0.96, p < 0.01), while the biases in the measurements of RVEF and RVEDV were relatively large. LVEF obtained from QBS correlated significantly with those from FPP and GBP, while RVEF from QBS did not. LVEF and LVEDV obtained from QBS were significantly correlated with those from QGS, but the regression lines were not close to the lines of identity. In conclusion, the measurements of LVEF and LVEDV with QBS have good reproducibility and are useful clinically, while those of RVEF and RVEDV are less useful compared with LVEF and LVEDV. The algorithm of QBS for the measurements of RVEF and RVEDV remains to be improved. PMID:17134018

  13. Mapeamento epicárdico da taquicardia ventricular sustentada em cardiopatias não isquêmicas Mapeo epicárdico de la taquicardia ventricular sostenida en cardiopatías no isquémicas Epicardial mapping of sustained ventricular tachycardia in nonischemic heart disease

    Directory of Open Access Journals (Sweden)

    Geórgia Guedes da Silva

    2011-02-01

    ón de la taquicardia ventricular (TV sostenida en pacientes con cardiopatía no isquémica. MÉTODOS: Veinte y seis pacientes con TV sostenida recurrente, siendo 22 (84,6% con cardiopatía chagásica crónica, dos (7,7% con cardiomiopatía dilatada idiopática y dos (7,7% portadores de displasia arritmogénica del ventrículo derecho, fueron sometidos a mapeo epicárdico con dos o tres microcatéteres, con 8 electrodos cada uno, simultáneamente al mapeo endocárdico convencional. Se utilizó catéter con punta de 4 mm para ablación con radiofrecuencia (RF realizada durante la TV inducida. RESULTADOS: De las 33 TVs inducidas, 25 fueron mapeadas y 20 tuvieron su origen definido. Once con origen epicárdica y 9 endocárdica. La estimulación ventricular programada no indujo TV sostenida en 11 (42,0% de los 26 pacientes después de la ablación. Eventos como recurrencia de la TV y muerte ocurrieron en 10,0% de los pacientes sometidos a la ablación con éxito, y en 59,0% de los fracasos, en control ambulatorio medio de 357 ± 208 días. CONCLUSIÓN: Circuitos subepicárdicos son frecuentes en pacientes con cardiopatía no isquémica. El mapeo epicárdico con múltiples catéteres realizado simultáneamente con el mapeo endocárdico contribuye a la identificación de estos circuitos en un mismo procedimiento.BACKGROUND: The complexity of reentrant circuits related to ventricular tachycardias decreases the success rate of radiofrequency ablation procedures. OBJECTIVE: To evaluate whether the epicardial mapping with multiple electrodes carried out simultaneously with the endocardial mapping helps in ablation procedures of sustained ventricular tachycardia (VT in patients with nonischemic heart disease. METHODS: Twenty-six patients with recurrent sustained VT, of which 22 (84.6% presenting chronic chagasic cardiomyopathy, 2 (7.7% with idiopathic dilated cardiomyopathy and 2 with right ventricular arrhythmogenic dysplasia (RVAD, were submitted to epicardial mapping with two or

  14. Free-Breathing 3D Imaging of Right Ventricular Structure and Function Using Respiratory and Cardiac Self-Gated Cine MRI

    OpenAIRE

    Yanchun Zhu; Jing Liu; Jonathan Weinsaft; Pascal Spincemaille; Nguyen, Thanh D.; Prince, Martin R.; Shanglian Bao; Yaoqin Xie; Yi Wang

    2015-01-01

    Providing a movie of the beating heart in a single prescribed plane, cine MRI has been widely used in clinical cardiac diagnosis, especially in the left ventricle (LV). Right ventricular (RV) morphology and function are also important for the diagnosis of cardiopulmonary diseases and serve as predictors for the long term outcome. The purpose of this study is to develop a self-gated free-breathing 3D imaging method for RV quantification and to evaluate its performance by comparing it with brea...

  15. Evaluation of Right Ventricular Global Longitudinal Function in Patients with Tetralogy of Fallot by Two-dimensional Ultrasound Speckle Tracking Imaging

    Institute of Scientific and Technical Information of China (English)

    李玉曼; 谢明星; 王新房; 吕清; 卢晓芳; 杨亚利; 马红; 方凌云; 张静; 李卫芹

    2010-01-01

    Quantification of right ventricular(RV)volume and function remains a challenge because of RV complex geometry by conventional echocardiography.The purpose of this study was to assess RV global longitudinal function in patients with tetralogy of Fallot(TOF)by 2-dimensional ultrasound speckle tracking imaging(STI).Thirty-eight patients with TOF were enrolled in this study and divided into child group(n=25)and adult group(n=13)according to age.Thirty-eight age-and sex-matched normal subjects were selected as c...

  16. Beating Heart Mitral Valve Replacement Surgery without Aortic Cross-Clamping via Right Thoracotomy in a Patient with Compromised Left Ventricular Functions

    Directory of Open Access Journals (Sweden)

    Ahmet Baris-Durukan

    2015-10-01

    Full Text Available Global myocardial ischemia and ischemia-reperfusion injury are potential adverse events related with cardioplegic arrest. Beating heart surgery has avoided such complications and adapted to valve surgery following successful results published on myocardial revascularization. Difficulty in weaning from cardiopulmonary bypass may be lessened by using on-pump beating heart surgery for mitral valve interventions. Here we describe a 64-year-old male patient with severe mitral regurgitation and dilated cardiomyopathy. Beating heart mitral valve replacement surgery was performed without aortic cross-clamping through a right thoracotomy approach. We believe that, particularly in patients with poor left ventricular functions, beating heart mitral valve surgery may be advantageous

  17. Pressure-overload hypertrophy of the developing heart reveals activation of divergent gene and protein pathways in the left and right ventricular myocardium.

    Science.gov (United States)

    Friehs, Ingeborg; Cowan, Douglas B; Choi, Yeong-Hoon; Black, Kendra M; Barnett, Reanne; Bhasin, Manoj K; Daly, Christian; Dillon, Simon J; Libermann, Towia A; McGowan, Francis X; del Nido, Pedro J; Levitsky, Sidney; McCully, James D

    2013-03-01

    Right ventricular (RV) and left ventricular (LV) myocardium differ in their pathophysiological response to pressure-overload hypertrophy. In this report we use microarray and proteomic analyses to identify pathways modulated by LV-aortic banding (AOB) and RV-pulmonary artery banding (PAB) in the immature heart. Newborn New Zealand White rabbits underwent banding of the descending thoracic aorta [LV-AOB; n = 6]. RV-PAB was achieved by banding the pulmonary artery (n = 6). Controls (n = 6 each) were sham-manipulated. After 4 (LV-AOB) and 6 (RV-PAB) wk recovery, the hearts were removed and matched RNA and proteins samples were isolated for microarray and proteomic analysis. Microarray and proteomic data demonstrate that in LV-AOB there is increased transcript expression levels for oxidative phosphorylation, mitochondria energy pathways, actin, ILK, hypoxia, calcium, and protein kinase-A signaling and increased protein expression levels of proteins for cellular macromolecular complex assembly and oxidative phosphorylation. In RV-PAB there is also an increased transcript expression levels for cardiac oxidative phosphorylation but increased protein expression levels for structural constituents of muscle, cardiac muscle tissue development, and calcium handling. These results identify divergent transcript and protein expression profiles in LV-AOB and RV-PAB and provide new insight into the biological basis of ventricular specific hypertrophy. The identification of these pathways should allow for the development of specific therapeutic interventions for targeted treatment and amelioration of LV-AOB and RV-PAB to ameliorate morbidity and mortality.

  18. Turner's syndrome, fibromuscular dysplasia, and stroke.

    Science.gov (United States)

    Lancman, M; Mesropian, H; Serra, P; Granillo, R

    1991-02-01

    We report a 43-year-old woman who presented with a right frontoparietotemporal ischemic stroke. She had been diagnosed with Turner's syndrome during childhood and had a history of chronic estrogen therapy. Cerebral angiography showed lesions characteristics of fibromuscular dysplasia involving the right internal carotid and right vertebral arteries. We are not aware of any previous reports describing an association between fibromuscular dysplasia and Turner's syndrome. Although chronic estrogen therapy cannot be ruled out as a cause of this patient's stroke, we suggest a possible etiologic relation between these two entities.

  19. Serial right ventricular endomyocardial biopsy in rapid-onset severe heart failure due to giant cell myocarditis

    NARCIS (Netherlands)

    van Haelst, Paul L.; Brugemann, Johan; Diercks, Gilles F.; Suurmeijer, Albert; van Veldhuisen, Dirk J.

    2006-01-01

    Giant cell myocarditis (GCM) is a serious condition that warrants immediate diagnosis and treatment. It often presents as rapidly progressive heart failure and/or malignant ventricular arrhythmias. Here, we describe a 34-year-old patient with myasthenia gravis who presented with GCM 2 weeks after re

  20. Oculodentodigital dysplasia

    Directory of Open Access Journals (Sweden)

    Dharmil C Doshi

    2016-01-01

    Full Text Available Oculodentodigital dysplasia is a rare, autosomal dominant disorder with high penetrance and variable expressivity, caused by mutations in the connexin 43 or gap junction protein alpha-1 gene. It has been diagnosed in fewer than 300 people worldwide with an incidence of around 1 in 10 million. It affects many parts of the body, particularly eyes (oculo, teeth (dento, and fingers and/or toes (digital. The common clinical features include facial dysmorphism with thin nose, microphthalmia, syndactyly, tooth anomalies such as enamel hypoplasia, anodontia, microdontia, early tooth loss and conductive deafness. Other less common features are abnormalities of the skin and its appendages, such as brittle nails, sparse hair, and neurological abnormalities. To prevent this syndrome from being overlooked, awareness of possible symptoms is necessary. Early recognition can prevent blindness, dental problems and learning disabilities. Described here is the case of a 21-year-old male who presented to the ophthalmology outpatient department with a complaint of bilateral progressive loss of vision since childhood.

  1. Coronary Artery Manifestations of Fibromuscular Dysplasia

    OpenAIRE

    Michelis, Katherine C.; Olin, Jeffrey W.; Kadian-Dodov, Daniella; D’Escamard, Valentina; Kovacic, Jason C.

    2014-01-01

    Fibromuscular dysplasia (FMD) involving the coronary arteries is an uncommon but important condition that can present as acute coronary syndrome, left ventricular dysfunction, or potentially sudden cardiac death. Although the classic angiographic “string of beads” that may be observed in renal artery FMD does not occur in coronary arteries, potential manifestations include spontaneous coronary artery dissection, distal tapering or long, smooth narrowing that may represent dissection, intramur...

  2. Ventricular arrhythmias associated with long-term endurance sports: what is the evidence?

    Science.gov (United States)

    Heidbuchel, Hein; Prior, David L; La Gerche, André

    2012-11-01

    Athletic performance tests the limits of the human body and mind. Awe-inspiring achievements is what makes sports so fascinating. It is well appreciated however that top-level sports may sometimes overtax the body, and can lead to injuries, most notably of musculo-skeletal nature. This paper defends the thesis that the heart can also develop sports injuries at the ventricular level. We will elaborate on our hypothesis, originally put forward in 2003, that intense endurance activities put a particularly high strain on the right ventricle (RV), which over time, may lead to a proarrhythmic state resembling right (or less often) left ventricular cardiomyopathy. This can develop even in the absence of underlying demonstrable genetic abnormalities, probably just as a result of excessive RV wall stress during exercise. The syndrome of 'exercise-induced arrhythmogenic RV cardiomyopathy' may easily be overlooked. Sports cardiologists, like orthopaedic specialists, should be prepared to realise that excessive sports activity can lead to cardiac sports injuries in some, which will help to council on safe participation in all.

  3. Displasia arritmogénica del ventrículo derecho: reporte de un caso y revisión de la literatura

    Directory of Open Access Journals (Sweden)

    Gilberth Vásquez Esquivel

    2011-06-01

    Full Text Available La displasia arritmogénica del ventrículo derecho se caracteriza por atrofia y reemplazo fibroso y graso del miocardio, y arritmias ventriculares. Se reporta el caso de una mujer de 54 años que se presentó con choque circulatorio fatal, haciéndose el diagnostico patológico de displasia arritmogénica del ventrículo derecho. Se discuten las características clínicas, diagnóstico y manejo de esta cardiopatía potencialmente letal y aún poco comprendida.Arrhythmogenic Right Ventricular Dysplasia: A Case Report and Review of the Literature Arrhythmogenic right ventricular dysplasia is characterized by atrophy, myocardial fibrofatty replacement and ventricular arrhythmias. The case of a 54-year- old woman with fatal cardiogenic shock and a pathological diagnosis of arrhythmogenic right ventricular dysplasia is presented. The clinical characteristics, diagnosis and management of this potentially lethal, and still poorly understood, cardiopathy are discussed.

  4. [Dextrocardia with situ solitus, ventricular loop, double outlet hypoplastic right ventricle and L-malposition of the great arteries. Description and surgical treatment of a rare and complex cardiopathy].

    Science.gov (United States)

    Fraisse, A; Ghez, O; Ligi, I; Laporte-Giugliano, V; Chetaille, P; Bonnet, J L; Aubert, F; Metras, D

    2002-05-01

    Despite the cardiac surgery improvements allowing the correction of the majority of congenital heart diseases with ventricle-great vessels discontinuity, some abnormalities increase the risk of bi-ventricular reparation. We herein report the case of a patient presenting a rare form of double outlet right ventricle with a ventricular loop, with moderate right ventricle hypoplasia. L-malposition of great vessels and pulmonary artery stenosis, and for whom we opted for a palliative surgical treatment including a systemic-pulmonary anastomosis followed by a upper right bi-directional cavo-pulmonary derivation. The last surgery was followed by recurrent right pleural effusions disappearing after the embolization of the systemic-pulmonary anastomosis by catheterism as it probably obstructed the draining of the cavo-pulmonary anastomosis. The relevance of this clinical case reported is, firstly the description of this ventricle loop resulted from a marked ventricular malposition which is a rare heart disease, and secondly the discussion about the surgical treatment, especially about the choice between palliative and curative surgery. Only comparative studies on long term morbidity and mortality between the bi-ventricular reparation and mono-ventricular palliation will allow the selection of the most appropriate surgical treatment.

  5. Nitroprusside modulates pulmonary vein arrhythmogenic activity

    Directory of Open Access Journals (Sweden)

    Chen Yao-Chang

    2010-03-01

    Full Text Available Abstract Background Pulmonary veins (PVs are the most important sources of ectopic beats with the initiation of paroxysmal atrial fibrillation, or the foci of ectopic atrial tachycardia and focal atrial fibrillation. Elimination of nitric oxide (NO enhances cardiac triggered activity, and NO can decrease PV arrhythmogensis through mechano-electrical feedback. However, it is not clear whether NO may have direct electrophysiological effects on PV cardiomyocytes. This study is aimed to study the effects of nitroprusside (NO donor, on the ionic currents and arrhythmogenic activity of single cardiomyocytes from the PVs. Methods Single PV cardiomyocytes were isolated from the canine PVs. The action potential and ionic currents were investigated in isolated single canine PV cardiomyocytes before and after sodium nitroprusside (80 μM, using the whole-cell patch clamp technique. Results Nitroprusside decreased PV cardiomyocytes spontaneous beating rates from 1.7 ± 0.3 Hz to 0.5 ± 0.4 Hz in 9 cells (P Conclusion Nitroprusside regulates the electrical activity of PV cardiomyocytes, which suggests that NO may play a role in PV arrhythmogenesis.

  6. Right ventricular dysfunction as an independent predictor of short- and long-term mortality in patients with heart failure

    DEFF Research Database (Denmark)

    Kjaergaard, Jesper; Akkan, Dilek; Iversen, Kasper Karmark;

    2007-01-01

    by co-existing chronic obstructive pulmonary disease (COPD). AIMS: To examine the prognostic information from TAPSE adjusted for the potential confounding effects of co-existing cardiovascular and COPD in a large series of patients admitted for new onset or worsening HF. METHODS AND RESULTS: Eight...... in HF including left ventricular function. The co-existence of COPD is also associated with an adverse prognosis independent of the RV systolic function....

  7. 频发右心室流出道室性期前收缩对右心室流出道结构影响的研究%Effect of frequent idiopathic ventricular premature contractions from right ventricular outflow tract on structure of right ventricular outflow tract

    Institute of Scientific and Technical Information of China (English)

    孔强; 史力生; 张钰聪; 陈宇嘉; 张帆; 徐东

    2012-01-01

    目的 探讨右心室流出道(RVOT)起源频发室性期前收缩对RVOT结构的影响.方法 选取2009~2011年行射频消融治疗的频发RVOT起源室性期前收缩患者30例,分析其心电图特征、动态心电图、心脏彩色超声结果及术中精确定位,分析室性期前收缩对RVOT结构的影响.结果 射频消融术前RVOT直径为(31.76±3.33)mm,术后6个月为(30.93±2.68)mm(P<0.01);相关性分析显示:RVOT直径与室性期前收缩负荷呈正相关(r=0.484,P<0.05).RVOT间隔部来源室性期前收缩QRS时限为(157.69±18.33) ms,游离壁来源室性期前收缩QRS时限为(179.23±16.05)ms(P<0.01),QRS时限与来源部位相关(r=0.566,P<0.01).室性期前收缩QRS时限与RVOT直径无相关性(r=0.097,P>0.05).结论 RVOT来源室性期前收缩经射频消融治疗后,RVOT直径有减小的趋势,其与室性期前收缩负荷呈正相关,与室性期前收缩形态无相关性.%Objective To investigate the effect of frequent ventricular premature contractions(VPCs) from right ventricular outflow tract (RVOT) on the structure of right ventricular outflow tract. Methods 30 patients with frequent VPCs from RVOT who underwent radiofrequency ablation from 2009 to 2011 were enrolled. The site of origin of VPCs was identified by the characters of ECG according to the stepwise electrocardiographic algorithm and the accurate anatomical location was identified by 3D electroanatomical non-contact mapping. Parameters of haemodynamic were accessed by means of transthoracic echocardiography before and 6 months after intervention. The average daily amount of VPCs was evaluated by Holter and the ECG characters of VPCs were also analyzed. Results Before and 6 months after intervention, the diameter of RVOT was (31. 76 ±3. 33) mm and (30. 93 ±2. 68) mm( P 0. 05). Conclusion The diameter of RVOT decreased after radiofrequency ablation for the patients with VPCs from RVOT and it correlated positively with the average daily

  8. Fibromuscular dysplasia

    Directory of Open Access Journals (Sweden)

    Jeunemaitre Xavier

    2007-06-01

    Full Text Available Abstract Fibromuscular dysplasia (FMD, formerly called fibromuscular fibroplasia, is a group of nonatherosclerotic, noninflammatory arterial diseases that most commonly involve the renal and carotid arteries. The prevalence of symptomatic renal artery FMD is about 4/1000 and the prevalence of cervicocranial FMD is probably half that. Histological classification discriminates three main subtypes, intimal, medial and perimedial, which may be associated in a single patient. Angiographic classification includes the multifocal type, with multiple stenoses and the 'string-of-beads' appearance that is related to medial FMD, and tubular and focal types, which are not clearly related to specific histological lesions. Renovascular hypertension is the most common manifestation of renal artery FMD. Multifocal stenoses with the 'string-of-beads' appearance are observed at angiography in more than 80% of cases, mostly in women aged between 30 and 50 years; they generally involve the middle and distal two-thirds of the main renal artery and in some case also renal artery branches. Cervicocranial FMD can be complicated by dissection with headache, Horner's syndrome or stroke, or can be associated with intracerebral aneurysms with a risk of subarachnoid or intracerebral hemorrhage. The etiology of FMD is unknown, although various hormonal and mechanical factors have been suggested. Subclinical lesions are found at arterial sites distant from the stenotic arteries, and this suggests that FMD is a systemic arterial disease. It appears to be familial in 10% of cases. Noninvasive diagnostic tests include, in increasing order of accuracy, ultrasonography, magnetic resonance angiography and computed tomography angiography. The gold standard for diagnosing FMD is catheter angiography, but this invasive procedure is only used for patients in whom it is clinically pertinent to proceed with revascularization during the same procedure. Differential diagnosis include

  9. Influence of High Right Ventricular Septal Pacing and Right Ventricular Apical Pacing on Cardiac Function%高位右室间隔部起搏与右室心尖部起搏对患者心功能的影响

    Institute of Scientific and Technical Information of China (English)

    贾国力; 邢程; 王海珠; 韩彩萍

    2015-01-01

    Objective:To explore the influence of high right ventricular septal(HRVS)pacing and right ventricular apical(RVA)pacing on patients’ cardiac function,left ventricular remodeling and ventricular synchrony.Method:126 patients who implanted VVI pacemaker because ofⅢdegree atrioventricular block(ⅢAVB)or sick sinus syndrome(SSS)in our hospital from January 2008 to December 2012 were selected as the research objects.Among them,there were 61 cases with RVA pacing and 65 cases with HRVS.The left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVEDD), QRS wave group width and New York Heart Association(NYHA)functional classification of the two groups were observed and compared before operation and six months,1 year after operation.The number of hospitalizations for heart failure after operation was compared between the two groups.Result:Before treatment,the differences in the indexes of the two groups were not statistically significant(P>0.05).Six months and one year after surgery,the LVEF of the HRVS group was higher than that of the RVA group,the LVEDD and QRS wave width of the HRVS group were lower than those of the RVA group,the differences above were all statistically significant(P0.05),术后6个月及1年,HRVS组LVEF高于RVA组,LVEDD及QRS波宽度均低于RVA组,比较差异均有统计学意义(P<0.05);术后1年,HRVS组NYHA心功能Ⅲ/Ⅳ级及因心力衰竭住院患者数低于RVA组,比较差异均有统计学意义(P<0.05)。结论:HRVS起搏对心脏起搏治疗患者心功能的不利影响低于RVA起搏,是更理想的起搏部位。

  10. Quantitative assessment of right ventricular function and pulmonary regurgitation in surgically repaired tetralogy of Fallot using 256-slice CT: comparison with 3-Tesla MRI

    Energy Technology Data Exchange (ETDEWEB)

    Yamasaki, Yuzo; Yonezawa, Masato; Matsuo, Yoshio; Kamitani, Takeshi; Higuchi, Ko; Honda, Hiroshi [Graduate School of Medical Sciences, Kyushu University, Department of Clinical Radiology, Higashi-ku, Fukuoka (Japan); Nagao, Michinobu; Kawanami, Satoshi [Graduate School of Medical Sciences, Kyushu University, Department of Molecular Imaging and Diagnosis, Higashi-ku, Fukuoka (Japan); Yamamura, Kenichiro [Graduate School of Medical Sciences, Kyushu University, Department of Pediatrics, Higashi-ku, Fukuoka (Japan); Sakamoto, Ichiro [Graduate School of Medical Sciences, Kyushu University, Department of Cardiovascular Medicine, Higashi-ku, Fukuoka (Japan); Shiokawa, Yuichi [Graduate School of Medical Sciences, Kyushu University, Department of Cardiovascular Surgery, Higashi-ku, Fukuoka (Japan); Yabuuchi, Hidetake [Graduate School of Medical Sciences, Kyushu University, Department of Health Sciences, Higashi-ku, Fukuoka (Japan)

    2014-12-15

    To compare 256-slice cardiac computed tomography (CCT) with cardiac magnetic resonance (CMR) imaging to assess right ventricular (RV) function and pulmonary regurgitant fraction (PRF) in patients with repaired tetralogy of Fallot (TOF). Thirty-three consecutive patients with repaired TOF underwent retrospective ECG-gated CCT and 3-Tesla CMR. RV and left ventricular (LV) end-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV) and ejection fraction (EF) were measured using CCT and CMR. PRF-CCT (%) was defined as (RVSV - LVSV)/RVSV. PRF-CMR (%) was measured by the phase-contrast method. Repeated measurements were performed to determine intra- and interobserver variability. CCT measurements, including PRF, correlated highly with the CMR reference (r = 0.71-0.96). CCT overestimated RVEDV (mean difference, 17.1 ± 2.9 ml), RVESV (12.9 ± 2.1 ml) and RVSV (4.2 ± 2.0 ml), and underestimated RVEF (-2.6 ± 1.0 %) and PRF (-9.1 ± 2.0 %) compared with CMR. The limits of agreement between CCT and CMR were in a good range for all measurements. The variability in CCT measurements was lower than those in CMR. The estimated effective radiation dose was 7.6 ± 2.6 mSv. 256-slice CCT can assess RV function and PRF with relatively low dose radiation exposure in patients with repaired TOF, but overestimates RV volume and underestimates PRF. (orig.)

  11. Quantitative assessment of right ventricular function and pulmonary regurgitation in surgically repaired tetralogy of Fallot using 256-slice CT: comparison with 3-Tesla MRI

    International Nuclear Information System (INIS)

    To compare 256-slice cardiac computed tomography (CCT) with cardiac magnetic resonance (CMR) imaging to assess right ventricular (RV) function and pulmonary regurgitant fraction (PRF) in patients with repaired tetralogy of Fallot (TOF). Thirty-three consecutive patients with repaired TOF underwent retrospective ECG-gated CCT and 3-Tesla CMR. RV and left ventricular (LV) end-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV) and ejection fraction (EF) were measured using CCT and CMR. PRF-CCT (%) was defined as (RVSV - LVSV)/RVSV. PRF-CMR (%) was measured by the phase-contrast method. Repeated measurements were performed to determine intra- and interobserver variability. CCT measurements, including PRF, correlated highly with the CMR reference (r = 0.71-0.96). CCT overestimated RVEDV (mean difference, 17.1 ± 2.9 ml), RVESV (12.9 ± 2.1 ml) and RVSV (4.2 ± 2.0 ml), and underestimated RVEF (-2.6 ± 1.0 %) and PRF (-9.1 ± 2.0 %) compared with CMR. The limits of agreement between CCT and CMR were in a good range for all measurements. The variability in CCT measurements was lower than those in CMR. The estimated effective radiation dose was 7.6 ± 2.6 mSv. 256-slice CCT can assess RV function and PRF with relatively low dose radiation exposure in patients with repaired TOF, but overestimates RV volume and underestimates PRF. (orig.)

  12. Role of temporary pacing at the right ventricular outflow tract in anesthetic management of a patient with asymptomatic sick sinus syndrome.

    Science.gov (United States)

    Nag, Kusha; Nagella, Amrutha Bindu; Kumar, V R Hemanth; Singh, Dewan Roshan; Ravishankar, M

    2015-01-01

    A 60-year-old woman posted for percutaneous nephrolithotomy with ureterolithotripsy was found to have a history of hypertension and ischemic heart disease from past 6 months on regular treatment. Pulse rate was irregularly irregular in a range of 56-60/min, unresponsive to atropine, with a sinus pause on the electrocardiogram. Although the patient was asymptomatic, anticipating unmasking of the sick sinus syndrome during general anesthesia in the prone position, a temporary pacemaker was implanted at right ventricular outflow tract (RVOT) septum before the scheduled surgery. A balanced anesthesia technique with endotracheal intubation was administered. There were several episodes of continuous pacing by the temporary pacemaker intraoperatively, which may be attributed to unmasking of the sinus node dysfunction due to general anesthesia. At the end of surgery, patient was extubated after adequate reversal from neuromuscular blockade. Postoperative period remained uneventful, and the pacemaker wires were removed on the 2(nd) postoperative day. With this case report, we highlight the importance of inserting a temporary pacemaker prior to anesthesia even in an asymptomatic patient if a sinus node dysfunction is suspected preoperatively and if intraoperative access to transvenous pacing is difficult such as in prone position. Pacing at RVOT septum minimizes ventricular dyssynchrony and improves hemodynamic parameters.

  13. Localization of precise origin of idiopathic ventricular tachycardia from the right ventricular outflow tract by a 12-lead ECG: a study of pace mapping using a multielectrode "basket" catheter.

    Science.gov (United States)

    Yoshida, Y; Hirai, M; Murakami, Y; Kondo, T; Inden, Y; Akahoshi, M; Tsuda, M; Okamoto, M; Yamada, T; Tsuboi, N; Hirayama, H; Ito, T; Toyama, J; Saito, H

    1999-12-01

    Radiofrequency catheter ablation guided by pace-mapping techniques has proven effective in eliminating idiopathic ventricular tachycardia (VT) originating from the right ventricular outflow tract (RVOT). A method for rapidly identifying the origin of VT from 12-lead electrocardiogram (ECG) findings would be helpful for the catheter ablation procedure. The purpose of this study is to precisely localize the origin of idiopathic VT from the RVOT by a 12-lead ECG from a study of multipoint pace mapping. In one patient with premature ventricular complex (PVC) and 3 with VT, a "basket" catheter was deployed in the RVOT for bipolar pacing from 56 sites in the endocardium of RVOT. Under fluoroscopy the pacing sites were classified into the septum and free wall. We investigated the QRS morphology in leads, I, II, and III; the depth of the QS wave in leads aVR and aVL; and the height of the initial r wave in leads V1 and V2. Pacing was captured in 30-47 of 56 sites (54%-84%). As the pacing sites changed from the anterior to posterior of the septum, the QS notch (-) type in lead I shifted through rs to R, while a shift from R type to rR' or Rr' was noted in leads II and III. As the pacing sites changed from the anterior to posterior of the free wall, lead I showed a shift from the QS notch (+) type to R, while a shift from rR' to Rr' (or rR' unchanged) was found in leads II and III. The depth of the QS wave in leads aVR and aVL showed a tendency for aVR to be deeper than aVL toward the posterolateral attachment of both the septum and free wall, whereas aVL tended to be deeper than aVR toward the anterior attachment. The initial r waves in V1 and V2 became greater as the pacing site was positioned at a higher or more posterior location. These findings may provide more precise and clinically useful diagnostic information on the site of the origin of idiopathic VT originating from the RVOT by a 12-lead ECG.

  14. Case of Recurrent Ventricular Fibrillations with Osborn Wave Developed during Therapeutic Hypothermia.

    Science.gov (United States)

    Kim, Chang-Yeon; Bae, Myung Hwan; Kim, Nam Kyun; Yang, Young Ae; Kim, Kyu Yeun; Lee, Jang Hoon; Eun, Jung Su; Cho, Yongkeun

    2015-01-01

    Therapeutic hypothermia (TH) has been used to protect neurological functions in cardiac arrest patient. Although Osborn wave is not pathognomonic of hypothermia, it is a well-known electrocardiogram finding of hypothermic patients. The cellular and ionic mechanisms of the Osborn wave have been suggested, and its relationship to tachyarrhythmias, such as ventricular tachycardia and ventricular fibrillation, is being explored. This case highlights the arrhythmogenic potential of Osborn wave and individual difference in response of TH. PMID:25653709

  15. Case of Recurrent Ventricular Fibrillations with Osborn Wave Developed during Therapeutic Hypothermia

    OpenAIRE

    Kim, Chang-Yeon; Bae, Myung Hwan; Kim, Nam Kyun; Yang, Young Ae; Kim, Kyu Yeun; Lee, Jang Hoon; Eun, Jung Su; Cho, Yongkeun

    2015-01-01

    Therapeutic hypothermia (TH) has been used to protect neurological functions in cardiac arrest patient. Although Osborn wave is not pathognomonic of hypothermia, it is a well-known electrocardiogram finding of hypothermic patients. The cellular and ionic mechanisms of the Osborn wave have been suggested, and its relationship to tachyarrhythmias, such as ventricular tachycardia and ventricular fibrillation, is being explored. This case highlights the arrhythmogenic potential of Osborn wave and...

  16. Right ventricular systolic function in patients with COPD by echocardio-graphy%超声心动图在慢性阻塞性肺疾病患者右心收缩功能中的评估价值

    Institute of Scientific and Technical Information of China (English)

    尤雷英; 杨永红

    2015-01-01

    Objective:To investigate the value of right ventricular systolic function in patients with chronic obstructive pulmona-ry disease( COPD) by echocardiography. Methods:56 patients with COPD and 53 healthy individuals in our hospital from June 2012 to June 2014 were chosen,respectively divided into COPD group and the control group. Right ventricular systolic function and structures were analyzed between the two groups by the performance of echocardiography. Results:The RA-1,RA-2,RA-3 and right ventricular outflow tract(RVOT)inner diameter in the COPD group were higher than those in the control group(P<0. 05);The right ventricular wall thickness(RVWT)in the COPD group was wider than that in the control group(P<0. 05);The tricuspid annular planesystolic ex-cursion(TAPSE)in the COPD group was lower than that in the control group(P<0. 05);The right ventricular myocardial performance index( RV-MPI) and longitudinal strain of right ventricular lateral wall basal segment( RV-strain) in the COPD group were higher than those in the control group(P<0. 05). Conclusion:The echocardiography can assess the systolic function and structure of right heart quantitatively. Right heart size of COPD patients is greater, and systolic and diastolic function has decreased. Therefore, echocardio-graphy can be used for early diagnosis of COPD.%目的::探讨超声心动图在评估慢性阻塞性肺疾病( chronic obstructive pulmonary disease,COPD)患者右心收缩功能中的临床价值。方法:选取2012年6月至2014年6月因COPD在我院诊治的患者56例设为COPD组及同期在我院体检的健康者53例设为对照组,通过超声心动图的表现情况分析两组间右心收缩功能。结果: COPD组右心房上下径、右心房左右径、右心房面积及右心室流出道近端( right ventricular outflow tract,RVOT)内径均大于对照组,差异有统计学意义( P <0.05);COPD组右心室侧壁厚度(right ventricular wall thickness,RVWT)厚于对照

  17. Assessment of right ventricular myocardium motion in patient with DDD pacing using VVI%速度向量成像观察双腔起搏前后右心室运动状态

    Institute of Scientific and Technical Information of China (English)

    周春蕾; 许迪; 陆凤翔; 江立红; 郑真; 施斌斌

    2011-01-01

    Objective To assess right ventricular myocardium motion in patients with dual chamber pacing (DDD) using velocity vector imaging (VVI), and to explore the clinical application value of VVI in evaluating right ventricular motion. Methods 23 patients before and after DDD pacemaker implantation were enrolled in this study. The peak systolic displacement of right ventricular segments was measured with VVI.The difference between pre and post pacemaker implantation was analyzed. Results Right ventricular displacement before and after DDD pacing was significantly decreasing from basal, mid to apical segments ( P <0.01 ). Compared with the values at the baseline, the displacement of interventricular septum, free wall and right ventricle with pacing was decreased (P < 0.01 ). Conclusions Right ventricular displacement with pacing was significantly decreased compared with the values at the baseline. VVI can accurately assess right ventricular systolic displacement in patients with DDD pacing, and objectively reflect right ventricular myocardial motion and function.%目的 探讨速度向量成像(VVI)技术分析双腔(DDD)起搏前后右心室心肌运动位移的变化规律,初步探讨VVI技术在评价右心室运动方面的应用价值.方法 23例DDD起搏患者术前术后均采用VVI技术检测右心室室壁各节段心肌收缩期纵向运动位移,并比较术前术后之差异.结果 术前术后右心室各室壁不同节段心肌收缩峰值位移表现为从基底段到心尖段依次降低,其中基底段与心尖段的差异有统计学意义(P<0.01);与术前相比,术后后间隔、游离壁及右心室整体位移较术前显著降低,差异有统计学意义(P<0.01).结论 DDD起搏后右心室心肌运动位移较术前明显降低;VVI可精确测量DDD起搏前后右心室心肌位移的程度,从而客观反映右心室之运动状态,进而判断右心室之功能.

  18. Assessment of right ventricular function for patients with rheumatic mitral stenosis by 64-slice multi-detector row computed tomography: comparison with magnetic resonance imaging

    Institute of Scientific and Technical Information of China (English)

    ZHANG Xiao-chun; YANG Zhi-gang; GUO Yin-kun; ZHANG Rui-ming; WANG Jian; ZHOU Dai-quan; CHENG Lin; CHEN Lin

    2012-01-01

    Background Right ventricular (RV) dysfunction ensues due to rheumatic mitral stenosis (RMS).The evaluation of RV function is clinically important for the diagnosis,treatment,and follow-up for patients with different degrees of RMS.Thepurpose of this study was to determine whether the 64-slice multi-detector row computed tomography (64-slice MDCT)can assess the RV function in RMS with high accuracy and reproducibility when compared to MR imaging (MRI).Methods Right ventricular end-diastolic and end-systolic volumes (RV-EDV and RV-ESV),stroke volume (RV-SV),ejection fraction (RV-EF),cardiac output (RV-CO),and wall mass (RV-Mass) were measured with dedicated cardiac analysis software on 64-slice MDCT and compared with values measured with MRI in 43 consecutive patients with RMS.Agreement between MRI and 64-MDCT results were compared with Bland and Altman analysis and linear regression analysis.Repeated measurements were performed to determine intraobserver and interobserver variability.Results No significant differences were revealed in calculated RV function parameters between the two methods.RV-EDV,RV-ESV,RV-SV,RV-EF,RV-CO,and RV-Mass by 64-slice MDCT were similar to those by MRI (P>0.05).There were good correlations (r=0.98,0.97,0.96,0.96,0.95 and 0.77,respectively) and close agreement (bias=-0.2 ml,-1.0ml,0.8 ml,0.5%,26.1 ml,and 0.5 g,respectively,P>0.05).The variability in 64-slice MDCT measurements was similar to that in MRI values.Conclusion ECG-gated 64-slice MDCT could assess the RV function in RMS with high accuracy and reproducibility when compared to MRI.

  19. Adaptive right ventricular performance in response to acutely increased afterload in a lamb model of congenital heart disease: evidence for enhanced Anrep effect.

    Science.gov (United States)

    Johnson, Rebecca C; Datar, Sanjeev A; Oishi, Peter E; Bennett, Stephen; Maki, Jun; Sun, Christine; Johengen, Michael; He, Youping; Raff, Gary W; Redington, Andrew N; Fineman, Jeffrey R

    2014-04-15

    Patients with pulmonary hypertension associated with congenital heart disease survive longer with preserved right ventricular (RV) function compared with those with primary pulmonary hypertension. The purpose of this study was to test the hypothesis that superior RV performance can be demonstrated, at baseline and when challenged with increased RV afterload, in lambs with chronic left-to-right cardiac shunts compared with control lambs. A shunt was placed between the pulmonary artery and the aorta in fetal lambs (shunt). RV pressure-volume loops were obtained 4 wk after delivery in shunt and control lambs, before and after increased afterload was applied using pulmonary artery banding (PAB). Baseline stroke volume (8.7 ± 1.8 vs. 15.8 ± 2.7 ml, P = 0.04) and cardiac index (73.0 ± 4.0 vs. 159.2 ± 25.1 ml·min(-1)·kg(-1), P = 0.02) were greater in shunts. After PAB, there was no difference in the change in cardiac index (relative to baseline) between groups; however, heart rate (HR) was greater in controls (168 ± 7.3 vs. 138 ± 6.6 beats/min, P = 0.01), and end-systolic elastance (Ees) was greater in shunts (2.63 vs. 1.31 × baseline, P = 0.02). Control lambs showed decreased mechanical efficiency (71% baseline) compared with shunts. With acute afterload challenge, both controls and shunts maintained cardiac output; however, this was via maladaptive responses in controls, while shunts maintained mechanical efficiency and increased contractility via a proposed enhanced Anrep effect-the second, slow inotropic response in the biphasic ventricular response to increased afterload, a novel finding in the RV. The mechanisms related to these physiological differences may have important therapeutic implications.

  20. Cardiac MR imaging in arrhythmogenic heart diseases; Kardiale MRT in der Diagnostik arrhythmogener Herzerkrankungen

    Energy Technology Data Exchange (ETDEWEB)

    Boehm, C.K.; Dinter, D.J.; Diehl, S.J.; Neff, K.W. [Universitaetsklinikum Mannheim, Institut fuer Klinische Radiologie, Mannheim (Germany); Papavassiliu, T.; Borggrefe, M. [Universitaetsklinikum Mannheim, Medizinische Klinik, Mannheim (Germany)

    2007-04-15

    Cardiac arrhythmias are assessed with a combination of history, clinical examination, electrocardiogram, Holter monitor, if necessary supplemented by invasive cardiac electrophysiology. In ischemic heart disease (IHD) coronary angiography is performed in addition. Echocardiography is usually the primary imaging modality. MRI is increasingly recognized as an important investigation allowing more accurate cardiac morphological and functional assessment. Approximately one-fifth of deaths in Western countries are due to sudden cardiac death, 80% of which are caused by arrhythmias. Typical causes range from diseases with high prevalence (IHD in men 30%) to myocarditis (prevalence 1-9%) and rare cardiomyopathies (prevalence HCM 0.2%, ARVC 0.02%, Brugada syndrome approx. 0.5%). The characteristic MRI features of arrhythmogenic diseases and the new aspects of characteristic distribution of late enhancement allow etiologic classification and differential diagnosis. MRI represents an important tool for detection of the underlying cause and for risk stratification in many diseases associated with arrhythmias. (orig.) [German] Herzrhythmusstoerungen werden durch die Zusammenschau von Anamnese, klinischer Untersuchung, Elektrokardiogramm, Langzeit-EKG sowie ggf. einer invasiven elektrophysiologischen Untersuchung beurteilt. Bei der koronaren Herzerkrankung (KHK) erfolgt zusaetzlich eine Koronarangiographie. Die Echokardiographie stellt das primaere bildgebende Verfahren dar. Die MRT des Herzens ermoeglicht eine genauere morphologische und funktionelle Darstellung des Herzens und gewinnt damit zunehmend an Bedeutung. Etwa jeder 5. Todesfall in westlichen Industriestaaten ist auf einen ploetzlichen Herztod zurueckzufuehren, davon sind ca. 80% durch Herzrhythmusstoerungen verursacht. Typische Ursachen reichen von Krankheiten mit hoher Praevalenz (KHK bei Maennern 30%) ueber Myokarditiden (Praevalenz 1-9%) bis zu selteneren Kardiomyopathien (Praevalenz HCM 0,2%, ARVC 0,02%, Brugada

  1. Right Ventricular Function After Acute Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention (from the Glycometabolic Intervention as Adjunct toPrimary Percutaneous Coronary Intervention in ST-Segment Elevation Myocardial Infarction III Trial)

    NARCIS (Netherlands)

    Gorter, Thomas M; Lexis, Chris P H; Hummel, Yoran M; Lipsic, Erik; Nijveldt, Robin; Willems, Tineke P; van der Horst, Iwan C C; van der Harst, Pim; van Melle, Joost P; van Veldhuisen, Dirk J

    2016-01-01

    Right ventricular (RV) dysfunction is a powerful risk marker after acute myocardial infarction (MI). Primary percutaneous coronary intervention (PCI) has markedly reduced myocardial damage of the left ventricle, but reliable data on RV damage using cardiac magnetic resonance imaging (MRI) are scarce

  2. Visualization and functional characterization of the postinfarction arrhythmogenic substrate

    NARCIS (Netherlands)

    Dessel, Pascalis Franciscus Hubertus Maria van

    2002-01-01

    Much knowledge concerning the mechanisms and nature of the postinfarction arrhythmogenic substrate has been gathered in the past decades. The ever-expanding therapeutic options require more insight in the selection of postinfarction patients at risk for developing life-threatening arrhythmias as wel

  3. Lamin A/C mutation affecting primarily the right side of the heart

    Directory of Open Access Journals (Sweden)

    Laura Ollila

    2013-04-01

    Full Text Available LMNA mutations are amongst the most important causes of familial dilated cardiomyopathy. The most important cause of arrhythmogenic right ventricular cardiomyopathy (ARVC is desmosomal pathology. The aim of the study was to elucidate the role of LMNA mutations among Finnish cardiomyopathy patients. We screened 135 unrelated cardiomyopathy patients for LMNA mutations. Because of unusual phenotype, two patients were screened for the known Finnish ARVC-related mutations of desmosomal genes, and their Plakophilin-2b gene was sequenced. Myocardial samples from two patients were examined by immunohistochemical plakoglobin staining and in one case by electron microscopy. We found a new LMNA mutation Phe237Ser in a family of five affected members with a cardiomyopathy affecting primarily the right side of the heart. The phenotype resembles ARVC but does not fulfill the Task Force Criteria. The main clinical manifestations of the mutation were severe tricuspid insufficiency, right ventricular enlargement and failure. Three of the affected patients died of the heart disease, and the two living patients received heart transplants at ages 44 and 47. Electron microscopy showed nuclear blebbing compatible with laminopathy. Immunohisto - chemical analysis did not suggest desmosomal pathology. No desmosomal mutations were found. The Phe237Ser LMNA mutation causes a phenotype different from traditional cardiolaminopathy. Our findings suggest that cardiomyopathy affecting primarily the right side of the heart is not always caused by desmosomal pathology. Our observations highlight the challenges in classifying cardiomyopathies, as there often is significant overlap between the traditional categories.

  4. Catheter ablation of a monofocal premature ventricular complex triggering idiopathic ventricular fibrillation.

    Science.gov (United States)

    Takatsuki, S; Mitamura, H; Ogawa, S

    2001-07-01

    A 62 year old man was admitted for evaluation of recurrent episodes of syncope. A surface ECG showed frequent repetitive premature ventricular complexes of right ventricular outflow tract origin. Ventricular fibrillation was inducible by programmed electrical stimulation but otherwise cardiac evaluation was unremarkable. A diagnosis of idiopathic ventricular fibrillation was made and an implantable cardioverter-defibrillator (ICD) was installed. However, spontaneous ventricular fibrillation recurred, requiring repeated ICD discharges. The ventricular fibrillation was reproducibly triggered by a single premature ventricular complex with a specific QRS morphology. Radiofrequency catheter ablation was carried out to eradicate this complex. No ventricular fibrillation has developed after this procedure, and the patient does not require drug treatment.

  5. A fatal case of acute pulmonary embolism caused by right ventricular masses of acute lymphoblastic lymphoma-leukemia in a 13 year old girl

    Directory of Open Access Journals (Sweden)

    Yu Mi Ko Ko

    2012-07-01

    Full Text Available We report a case of a 13-year-old girl with acute lymphoblastic lymphoma- leukemia, who presented with a cardiac metastasis in the right ventricle, resulting in a pulmonary embolism. At the time of her leukemia diagnosis, a cardiac mass was incidentally found. The differential diagnosis for this unusual cardiac mass included cardiac tumor, metastasis, vegetation, and thrombus. Empirical treatment was initiated, including anticoagulation and antibiotics. She underwent plasmapheresis and was administered oral prednisolone for her leukemia. Five days later, she experienced sudden hemodynamic collapse and required extracorporeal membrane oxygenation insertion and emergency surgery. These interventions proved futile, and the patient died. Pathology revealed that the cardiac mass comprised an aggregation of small, round, necrotic cells consistent with leukemia. This is the first known case of acute lymphoblastic leukemia presenting as a right ventricular mass, with consequent fatal acute pulmonary embolism. A cardiac mass in a child with acute leukemia merits investigation to rule out every possible etiology, including vegetation, thrombus, and even a mass of leukemic cells, which could result in the fatal complication of pulmonary embolism.

  6. Naxos disease: Cardiocutaneous syndrome due to cell adhesion defect

    OpenAIRE

    Protonotarios Nikos; Tsatsopoulou Adalena

    2006-01-01

    Abstract Naxos disease is a recessively inherited condition with arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) and a cutaneous phenotype, characterised by peculiar woolly hair and palmoplantar keratoderma. The disease was first described in families originating from the Greek island of Naxos. Moreover, affected families have been identified in other Aegean islands, Turkey, Israel and Saudi Arabia. A syndrome with the same cutaneous phenotype and predominantly left ventric...

  7. Sudden cardiac death in children and adolescents (excluding Sudden Infant Death Syndrome)

    International Nuclear Information System (INIS)

    Sudden death in the young is rare. About 25% of cases occur during sports. Most young people with sudden cardiac death (SCD) have underlying heart disease, with hypertrophic cardiomyopathy and coronary artery anomalies being commonest in most series. Arrhythmogenic right ventricular dysplasia and long QT syndrome are the most common primary arrhythmic causes of SCD. It is estimated that early cardiopulmonary resuscitation and widespread availability of automatic external defibrillators could prevent about a quarter of pediatric sudden deaths

  8. Sudden cardiac death in children and adolescents (excluding Sudden Infant Death Syndrome)

    OpenAIRE

    Gajewski Kelly; Saul Philip

    2010-01-01

    Sudden death in the young is rare. About 25% of cases occur during sports. Most young people with sudden cardiac death (SCD) have underlying heart disease, with hypertrophic cardiomyopathy and coronary artery anomalies being commonest in most series. Arrhythmogenic right ventricular dysplasia and long QT syndrome are the most common primary arrhythmic causes of SCD. It is estimated that early cardiopulmonary resuscitation and widespread availability of automatic external defibrillators...

  9. A 19-year-old male with palpitations

    OpenAIRE

    Upadhyay, Shailendra; Upadhyay, Shweta

    2008-01-01

    A 19-year-old male presented to the emergency department (ED) following intermittent episodes of palpitations. Classical “epsilon waves” noted on his initial electrocardiogram prompted an evaluation for arrhythmogenic right ventricular dysplasia (ARVD). The diagnosis was confirmed with magnetic resonance imaging of the heart and stress test. A prompt recognition and management of this condition in the ED helped prevent significant mortality that may be associated with ARVD.

  10. 右心室间隔部室性早搏/室性心动过速的心电图特征及射频消融治疗%Electrocardiographic characteristics and radiofrequency catheter ablation of premature ventricular complexes/ventricular tachycardia originating from right ventricular septum

    Institute of Scientific and Technical Information of China (English)

    王永光; 林加锋; 李岳春; 季亢挺; 殷日鹏

    2015-01-01

    Objective To observe the curative efficacy and safety of radiofrequency catheter ablation and the electrocardiographic characteristics of idiopathic premature ventricular complexes/ventricular tachycardia(PVC/VT) originating from right ventricular septum.Methods Electrocardiographic characteristics and variation of PVC/VT originating from right ventricular septum were analyzed in 62 patients [32 males,average age of (57.0 ± 18.8) years old] undergoing radiofrequency catheter ablation.Results Forty-nine patients (79.0%) were successfully ablated without related complications.Its electrocardiographic characteristics and change rulewere as follows:①QRS morphology was mainly R in lead Ⅰ;②most was R,a few was r,m or qr in lead aVL;③QS,qs or r in lead aVR;④The position of the origin was positively associated with R wave amplitude in inferior leads,but negatively correlated with the amplitude of S wave;⑤PVC/VT originating from right ventricular outflow tract always manifested as R wave in the inferior leads,while the majority of PVC/VT originating from right ventricular septum showed S wave in at least one or more inferior leads;⑥In addition to PVC/ VT originating from right ventricular septum adjacent to tricuspid annulus and the middle upper septum was rS in lead V1,most PVC/IVT originating from other parts was QS in lead V1,and with the origin point moving down to the middle and apical segments,the amplitude and distribution of precordial R wave becomes less,while QS wave was deeper and distributed more widely.Conclusion Radiofrequency catheter ablation is safe and effective for treating PVC/VT originating from the right ventricular septum,the electrocardiographic characteristics of different origins have certain change rules,grasping these characteristics will be benefit to determine its origin,shorten the operation time.%目的 探讨右心室间隔部起源特发性室性早搏/室性心动过速(PVC/VT)的体表心电图特点及射频消融治

  11. 单导管射频消融治疗右室流出道室性期前收缩%Radiofrequency catheter ablation of premature ventricular contractions from right ventricular outflow tract by single catheter electrode

    Institute of Scientific and Technical Information of China (English)

    梁锦军; 黄鹤; 杨波; 万军; 唐艳红; 江洪; 黄从新

    2011-01-01

    AIM: To assess the clinical effects of ablation of premature ventricular contractions ( PVCs ) in right ventricular outflow tracl ( RVOT) using a single catheter electrode. METHODS: Single catheter technique for radiofrequency catheter ablation ( RFCA) was performed in 65 consecutive patients with severe symptomatic monomorphic PVCs originating within the RVOT. A 7-Fr, 4-mm-tip catheter was used for both mapping and ablation. Target sites were localized by pace mapping. Pace mapping demonstrated identical QRS complex configurations during pacing and during arrhythmia in at least 11 leads. RESULTS; Acute ablation success was achieved in 63/65 patients (96. 9% ). During the follow-up of ( 28 ± 13) months, recurrence and reablation were done in three patients (4. 6% ). Two of these patients remained arrhythmia-free. Surgical time was (50+27) min, and fluoroscopy time was (8. 1 ±3. 8) min. No ablation-related complications occurred during the follow-up of 15 -40 months. CONCLUSIONS; Single catheter technique is safe and effective for mapping and ablation of PVCs from RVOT.%目的:观察单导管射频消融治疗右室流出道室性期前收缩(室性早搏,室早)的安全性和临床效果.方法:经常规体检、生化检查、X线胸片、心脏彩超、长程心电图等各种检查后,入选65例患者,采用温控消融导管以起搏为主的方法进行标测,并对单导管射频消融的安全性和临床效果进行总结.结果:消融即刻成功率97%( 63/65),其中2例放弃消融术;随访15~40个月,有3例复发并再次手术,成功2例,总成功率为95%( 62/65),无复发.电生理检测和消融时间:(50±27) min;曝光时间:(8.1±3.8)min,所有患者术中及术后均未发生消融相关并发症.结论:单导管射频消融治疗右室流出道室早安全有效,并能减少消融操作及X线暴露时间.

  12. Potential of right to left ventricular volume ratio measured on chest CT for the prediction of pulmonary hypertension: correlation with pulmonary arterial systolic pressure estimated by echocardiography

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Heon [Soon Chun Hyang University, Department of Radiology, Bucheon (Korea, Republic of); Kim, Seok Yeon [Seoul Medical Center, Department of Cardiology, Seoul (Korea, Republic of); Lee, Soo Jeong [Terarecon Korea, Seoul (Korea, Republic of); Kim, Jae Kyun [Chung-Ang University College of Medicine, Department of Radiology, Seoul (Korea, Republic of); Reddy, Ryan P.; Schoepf, U.J. [Medical University of South Carolina, Department of Radiology and Radiological Science and Division of Cardiology, Department of Medicine, Charleston, SC (United States)

    2012-09-15

    To investigate the correlation of right ventricular (RV) to left ventricular (LV) volume ratio measured by chest CT with pulmonary arterial systolic pressure (PASP) estimated by echocardiography. 104 patients (72.47 {+-} 13.64 years; 39 male) who had undergone chest CT and echocardiography were divided into two groups (hypertensive and normotensive) based upon an echocardiography-derived PASP of 25 mmHg. RV to LV volume ratios (RV{sub V}/LV{sub V}) were calculated. RV{sub V}/LV{sub V} was then correlated with PASP using regression analysis. The Area Under the Curve (AUC) for predicting pulmonary hypertension on chest CT was calculated. In the hypertensive group, the mean PASP was 46.29 {+-} 14.42 mmHg (29-98 mmHg) and there was strong correlation between the RV{sub V}/LV{sub V} and PASP (R = 0.82, p < 0.001). The intraobserver and interobserver correlation coefficients for RV{sub V}/LV{sub V} were 0.990 and 0.892. RV{sub V}/LV{sub V} was 1.01 {+-} 0.44 (0.51-2.77) in the hypertensive and 0.72 {+-} 0.14 (0.52-1.11) in the normotensive group (P <0.05). With 0.9 as the cutoff for RV{sub V}/LV{sub V}, sensitivity and specificity for predicting pulmonary hypertension over 40 mmHg were 79.5 % and 90 %, respectively. The AUC for predicting pulmonary hypertension was 0.87 RV/LV volume ratios on chest CT correlate well with PASP estimated by echocardiography and can be used to predict pulmonary hypertension over 40 mmHg with high sensitivity and specificity. (orig.)

  13. Potential of right to left ventricular volume ratio measured on chest CT for the prediction of pulmonary hypertension: correlation with pulmonary arterial systolic pressure estimated by echocardiography

    International Nuclear Information System (INIS)

    To investigate the correlation of right ventricular (RV) to left ventricular (LV) volume ratio measured by chest CT with pulmonary arterial systolic pressure (PASP) estimated by echocardiography. 104 patients (72.47 ± 13.64 years; 39 male) who had undergone chest CT and echocardiography were divided into two groups (hypertensive and normotensive) based upon an echocardiography-derived PASP of 25 mmHg. RV to LV volume ratios (RVV/LVV) were calculated. RVV/LVV was then correlated with PASP using regression analysis. The Area Under the Curve (AUC) for predicting pulmonary hypertension on chest CT was calculated. In the hypertensive group, the mean PASP was 46.29 ± 14.42 mmHg (29-98 mmHg) and there was strong correlation between the RVV/LVV and PASP (R = 0.82, p V/LVV were 0.990 and 0.892. RVV/LVV was 1.01 ± 0.44 (0.51-2.77) in the hypertensive and 0.72 ± 0.14 (0.52-1.11) in the normotensive group (P V/LVV, sensitivity and specificity for predicting pulmonary hypertension over 40 mmHg were 79.5 % and 90 %, respectively. The AUC for predicting pulmonary hypertension was 0.87 RV/LV volume ratios on chest CT correlate well with PASP estimated by echocardiography and can be used to predict pulmonary hypertension over 40 mmHg with high sensitivity and specificity. (orig.)

  14. Assessment of left and right ventricular diastolic and systolic functions using two-dimensional speckle-tracking echocardiography in patients with coronary slow-flow phenomenon.

    Directory of Open Access Journals (Sweden)

    Yonghuai Wang

    Full Text Available Coronary slow-flow phenomenon (CSFP is an angiographic diagnosis characterised by a low rate of flow of contrast agent in the normal or near-normal epicardial coronary arteries. Many of the patients with CSFP may experience recurrent acute coronary syndromes. However, current clinical practice tends to underestimate the impact of CSFP due to the yet unknown effect on the cardiac function. This study was performed to evaluate left ventricular (LV and right ventricular (RV diastolic and systolic functions, using two-dimensional (2D longitudinal strain and strain rate, in patients with CSFP, and to determine the relationships between the thrombolysis in myocardial infarction (TIMI frame count (TFC and LV and RV diastolic and systolic functions.Sixty-three patients with CSFP and 45 age- and sex-matched controls without CSFP were enrolled in the study. Diagnosis of CSFP was made by TFC. LV and RV diastolic and systolic functions were assessed by 2D speckle-tracking echocardiography.LV peak early diastolic longitudinal strain rate (LSRe was lower in patients with CSFP than in controls (P = 0.01. LV peak systolic longitudinal strain (LS and LV peak systolic longitudinal strain rate (LSRs were lower in patients with CSFP than in controls (P = 0.004 and P = 0.03, respectively. There was no difference in LV ejection fraction. RV peak early diastolic longitudinal strain rate (RSRe was lower in patients with CSFP than in controls (P = 0.03. There were no differences in RV peak systolic longitudinal strain (RS, RV peak systolic longitudinal strain rate (RSRs, or RV fractional area change among the groups. The mean TFC correlated negatively with LSRe and RSRe in patients with CSFP (r = -0.26, P = 0.04 and r = -0.32, P = 0.01, respectively.LV diastolic and systolic functions were impaired in patients with CSFP. CSFP also affected RV diastolic function, but not RV systolic function.

  15. Simultaneous beat-by-beat investigation of the effects of the Valsalva maneuver on left and right ventricular filling and the possible mechanism.

    Directory of Open Access Journals (Sweden)

    Zhen Wang

    Full Text Available Although the influence of the Valsalva maneuver on the heart and circulatory system has been investigated, the mechanism of intrathoracic pressure influencing cardiovascular function is unclear. To test our hypothesis that the interaction between the anatomy-determined partially-intrathoracic system and the fully-intrathoracic system might explain those issues and help to disclose the mechanism, we used the Hitachi dual pulse wave Doppler echocardiographic apparatus to investigate simultaneously the beat-by-beat influence of 40-mmHg Valsalva maneuver on left and right cardiac ventricular filling in 30 male adult volunteers. The mitral and tricuspid blood inflow velocity spectra during the Valsalva maneuver were recorded simultaneously. The peak velocity (PV, velocity-time integral (VTI and inflow volume (IV of each cycle were measured or calculated. The PV, VTI and IV of the left heart remained unchanged at the first beat after the Valsalva maneuver onset (compared with those at rest, p>0.1 and then decreased gradually to the lowest at the 11±1.2th beat (range, 9th to 12th beat. Simultaneously, the PV, VTI and IV of the right heart decreased significantly (p<0.05 at the first cycle, decreased rapidly to the lowest at the 6±0.8th beat (range, 4th to 7th beat and then increased gradually to the 9±1.3th beat (range, 8th to 10th beat. These results suggest that the left heart and right heart have different physiological responses to the Valsalva maneuver. These could be explained by our hypothesis, the interaction between the partially-intrathoracic system and the fully-intrathoracic system, which might help to disclose the mechanism of how intrathoracic pressure influences the heart and circulatory system.

  16. Right and left ventricular ejection fraction after an acute inferior wall myocardial infarction and the value of V4R to predict the site of obstruction

    Energy Technology Data Exchange (ETDEWEB)

    Braat, S.H.; Brugada, P.; Den Dulk, K.; Wellens, H.J.J.

    1984-01-01

    This study was undertaken to compare the right (RVEF) and left ventricular ejection fraction (LVEF) after an acute inferior wall myocardial infarction (MI) caused by an obstruction in the right coronary artery (RCA) or circumflex coronary artery (CX) and to evaluate the value of lead V4R to predict the site of stenosis which caused the MI. In 42 consecutive patients (pts) admitted with an acute inferior wall MI a standard ECG and V4R were recorded. A nuclear angiogram was made one week after the acute MI and the RVEF and LVEF were calculated. Ten to 14 days (mean 12.7) after the acute MI a coronary angiogram was performed to determine the site of occlusion, which had caused the acute MI. According to the site of occlusion the pts were divided in three groups: Group A: the stenosis which had caused the MI was located in the RCA above the first branch to the right ventricle (RV); Group B: the stenosis was below the first branch to the RV in the RCA and Group C: the stenosis was located in the CX. The RVEF and LVEF in these groups are given. Nineteen pts had ST-segment elevation greater than or equal to 1 mm in V/sub 4/R and 17 of these pts had an obstruction above the first branch to the RV in the RCA. There is statistically no significant difference between the LVEF in the three different groups while the RVEF is significantly lower in group A. These pts can be identified by recording V4R.

  17. LEFT VENTRICULAR INFLOW OBSTRUCTION BY GIANT ATRIAL SEPTAL ANEURYSM IN A NEONATE WITH HYPOPLASTIC RIGHT HEART SYNDROME: CASE REPORT.

    Science.gov (United States)

    Yuko-Jowi, C; Okello, C A

    2013-02-01

    Atrial septal aneurysm remains a rare congenital cardiac malformation. In the neonatal age group it can occur as an isolated cardiac malformation or in association with complex hypoplastic cardiac malformations of the right and left heart. In the adult population most aneurysms have been described in association with stroke. Baby H.N delivered on 10/05/2008 by C/S, was cyanosed at birth with systemic desaturation. Chest X-ray showed oligaemic lung fields while two dimensional echocardiograms showed tricuspid atresia with hypoplastic right ventricle, large secundum atrial septal defect, and highly mobile gigantic aneurysms of the atrial septum obstructing the inflow of the mitral valve and entering the left ventricle in diastole. Surgical intervention was not possible and child died on second day.

  18. Successful Tricuspid Valve Replacement in a Patient with Severe Pulmonary Arterial Hypertension and Preserved Right Ventricular Systolic Function

    Directory of Open Access Journals (Sweden)

    Jamil A. Aboulhosn

    2009-01-01

    Full Text Available A 56-year-old patient with severe pulmonary hypertension developed severe tricuspid regurgitation, right-sided heart failure, and congestive hepatopathy. She was transferred for possible lung transplant and/or tricuspid valve surgery. Clinical and echocardiographic assessment provided confidence that acute tricuspid valve failure was responsible for the decompensation and that tricuspid valve replacement despite pulmonary hypertension could be performed.

  19. Case of Successful Mapping of Epicardial Surface of the Basal Part of the Left Ventricle during Ventricular Tachyarrhythmia Radiofrequency Ablation

    Directory of Open Access Journals (Sweden)

    Bockeria L. A.

    2012-09-01

    rhythm and complete elimination of symptomatic ventricular tachyarrhythmiae. Disadvantages of this procedure: possible complications (hemopericardium, precordialgiae, acute myocardial infarction, absence of 100% possibility to use radiofrequency ablation because of supposed arrhythmogenic area of coronary arteries and epicardial body fat; besides, there are the cases of intramyocardial position of ectopic activity.

  20. Recurrent Monostotic Fibrous Dysplasia in the Mandible

    Directory of Open Access Journals (Sweden)

    Nilton Alves

    2016-01-01

    Full Text Available Fibrous dysplasia (FD is a condition in which normal bone marrow is replaced by an abnormal proliferation of new fibrous connective tissue. Female patient, white, 20 years old, attended the dental clinic reporting a slow increase in volume in the right mandible region over the last 5 years. She was examined by imaging: the panoramic X-ray revealed a lesion with the appearance of ground glass while the cone-beam computed tomography showed an extensive lesion in the region of the right hemimandible. The histopathological examination was compatible with fibrous dysplasia. Bone gammagraphy was indicated, plus an endocrinological study to eliminate polyostotic forms, which produced a negative result. Monostotic fibrous dysplasia in the right hemimandible was diagnosed. Conservative surgery was carried out and after 1 year recurrence of the tumour was observed. We may conclude that conservative surgery might not be the best choice for treatment for monostotic fibrous dysplasia in the mandible and that other options must be considered, such as radical surgery or the use of bisphosphonates. In our study, we may also conclude that it is very important to explain to the patient the possibility of recurrence of the lesion and the need for monitoring with periodic imaging studies.

  1. Right ventricular nitric oxide signaling in an ovine model of congenital heart disease: a preserved fetal phenotype.

    Science.gov (United States)

    Kameny, Rebecca Johnson; He, Youping; Morris, Catherine; Sun, Christine; Johengen, Michael; Gong, Wenhui; Raff, Gary W; Datar, Sanjeev A; Oishi, Peter E; Fineman, Jeffrey R

    2015-07-01

    We recently reported superior right ventricle (RV) performance in response to acute afterload challenge in lambs with a model of congenital heart disease with chronic left-to-right cardiac shunts. Compared with control animals, shunt lambs demonstrated increased contractility because of an enhanced Anrep effect (the slow increase in contractility following myocyte stretch). This advantageous physiological response may reflect preservation of a fetal phenotype, since the RV of shunt lambs remains exposed to increased pressure postnatally. Nitric oxide (NO) production by NO synthase (NOS) is activated by myocyte stretch and is a necessary intermediary of the Anrep response. The purpose of this study was to test the hypothesis that NO signaling is increased in the RV of fetal lambs compared with controls and shunt lambs have persistence of this fetal pattern. An 8-mm graft was placed between the pulmonary artery and aorta in fetal lambs (shunt). NOS isoform expression, activity, and association with activating cofactors were determined in fetal tissue obtained during late-gestation and in 4-wk-old juvenile shunt and control lambs. We demonstrated increased RNA and protein expression of NOS isoforms and increased total NOS activity in the RV of both shunt and fetal lambs compared with control. We also found increased NOS activation and association with cofactors in shunt and fetal RV compared with control. These data demonstrate preserved fetal NOS phenotype and NO signaling in shunt RV, which may partially explain the mechanism underlying the adaptive response to increased afterload seen in the RV of shunt lambs.

  2. Living after sudden death: A case report of Naxos disease

    Directory of Open Access Journals (Sweden)

    Jose Alberto Garcia Noain

    2012-01-01

    Full Text Available Naxos disease is a recessive inherited condition with arrhythmogenic right ventricular dysplasia (ARVD and a peculiar cutaneous phenotype (woolly hair and a palmoplantar keratoderma. Woolly hair appears from birth, palmoplantar keratoderma develops during childhood and cardiomyopathy is clinically manifested by adolescence. Patients present with syncope, sustained ventricular tachycardia or sudden death. We report a case of a 14 year old boy from Spain, who was admitted into our emergency room after being resuscitated from cardiac arrest, secondary to malignant ventricular tachycardia that developed while he was playing basketball.

  3. Evaluation of right ventricular volume and mass using retrospective ECG-gated cardiac multidetector computed tomography: comparison with first-pass radionuclide angiography

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Tae Hoon [Yonsei University College of Medicine, Department of Radiology, Seoul (Korea); Yongdong Severance Hospital, Department of Radiology, Seoul (Korea); Ryu, Young Hoon; Hur, Jin; Kim, Sang Jin; Kim, Hyun Soo; Choi, Byoung Wook [Yonsei University College of Medicine, Department of Radiology, Seoul (Korea); Kim, Young; Kim, Hyung Jung [Yonsei University College of Medicine, Department of Pulmonology, Seoul (Korea)

    2005-09-01

    The purposes of this study were to evaluate the right ventricular (RV) volume and mass using cardiac multidetector computed tomography (MDCT) and to compare the cardiac MDCT results with those from first-pass radionuclide angiography (FPRA). Twenty patients were evaluated for the RV end-diastolic volume (RVEDV), the RV end-systolic volume (RVESV), the RV ejection fraction (RVEF), and RV mass using cardiac MDCT with a two-phase reconstruction method based on ECG. The end-diastolic phase was reconstructed at the starting point of the QRS complex on ECG, and the end-systolic phase was reconstructed at the halfway point of the ascending T-wave on ECG. The RV mass was measured for the end-systole. The RVEF was also obtained by FPRA. The mean RVEF (47{+-}7%) measured by cardiac MDCT was well correlated with that (44{+-}6%) measured by FPRA (r=0.854). A significant difference in the mean RVEF was found between cardiac MDCT and FPRA (p=0.001), with an overestimation of 2.9{+-}5.3% by cardiac MDCT versus FPRA. The interobserver variability was 4.4% for the RVEDV, 6.8% for the RVESV, and 7.9% for the RV mass, respectively. Cardiac MDCT is relatively simple and allows the RV volume and mass to be assessed, and the RVEF obtained by cardiac MDCT correlates well with that measured by FPRA. (orig.)

  4. Four-dimensional computed tomography: a method of assessing right ventricular outflow tract and pulmonary artery deformations throughout the cardiac cycle

    Energy Technology Data Exchange (ETDEWEB)

    Schievano, Silvia; Capelli, Claudio; Young, Carol; Lurz, Philipp; Nordmeyer, Johannes; Owens, Catherine; Bonhoeffer, Philipp; Taylor, Andrew M. [UCL, Institute of Child Health and Great, Ormond Street Hospital for Children, Cardiovascular Unit, London (United Kingdom)

    2011-01-15

    To characterise 3D deformations of the right ventricular outflow tract (RVOT)/ pulmonary arteries (PAs) during the cardiac cycle and estimate the errors of conventional 2D assessments. Contrast-enhanced, ECG-gated cardiovascular computed tomography (CT) findings were retrospectively analysed from 12 patients. The acquisition of 3D images over 10 phases of the cardiac cycle created a four-dimensional CT (4DCT) dataset. The datasets were reconstructed and deformation measured at various levels of the RVOT/PAs in both space and time. Section planes were either static or dynamic relative to the motion of the structures. 4DCT enabled measurement and characterisation of in vivo 3D changes of patients' RVOT/PA during the cardiac cycle. The studied patient population showed a wide range of RVOT/PA morphologies, sizes and dynamics that develop late after surgical repair of congenital heart disease. There were also significant differences in the measured cross-sectional areas of the structures between static and dynamic section planes (up to 150%, p < 0.05) secondary to large 3D displacements and rotations. 4DCT imaging data suggest high variability in RVOT/PA dynamics and significant errors in deformation measurements if 3D analysis is not carried out. These findings play an important role for the development of novel percutaneous approaches to pulmonary valve intervention. (orig.)

  5. Semi-quantitative assessment of right ventricular function in comparison to a 3D volumetric approach: A cardiovascular magnetic resonance study

    Energy Technology Data Exchange (ETDEWEB)

    Nijveldt, Robin; Germans, Tjeerd; Rossum, Albert C. van [VU University Medical Center, Department of Cardiology, Amsterdam (Netherlands); Interuniversity Cardiology Institute of the Netherlands, Utrecht (Netherlands); McCann, Gerald P. [University Hospitals Leicester, Department of Cardiology, Leicester (United Kingdom); Beek, Aernout M. [VU University Medical Center, Department of Cardiology, Amsterdam (Netherlands)

    2008-11-15

    Right ventricular (RV) volume measurements with cardiovascular magnetic resonance (CMR) is considered the gold standard, but acquisition and analysis remain time-consuming. The aim of our study was therefore to investigate the accuracy and performance of a semi-quantitative assessment of RV function in CMR, compared to the standard quantitative approach. Seventy-five subjects with pulmonary hypertension (15), anterior myocardial infarction (15), inferior myocardial infarction (15), Brugada syndrome (15) and normal subjects (15) underwent cine CMR. RV end-systolic and end-diastolic volumes were determined to calculate RV ejection fraction (EF). Four-chamber cine images were used to measure tricuspid annular plane systolic excursion (TAPSE). RV fractional shortening (RVFS) was calculated by dividing TAPSE by the RV end-diastolic length. RV EF correlated significantly with TAPSE (r = 0.62, p < 0.01) and RVFS (r = 0.67, p < 0.01). Sensitivity to predict RV dysfunction was comparable between TAPSE and RVFS, with higher specificity for RVFS, but comparable areas under the ROC curve. Intra- and inter-observer variability of RV EF was better than TAPSE (3%/4% versus 7%/15%, respectively). For routine screening in clinical practice, TAPSE and RVFS seem reliable and easy methods to identify patients with RV dysfunction. The 3D volumetric approach is preferred to assess RV function for research purposes or to evaluate treatment response. (orig.)

  6. Inhalation of the BK(Ca-opener NS1619 attenuates right ventricular pressure and improves oxygenation in the rat monocrotaline model of pulmonary hypertension.

    Directory of Open Access Journals (Sweden)

    Marc Revermann

    Full Text Available BACKGROUND: Right heart failure is a fatal consequence of chronic pulmonary hypertension (PH. The development of PH is characterized by increased proliferation of vascular cells, in particular pulmonary artery smooth muscle cells (PASMCs and pulmonary artery endothelial cells. In the course of PH, an escalated right ventricular (RV afterload occurs, which leads to increased perioperative morbidity and mortality. BK(Ca channels are ubiquitously expressed in vascular smooth muscle cells and their opening induces cell membrane hyperpolarization followed by vasodilation. Moreover, BK activation induces anti-proliferative effects in a multitude of cell types. On this basis, we hypothesized that treatment with the nebulized BK channel opener NS1619 might be a therapy option for pulmonary hypertension and tested this in rats. METHODS: (1 Rats received monocrotaline injection for PH induction. Twenty-four days later, rats were anesthetized and NS1619 or the solvent was administered by inhalation. Systemic hemodynamic parameters, RV hemodynamic parameters, and blood gas analyses were measured before as well as 30 and 120 minutes after inhalation. (2 Rat PASMCs were stimulated with PDGF-BB in the presence and absence of NS1619. AKT, ERK1 and ERK2 activation were investigated by western blot analyses, and relative cell number was determined 48 hours after stimulation. RESULTS: Inhalation of a 12 µM and 100 µM NS1619 solution significantly reduced RV pressure without affecting systemic arterial pressure. Blood gas analyses demonstrated significantly reduced carbon dioxide and improved oxygenation in NS1619-treated animals pointing towards a considerable pulmonary shunt-reducing effect. In PASMC's, NS1619 (100 µM significantly attenuated PASMC proliferation by a pathway independent of AKT and ERK1/2 activation. CONCLUSION: NS1619 inhalation reduces RV pressure and improves oxygen supply and its application inhibits PASMC proliferation in vitro. Hence, BK

  7. Ultrastructural characteristics of the formation and development of the intercalated disc in the rat left and right working ventricular myocardium on the postnatal ontogenetic stages

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    Petruk N.S.

    2013-01-01

    Full Text Available Background. Maintenance of the normal distribution of intercellular contacts between cardiomyocytes and preservation of the correct geometry of the intercalated disc are essential conditions for the proper functioning of the heart. Objective. To provide complex ultrastructural evaluation of the mechanism of formation and development of the intercalated disc in rat ventricular myocardium on postnatal stages of development. Methods. Rats at the age of 1, 3, 7, 14, 30 days after birth and mature individuals were used as an object. Transmission electron microscopy, morphometric and statistical methods were applied. In particular, the convolution index was evaluated to characterize quantitative changes of the dynamics of configuration of intercalated disc. Results. It was found that the redistribution of adherens junctions from the lateral surface of cardiomyocytes occurs most rapidly from 3rd to 14th days after birth. The gap junctions trimming occurs due to their internalization with subsequent formation of the annular gap junction profile in the sarcoplasm; these profiles are inserted into the intercalated disc at the last turn. The process of complication of the geometry of intercalated disc is accompanied by the consistent increase of convolution index in the mature myocardium of the left and right ventricles up to 2,46±0,17 and 1,94±0,14, respectively. The predominance of the convolution index in the left ventricle over the levels in the right ventricle was the most prominent on the 14th day of postnatal development (38,1%; p<0,05 and in the mature myocardium – 26,8% (p<0,05. Conclusion. As the result of physiological hypertrophy and adaptive remodeling of cardiomyocyte in the postnatal rat cardiogenesis redistribution of diffusely located intercellular junctions from the periphery to the terminal areas of the cell occurs. The formation of a definitive pattern of distribution of intercellular junctions is completed at the puberty.

  8. Dysplasia epiphysealis capitis femoris. Meyer dysplasia

    Directory of Open Access Journals (Sweden)

    Enrique Vergara-Amador

    2011-01-01

    Full Text Available Introduction: Epiphyseal dysplasia of the femoral head (EDFH is defined as an alteration in the development of the child’s hip, characterized by delayed ossification of the proximal femoral epiphysis. Methods: Herein, we present six cases of epiphyseal dysplasia of the femoral head (EDFH, seen by the principal author (EVA within the last six years with minimum follow up at 15 months. Results: The cases were all diagnosed as casual findings. None of the children had symptoms or clinical signs in the hip, only one had a history of hip pain for five days, two months prior, which was diagnosed at the time as transient synovitis. Discussion: Among the differential diagnoses, the main one is Perthes disease, which is differentiated by several parameters like earlier age onset for EDFH (in children below 4 years of age, bilateralism (50% vs. 10%, and a calmer presentation in Meyer’s dysplasia. The evolution in Meyer’s dysplasia is toward improving radiographic changes. None of the patients revealed incongruence of the hip or early degenerative changes, indicating an excellent prognosis. Many authors think it is a variant of the normal ossification of the femoral head.

  9. Catheter ablation of a polymorphic ventricular tachycardia inducing monofocal premature ventricular complex.

    Science.gov (United States)

    Uemura, Takashi; Yamabe, Hiroshige; Tanaka, Yasuaki; Morihisa, Kenji; Kawano, Hiroaki; Kaikita, Koichi; Sumida, Hitoshi; Sugiyama, Seigo; Ogawa, Hisao

    2008-01-01

    Ventricular tachycardia originating from the right ventricular outflow tract (RVOT) is considered benign, but sometimes it causes polymorphic ventricular tachycardia and ventricular fibrillation, resulting in sudden cardiac death. A 58-year-old woman without structural heart disease was admitted for evaluation of recurrent episodes of syncope. Surface ECG showed frequent repetitive premature ventricular contraction (PVC) of RVOT origin. Polymorphic ventricular tachycardia triggered by the same PVC was documented by Holter ECG during an episode of syncope. Radiofrequency catheter ablation was performed to eradicate this PVC. No polymorphic ventricular tachycardia has developed after the procedure, and the patient has had no recurrence of syncope.

  10. Study of left ventricular systolic synchrony and sequence in patients with premature ventricular complexes from right ventricular outflow tract%右心室流出道起源室性期前收缩患者左心室收缩同步性及时序的研究

    Institute of Scientific and Technical Information of China (English)

    姚静; 许迪; 陆凤翔; 雍永宏; 庄燕; 季玲; 曹克将

    2010-01-01

    目的 分析正常人及右室流出道(right ventricular outflow tract,RVOT)起源室性期前收缩(premature ventricular complexes,PVCs)患者收缩期应变达峰时间,探讨RVOT起源PVCs患者心肌收缩同步性及时序规律.方法 应用斑点追踪成像(speckle tracking imaging,STI)技术测量30例RVOT起源PVCs患者在窦性心搏、室性心搏时及30例正常人纵向(TsL)、环周(TsC)、径向(TsR)收缩期应变达峰时间,分别计算标准差,并分析室性心搏时各方向应变达峰时间时序分布规律.结果 与正常对照组比较,RVOT起源PVCs患者在室性心搏时TsL、TsC、TsR标准差均增大,窦性心搏时TsC、TsR标准差增大.室性心搏时,TsL、TsR从心尖至基底的不同层面间差异显著;TsL、TsC在不同室壁间差异显著.结论 RVOT起源PVCs患者在窦性心搏及室性心搏时均存在失同步状态,其中室性心搏时各方向应变达峰时间时序分布存在规律.%Objective To evaluate left ventricular(LV) systolic synchrony and sequence in patients with premature ventricular complexes(PVCs) from right ventricular outflow tract (RVOT).Methods Thirty patients with frequent isolated PVCs from RVOT and 30 healthy subjects as control were included.Speckle tracking imaging (STI) was performed to assess the time-to-peak segmental systolic strain in longit udinal(TsL), circumferential (TsC) and radial (TsR) direction.The standard deviation (SD) of TsL,TsC and TsR of 18 LV segments were calculated respectively.All values of patients with PVCs were recorded during sinus beats(PVC-S) and PVC beats(PVC-V) respectively.LV systolic sequence in PVC-V was analyzed.Results Significant differences were observed in the SD values between the PVC-V and control subjects in three directions,as well as between the PVC-S and control subjects in circumferential and radial direction.In PVC-V significance difference was seen in TsL and TsR from apical to basal level,as well as in TsL and TsC in different

  11. 轻度心功能受损的高度房室传导阻滞患者采用中位间隔部起搏是否优于心尖部起搏?%Is right ventricular mid-septal pacing superior to apical pacing in patients with high degree atrio-ventricular block and moderately depressed left ventricular function?

    Institute of Scientific and Technical Information of China (English)

    Kang CHEN; Ying CHEN; Gang GU; Wei-feng SHEN; Li-qun WU; Ye MAO; Shao-hua LIU; Qiong WU; Qing-zhi LUO; Wen-qi PAN; Qi JIN; Ning ZHANG; Tian-you LING

    2014-01-01

    研究目的:对于轻度心功能受损的高度房室传导阻滞患者,明确右室起搏的最优化位置,同时明确哪一类患者能够从最优化的右心室起搏中获益。  创新要点:首次明确相比于右心室心尖部起搏,中位间隔部起搏明显改善轻度心功能受损,尤其是左室射血分数在35%~40%的高度房室传导阻滞患者的临床预后。  研究方法:随机分配进入中位间隔部起搏或心尖部起搏的患者,在基线状态下记录N-末端脑钠肽前体、六分钟步行试验以及心超结果;随访18个月后观察上述结果变化。同时,根据射血分数的不同进行亚组分析。  重要结论:相比于右心室心尖部起搏,中位间隔部起搏能够改善轻度心功能受损的高度房室传导阻滞患者的临床预后,尤其对于左室射血分数在35%~40%的患者。%Objective:We are aimed to investigate whether right ventricular mid-septal pacing (RVMSP) is superior to conventional right ventricular apical pacing (RVAP) in improving clinical functional capacity and left ventricular ejection fraction (LVEF) for patients with high-degree atrio-ventricular block and moderately depressed left ventricle (LV) function. Methods:Ninety-two patients with high-degree atrio-ventricular block and moderately reduced LVEF (ranging from 35%to 50%) were randomly allocated to RVMSP (n=45) and RVAP (n=47). New York Heart Association (NYHA) functional class, echocardiographic LVEF, and distance during a 6-min walk test (6MWT) were determined at 18 months after pacemaker implantation. Serum levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) were measured using an enzyme-linked immunosorbent assay (ELISA) kit. Results:Compared with baseline, NYHA functional class remained unchanged at 18 months, distance during 6MWT (485 m vs. 517 m) and LVEF (36.7% vs. 41.8%) were increased, but BNP levels were reduced (2352 pg/ml vs. 710 pg/ml) in the RVMSP group

  12. Alpha B-crystallin prevents the arrhythmogenic effects of particulate matter isolated from ambient air by attenuating oxidative stress

    Energy Technology Data Exchange (ETDEWEB)

    Park, Hyelim [The Division of Cardiology, Yonsei University College of Medicine, Seoul (Korea, Republic of); Brain Korea 21 Project for Medical Science, Yonsei University, Seoul (Korea, Republic of); Park, Sanghoon; Jeon, Hyunju [The Division of Cardiology, Yonsei University College of Medicine, Seoul (Korea, Republic of); Song, Byeong-Wook [The Division of Cardiology, Yonsei University College of Medicine, Seoul (Korea, Republic of); Brain Korea 21 Project for Medical Science, Yonsei University, Seoul (Korea, Republic of); Kim, Jin-Bae [Division of Cardiology, Kyung Hee University College of Medicine, Seoul (Korea, Republic of); Kim, Chang-Soo [The Department of Preventive Medicine, Yonsei University College of Medicine, Seoul (Korea, Republic of); Pak, Hui-Nam [The Division of Cardiology, Yonsei University College of Medicine, Seoul (Korea, Republic of); Hwang, Ki-Chul [The Division of Cardiology, Yonsei University College of Medicine, Seoul (Korea, Republic of); Brain Korea 21 Project for Medical Science, Yonsei University, Seoul (Korea, Republic of); Lee, Moon-Hyoung [The Division of Cardiology, Yonsei University College of Medicine, Seoul (Korea, Republic of); Chung, Ji Hyung, E-mail: jhchung@yuhs.ac [The Division of Cardiology, Yonsei University College of Medicine, Seoul (Korea, Republic of); Joung, Boyoung, E-mail: cby6908@yuhs.ac [The Division of Cardiology, Yonsei University College of Medicine, Seoul (Korea, Republic of); Brain Korea 21 Project for Medical Science, Yonsei University, Seoul (Korea, Republic of)

    2013-01-15

    Ca{sup 2+}/calmodulin-dependent protein kinase II (CaMKII) is activated by particulate matter (PM) isolated from ambient air and linked to prolonged repolarization and cardiac arrhythmia. We evaluated whether alpha B-crystallin (CryAB), a heat shock protein, could prevent the arrhythmogenic effects of PM by preventing CaMKII activation. CryAB was delivered into cardiac cells using a TAT-protein transduction domain (TAT-CryAB). ECGs were measured before and after tracheal exposure of diesel exhaust particles (DEP) and each intervention in adult Sprague–Dawley rats. After endotracheal exposure of DEP (200 μg/mL for 30 minutes, n = 11), QT intervals were prolonged from 115 ± 14 ms to 144 ± 20 ms (p = 0.03), and premature ventricular contractions were observed more frequently (0% vs. 44%) than control (n = 5) and TAT-Cry (n = 5). However, DEP-induced arrhythmia was not observed in TAT-CryAB (1 mg/kg) pretreated rats (n = 5). In optical mapping of Langendorff-perfused rat heats, compared with baseline, DEP infusion of 12.5 μg/mL (n = 12) increased apicobasal action potential duration (APD) differences from 2 ± 6 ms to 36 ± 15 ms (p < 0.001), APD restitution slope from 0.26 ± 0.07 to 1.19 ± 0.11 (p < 0.001) and ventricular tachycardia (VT) from 0% to 75% (p < 0.001). DEP infusion easily induced spatially discordant alternans. However, the effects of DEP were prevented by TAT-CryAB (1 mg/kg, n = 9). In rat myocytes, while DEP increased reactive oxygen species (ROS) generation and phosphated CaMKII, TAT-CryAB prevented these effects. In conclusion, CryAB, a small heat shock protein, might prevent the arrhythmogenic effects of PM by attenuating ROS generation and CaMKII activation. -- Highlights: ► Particulate matter (PM) increases arrhythmia. ► PM induced arrhythmias are related with oxidative stress and CaMKII activation. ► Alpha B-crystallin (CryAB) could attenuate the arrhythmogenic effect of PM. ► CryAB decreases oxidative stress and CaMKII activation

  13. A case of Lamin C gene-mutation with preserved systolic function and ventricular dysrrhythmia

    Directory of Open Access Journals (Sweden)

    Kevin Kit Ng

    2013-02-01

    Full Text Available Lamin A/C gene-related cardiomyopathy is associated with progressive heart failure and malignant arrhythmias. Current guidelines advise the use of implantable defibrillators to prevent arrhythmogenic sudden cardiac death only in situations where there is evidence of severe left ventricular dysfunction. We describe a case of a woman with genetically confirmed Lamin C deficiency with preserved left ventricular function in whom an implantable defibrillator was inserted and within a month of implantation was used to terminate symptomatic ventricular tachycardia.

  14. PATHOLOGICAL AND MORPHOLOGICAL RESEARCH OF EXPERIMENTAL ACETABULAR DYSPLASIA

    Institute of Scientific and Technical Information of China (English)

    张自明; 马瑞雪; 吉士俊; 牛之彬

    2004-01-01

    Objective To investigate the pathological mechanism of hip dysplasia. Methods The left knee joints of eighteen rabbits were fixed in extending position with plaster cylinder for four weeks, but their hip joints were flexed. The right side served as control. Roentgenogram was made in all animals. The changes of the xray films and the pathological findings between left and right hips were compared. Results Appearance of hip dysplasia was obvious at four weeks after plaster fixation. There were pathological changes, including shallow acetabulum and flat femoral head, increased acetabular index and decreased acetabular head index on the x-ray films.Conclusion The hip dysplasia is the result of prolonged extending position of the knee joint. Abnormal knee posture seems to be one of the important factors of hip dysplasia. This kind of deformation may be worsened with time.

  15. Polyostotic fibrous dysplasia

    International Nuclear Information System (INIS)

    Fibrous dysplasia is a benign fibro-osseous condition that is replacement of normal bone and marrow tissues by cellular fibrous tissue and immature bone, and it is divided into monostotic type and polyostotic type. Polyostotic fibrous dysplasia involves multiple bones, such as skull, jaw bones, femur and tibia. And it is also divided into two forms: the less severe Jaffe's type and the more severe Albright's syndrome. Clinically, it frequently occurs in the 2nd decade, and occurs more frequently in maxilla than in mandible. And the lesions of fibrous dysplasia tend to become static as skeletal maturity is reached. The authors experienced three cases of polyostosic fibrous dysplasia in the craniofacial area with the complaints of facial asymmetry due to painless swelling. And we discussed the clinical, radiological, and histopathological features of these cases with a brief review of the literatures.

  16. Polyostotic fibrous dysplasia

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Kang Sook; Park, Sang Eok; Choi, Karp Shik [Dept. of Dental Radiology, College of Dentistry, Kyungpook National University, Daegu (Korea, Republic of)

    1994-02-15

    Fibrous dysplasia is a benign fibro-osseous condition that is replacement of normal bone and marrow tissues by cellular fibrous tissue and immature bone, and it is divided into monostotic type and polyostotic type. Polyostotic fibrous dysplasia involves multiple bones, such as skull, jaw bones, femur and tibia. And it is also divided into two forms: the less severe Jaffe's type and the more severe Albright's syndrome. Clinically, it frequently occurs in the 2nd decade, and occurs more frequently in maxilla than in mandible. And the lesions of fibrous dysplasia tend to become static as skeletal maturity is reached. The authors experienced three cases of polyostosic fibrous dysplasia in the craniofacial area with the complaints of facial asymmetry due to painless swelling. And we discussed the clinical, radiological, and histopathological features of these cases with a brief review of the literatures.

  17. Relationships between left heart chamber dilatation on echocardiography and left-to-right ventricle shunting quantified by cardiac catheterization in children with ventricular septal defects.

    Science.gov (United States)

    Gokalp, Selman; Guler Eroglu, Ayse; Saltik, Levent; Koca, Bulent

    2014-04-01

    Left atrium and/or left ventricle dilatation on echocardiography is considered to be an indication for closure of ventricular septal defects (VSD). No study has addressed the accuracy of using dilated left heart chambers when defining significant left-to-right shunting quantified by cardiac catheterization in isolated small or moderate VSDs. In this study, the relation between dilated left heart chambers, measured by echocardiography, and left-to-right ventricle shunting, quantified by cardiac catheterization, was evaluated in patients with isolated VSD. The medical records of all patients with isolated VSD who had undergone catheterization from 1996 to 2010 were examined retrospectively. Normative data for left heart chambers adjusted for body weight (BW) and body surface area (BSA) were used. The pulmonary-to-systemic flow ratio (Qp:Qs) was calculated by an oximetry technique. A total of 115 patients (mean age 7.3 ± 5 years) fulfilled the inclusion criteria. There was a statistically significant difference in terms of Qp:Qs between the patient groups with normal and dilated left heart chambers, when adjusted for BW and BSA (p = 0.001 and p = 0.002, respectively). But the relationships between Qp:Qs and left heart chamber sizes on echocardiography were not strong enough to be useful for making surgical decisions, as left heart chamber dilatation was not significantly associated with Qp:Qs ≥ 2 (p = 0.349 when adjusted for BW, p = 0.107 when adjusted for BSA). Left heart chamber dilatation was significantly associated with Qp:Qs ≥ 1.5 only when it was adjusted for BSA (for BW p = 0.022, for BSA p = 0.006). As a result, left heart chamber dilatation measured by echocardiography does not show significant left-to-right ventricle shunting, as quantified by catheterization. We still advocate that catheter angiography should be undertaken when left heart chambers are dilated in echocardiography in order to make decisions about closing small- to moderate-sized VSD.

  18. Attenuated right ventricular energetics evaluated using {sup 11}C-acetate PET in patients with pulmonary hypertension

    Energy Technology Data Exchange (ETDEWEB)

    Yoshinaga, Keiichiro [Hokkaido University Graduate School of Medicine, Department of Molecular Imaging, Sapporo, Hokkaido (Japan); Ohira, Hiroshi; Tsujino, Ichizo; Sato, Takahiro; Nishimura, Masaharu [Hokkaido University Graduate School of Medicine, First Department of Medicine, Sapporo (Japan); Oyama-Manabe, Noriko [Hokkaido University Hospital, Diagnostic and Interventional Radiology, Sapporo (Japan); Mielniczuk, Lisa; Beanlands, Rob S.B. [Ottawa Heart Institute, Division of Cardiology, Ottawa, Ontario (Canada); Katoh, Chietsugu; Kasai, Katsuhiko [Hokkaido University Graduate School of Medicine, Faculty of Health Science, Sapporo (Japan); Manabe, Osamu; Tomiyama, Yuuki; Tamaki, Nagara [Hokkaido University Graduate School of Medicine, Department of Nuclear Medicine, Sapporo (Japan); Fujii, Satoshi [Nagoya City University Graduate School of Pharmaceutical Sciences, Nagoya (Japan); Ito, Yoichi M. [Hokkaido University Graduate School of Medicine, Department of Biostatistics, Sapporo (Japan)

    2014-06-15

    The right ventricle (RV) has a high capacity to adapt to pressure or volume overload before failing. However, the mechanisms of RV adaptation, in particular RV energetics, in patients with pulmonary hypertension (PH) are still not well understood. We aimed to evaluate RV energetics including RV oxidative metabolism, power and efficiency to adapt to increasing pressure overload in patients with PH using {sup 11}C-acetate PET. In this prospective study, 27 patients with WHO functional class II/III PH (mean pulmonary arterial pressure 39.8 ± 13.5 mmHg) and 9 healthy individuals underwent {sup 11}C-acetate PET. {sup 11}C-acetate PET was used to simultaneously measure oxidative metabolism (k{sub mono}) for the left ventricle (LV) and RV. LV and RV efficiency were also calculated. The RV ejection fraction in PH patients was lower than in controls (p = 0.0054). There was no statistically significant difference in LV k{sub mono} (p = 0.09). In contrast, PH patients showed higher RV k{sub mono} than did controls (0.050 ± 0.009 min{sup -1} vs. 0.030 ± 0.006 min{sup -1}, p < 0.0001). PH patients exhibited significantly increased RV power (p < 0.001) and hence increased RV efficiency compared to controls (0.40 ± 0.14 vs. 0.017 ± 0.12 mmHg.mL.min/g, p = 0.001). The RV oxidative metabolic rate was increased in patients with PH. Patients with WHO functional class II/III PH also had increased RV power and efficiency. These findings may indicate a myocardial energetics adaptation response to increasing pulmonary arterial pressure. (orig.)

  19. The non-specificity of the left/right ventricular amplitude ratio (LV/RV) for mitral insufficiency

    Energy Technology Data Exchange (ETDEWEB)

    Preston, D.F.; Reinsel, M.S.; Martin, N.L.; Robinson, R.G.

    1984-01-01

    The purpose of this study was to determine the specificity of the LV/RV for mitral insufficiency. One hundred and sixty patients underwent MUGA studies as part of their diagnostic evaluation. Phase analysis was performed. In the amplitude image, the LV/RV was measured. Patients were divided into 11 clinical groups based on chart review after adequate follow-up. The groups were compared by Duncan's Multiple Comparsion Test. Patients with mitral insufficiency (N = 12, mean LV/RV = 2.36), those with idiopathic myocardiopathy (8, 2.29) and those with normal hearts having lung disease on chest x-ray (22, 1.78) formed a group which at the p < .05 level were not different from one another. Patients with idiopathic myocardiography, normal hearts with lung disease on chest x-ray, normal hearts with lung disease (23, 1.71) formed a second group which partially overlapped with both the first and third groups. The third group consisted of normal hearts with lung disease, normal hearts not taking adriamycin (18, 1.53), normal hearts taking adriamycin (22, 1.50), congestive heart failure (19, 1.50), arteriosclerotic heart disease, normal hearts (15, 1.29), chronic obstructive pulmonary disease and acute myocardial infarction. The LV/RV is not specific for mitral insufficiency. Idiopathic myocardiography, and normal hearts with lung disease on chest x-ray (metastases, cancer of the lung, infiltrates, fibrosis, and/or COPD) cannot be differentiated on a statistical basis. The mitral insufficiency group had the greatest values of LV/RV. It appears that decreased RV amplitude seen with diseases causing strain on the right ventricle will result in elevated LV/RV ratios.

  20. Right ventricular ejection fraction is better reflected by transverse rather than longitudinal wall motion in pulmonary hypertension

    Directory of Open Access Journals (Sweden)

    Westerhof Nico

    2010-06-01

    Full Text Available Abstract Background Longitudinal wall motion of the right ventricle (RV, generally quantified as tricuspid annular systolic excursion (TAPSE, has been well studied in pulmonary hypertension (PH. In contrast, transverse wall motion has been examined less. Therefore, the aim of this study was to evaluate regional RV transverse wall motion in PH, and its relation to global RV pump function, quantified as RV ejection fraction (RVEF. Methods In 101 PH patients and 29 control subjects cardiovascular magnetic resonance was performed. From four-chamber cine imaging, RV transverse motion was quantified as the change of the septum-free-wall (SF distance between end-diastole and end-systole at seven levels along an apex-to-base axis. For each level, regional absolute and fractional transverse distance change (SFD and fractional-SFD were computed and related to RVEF. Longitudinal measures, including TAPSE and fractional tricuspid-annulus-apex distance change (fractional-TAAD were evaluated for comparison. Results Transverse wall motion was significantly reduced at all levels compared to control subjects (p fractional-SFD and SFD were related to RVEF, with the strongest relation at mid RV (R2 = 0.70, p 2 = 0.62, p fractional-TAAD, weaker relations with RVEF were found (R2 = 0.21, p 2 = 0.27, p Conclusions Regional transverse wall movements provide important information of RV function in PH. Compared to longitudinal motion, transverse motion at mid RV reveals a significantly stronger relationship with RVEF and thereby might be a better predictor for RV function.

  1. Right ventricular involvement in patients with Fabry's disease and the effect of enzyme replacement therapy

    Energy Technology Data Exchange (ETDEWEB)

    Wuest, W. [Universitaetsklinikum Erlangen (Germany). Radiologisches Inst.; Machann, W.; Koestler, H.; Hahn, D.; Beer, M. [Universitaetsklinikum Wuerzburg (Germany). Inst. fuer Roentgendiagnostik; Breunig, F.; Weidemann, F.; Wanner, C. [Universitaetsklinikum Wuerzburg (Germany). Medizinische Klinik I

    2011-11-15

    According to echocardiography reports, Fabry cardiomyopathy not only affects the left ventricle (LV) but also the right ventricle (RV). Until now no MRI studies about the effect of enzyme replacement therapy (ERT) on the RV are available. We evaluated the effect of ERT on the RV. In this prospective trial 14 patients with genetically proven Fabry's disease were examined using a 1.5 T MR scanner before ERT and after 13 {+-} 1 months of ERT. All patients underwent cardiac MR imaging and the RV/LV cardiac morphology and function were analyzed. At baseline examination the values were as follows: RV mass 31 {+-} 6 g/m{sup 2}, end-diastolic volume (EDV) 88 {+-} 13 ml/m{sup 2}, end-systolic volume (ESV) 39 {+-} 9 ml/m{sup 2}, stroke volume (SV) 49 {+-} 7 ml/m{sup 2} and ejection fraction (EF) 56 {+-} 5 %. The RV mass and EDV decreased significantly after 13 {+-} 1 months on ERT (mass 27 {+-} 7 g/m{sup 2}, p < 0.05, EDV 76 {+-} 24 ml/m{sup 2}, p < 0.05), with no significant change of ESV (33 {+-} 13 ml/m{sup 2}), SV (43 {+-} 12 ml/m{sup 2}) and EF (57 {+-} 7 %). The LV mass (102 {+-} 26 g/m{sup 2} vs. 94 {+-} 27 g/m{sup 2}, p < 0.05), EDV (76 {+-} 13 ml/m{sup 2} vs. 66 {+-} 22 ml/m{sup 2}, p < 0.05) and ESV (29 {+-} 9 ml/m{sup 2} vs. 23 {+-} 9 ml/m{sup 2}, p < 0.05) decreased significantly while the EF (64 {+-} 7 % vs. 66 {+-} 5 %; p < 0.05) increased significantly. Besides the known beneficial effect on the LV, ERT improves RV mass and EDV. (orig.)

  2. Craniofacial fibrous dysplasia

    Directory of Open Access Journals (Sweden)

    Aakarsh Jhamb

    2012-01-01

    Full Text Available Fibrous dysplasia can present clinically in varied forms which may appear as collision of different pathologic processes. We report a rare case of craniofacial fibrous dysplasia with coexisting epithelial lined cyst and superimposed osteomyelitis with sequestrum formation. Its clinical features and management with possible hypotheses are described along with the post operative course. Pertinent literature has been reviewed with emphasis on pathogenesis of this unique occurrence.

  3. Gracile bone dysplasias

    Energy Technology Data Exchange (ETDEWEB)

    Kozlowski, Kazimierz [Department of Medical Imaging, The Children' s Hospital at Westmead, Locked Bag 4001, Westmead 2145, NSW (Australia); Masel, John [Department of Radiology, Royal Children' s Hospital, Brisbane (Australia); Sillence, David O. [Department of Paediatrics and Child Health, The University of Sydney (Australia); Arbuckle, Susan [Department of Anatomical Pathology, The Children' s Hospital at Westmead, NSW (Australia); Juttnerova, Vera [Oddeleni Lekarske Genetiky, Hradec Kralove (Czech Republic)

    2002-09-01

    Gracile bone dysplasias constitute a group of disorders characterised by extremely slender bones with or without fractures. We report four newborns, two of whom showed multiple fractures. Two babies had osteocraniostenosis and one had features of oligohydramnios sequence. The diagnosis in the fourth newborn, which showed thin long bones and clavicles and extremely thin, poorly ossified ribs, is uncertain. Exact diagnosis of a gracile bone dysplasia is important for genetic counselling and medico-legal reasons. (orig.)

  4. 肺动脉高压所致右心衰竭的机制和治疗%The mechanism and treatment of pulmonary arterial hypertension-mediated right ventricular failure

    Institute of Scientific and Technical Information of China (English)

    Hong David; HONG Zhi-gang; CHEN Wei-guo

    2012-01-01

    Pulmonary arterial hypertension (PAH) is a severe disease and eventually causes right heart failure not controlled. In this paper, we review the mechanism of PAH-mediated right ventricular failure. There are two ma-jor kinds of right ventricular failure; Acute right ventricular heart failure and chronic right ventricular failure, which includes adaptive and maladaptive stages. During acute pulmonary arterial embolism-mediated right ventricular fail-ure, ventricular failure may involve an acute inflammatory response, in which cardiomyocytes dissolve, neutrophil and monocyte migrate into the locus. The sudden pressure overload results in activation of the nuclear factor of B (NF-KB) signaling pathways. These signaling pathways activation cause a series of responses, such as cytokines release and neutrophil chemotaxis. At same time, the endothelium releases Ang H , magnifying these effects. In contrast to acute right ventricular failure, PAH-mediated chronic right ventricular failure has two different stages. In the early stage, the right heart adapts to the PAH as follows; the increased mechanical stretch activates the signal pathways of angiotensin receptor type I , integrin and insulin like growth factor. These signal pathways activation cause cytoskeleton rearrangement, increased calcium release, and mTOR activation followed by increased protein synthesis, finally resulting in right ventricular hypertrophy. The TGF-J3 signaling pathway also plays an important role in the process. During the late stage, the right ventricle loses its adaptive ability and falls into heart failure. In this maladaptive period, mechanical stress activates the integrin signaling pathway and results in calcium release, matrix metalloproteinase(MMP}2 and MMP9 are activated and contribute to scar formation. Additionally, meta-bolic changes may play an important role in PAH-induced right ventricular failure. Aerobic metabolism shifts to an-aerobic metabolism during PAH-mediated right

  5. Polyostotic Fibrous Dysplasia of Cranio-Maxillofacial Area

    International Nuclear Information System (INIS)

    Fibrous dysplasia is believed to be a hamartomatous developmental lesion of unknown origin. This disease is divided into monostotic and polyostotic fibrous dysplasia. Polyostotic type can be divided into craniofacial type, Lichtenstein-Jaffe type, and McCune-Albright syndrome. In this case, a 31-year-old female presented spontaneous loss of right mandibular teeth before 5 years and has shown continuous expansion of right mandibular alveolus. Through the radiographic view, the coarse pattern of the mixed radiopaque-lucent lesion was seen on the right mandibular body, and there was diffuse pattern of the mixed radiopaque-lucent lesion with ill-defined margin in the left mandibular body. In the right calvarium, the lesion had cotton-wool appearance. Partial excision for contouring, multiple extraction, and alveoloplasty were accomplished under general anesthesia for supportive treatment. Finally we could conclude this case was polyostotic fibrous dysplasia of cranio-maxillofacial area based on the clinical, radiologic finding, and histopathologic examination.

  6. Polyostotic Fibrous Dysplasia of Cranio-Maxillofacial Area

    Energy Technology Data Exchange (ETDEWEB)

    Han, Jin Woo; Kwon, Hyuk Rok; Lee, Jin Ho; Park, In Woo [Dept. of Oral and Maxillofacial Radiology, College of Dentistry, Kangnung National University, Kangnung (Korea, Republic of)

    2000-06-15

    Fibrous dysplasia is believed to be a hamartomatous developmental lesion of unknown origin. This disease is divided into monostotic and polyostotic fibrous dysplasia. Polyostotic type can be divided into craniofacial type, Lichtenstein-Jaffe type, and McCune-Albright syndrome. In this case, a 31-year-old female presented spontaneous loss of right mandibular teeth before 5 years and has shown continuous expansion of right mandibular alveolus. Through the radiographic view, the coarse pattern of the mixed radiopaque-lucent lesion was seen on the right mandibular body, and there was diffuse pattern of the mixed radiopaque-lucent lesion with ill-defined margin in the left mandibular body. In the right calvarium, the lesion had cotton-wool appearance. Partial excision for contouring, multiple extraction, and alveoloplasty were accomplished under general anesthesia for supportive treatment. Finally we could conclude this case was polyostotic fibrous dysplasia of cranio-maxillofacial area based on the clinical, radiologic finding, and histopathologic examination.

  7. Evaluation of Right Ventricular Function in Patients with Idiopathic Pulmonary Arterial Hypertension by Echocardiography%超声心动图评价特发性肺动脉高压病右心功能研究

    Institute of Scientific and Technical Information of China (English)

    浦江; 徐黎莎; 王建平; 黄娟; 施林妹

    2011-01-01

    目的 评价二维彩色多普勒超声心动图 (2DCDE)在特发性肺动脉高压(IPAH)病患者的右心功能检测中的价值.方法 运用2DCDE检测27例IPAH患者二维图像上右室舒张末期横径(RVDD)、右室游离壁舒张末期厚度(RVDW)、主肺动脉内径(MPA)、右室舒张末期面积(RVEDA)和右室收缩末期面积(RVESA)并计算右室面积变化率(RVFCA);M型超声测量三尖瓣环收缩期位移(TAPSE);脉冲多普勒测量三尖瓣下舒张期血流充盈值E、A并计算E/A比值;通过三尖瓣上反流峰值估测肺动脉收缩压(SPAP);组织多普勒法测量三尖瓣环游离壁右室肌收缩期峰值速度(Sm)、舒张早期峰值速度(Em)、舒张晚期峰值速度(Am)以及右室肌等容收缩、舒张时间(ICT和IRT)和射血时间(ET),计算心肌运动指数(MPI).所有测值与30例正常人各项超声指标对比分析.结果 与正常对照组比较:(1)IPAH患者的RVDD和RVDW明显增大,而RVPCA和TAPSE降低.(2)IPAH患者三尖瓣下血流峰值流速E/A比值下降,SPAP显著增高.(3)IPAH患者右室肌舒张期心肌运动速度Em/Am比值降低,右室肌等容时间(ICT+IET)延长,ET缩短,MPI增加.两组各项超声指标差异显著(P<0.01).结论 2DCDE技术能较准确地对IPAH患者的右心结构和功能变化进行评价.%Objective To evaluate the value of two-dimensional color Doppler echocardiography (2DCDE) in testing the right heart function of patients with idiopathic pulmonary arterial hypertension (IPAH). Methods 27 cases with IPAH were studied. Right ventricular end-diastolic diameter (RVDD), right ventricular free wall end-diastolic thickness (RVDW), the main pulmonary artery (MPA), right ventricular end-diastolic area (RVEDA) and right ventricular end-systolic area (RVESA) were measured using 2DCDE, and right ventricular fractional area change (RVFCA) was calculated; Tricuspid annular plane systolic excursion (TAPSE) was measured by M-mode ultrasound; The diastolic blood flow

  8. Severity assessment of pulmonary embolism using dual energy CT - correlation of a pulmonary perfusion defect score with clinical and morphological parameters of blood oxygenation and right ventricular failure

    Energy Technology Data Exchange (ETDEWEB)

    Thieme, Sven F. [Ludwig-Maximilians-Universitaet, Department of Clinical Radiology, Muenchen (Germany); Institut fuer Klinische Radiologie der LMU Muenchen, Muenchen (Germany); Ashoori, Nima; Bamberg, Fabian; Sommer, Wieland H.; Johnson, Thorsten R.C.; Maxien, Daniel; Helck, Andreas D.; Reiser, Maximilian F.; Nikolaou, Konstantin [Ludwig-Maximilians-Universitaet, Department of Clinical Radiology, Muenchen (Germany); Leuchte, Hanno; Becker, Alexander [Ludwig-Maximilians-Universitaet, Department of Medicine I, Muenchen (Germany); Behr, Juergen [Ludwig-Maximilians-Universitaet, Department of Medicine I, Muenchen (Germany); Berufsgenossenschaftliches Universitaetsklinikum Bergmannsheil GmbH Ruhr-Universitaet Bochum, Department of Medicine III, Bochum (Germany)

    2012-02-15

    To correlate a Dual Energy (DE)-based visual perfusion defect scoring system with established CT-based and clinical parameters of pulmonary embolism (PE) severity. In 63 PE patients, DE perfusion maps were visually scored for perfusion defects (P-score). Vascular obstruction was quantified using the Mastora score. Both scores were correlated with short-axis diameters of the right and left ventricle, their ratio (RV/LV ratio), width of the pulmonary trunk, a number of clinical parameters and each other. Univariate and multivariate analyses were performed. Times to generate both scores were recorded. After univariate and multivariate analysis, a significant (p < 0.05) correlation with the P-score was shown for the Mastora score (r = 0.65), RV/LV ratio (r = 0.47), width of the pulmonary trunk (r = 0.26), troponin I (r = 0.43) and PaO{sub 2} (r = -0.50). For the left ventricular diameter, only univariate analysis showed a significant correlation. Mastora score correlated significantly with RV/LV ratio (r = 0.36), width of the pulmonary trunk (r = 0.27), PaO{sub 2} (r = -0.41) and troponin I (r = 0.37). Mean time for generating the P-score was significantly shorter than for the Mastora score. A DE-based P-score correlates with a number of parameters of PE severity. It might be easier and faster to perform than some traditional CT scoring methods for vascular obstruction. (orig.)

  9. Benefit of combining quantitative cardiac CT parameters with troponin I for predicting right ventricular dysfunction and adverse clinical events in patients with acute pulmonary embolism

    International Nuclear Information System (INIS)

    Objective: To prospectively evaluate the diagnostic accuracy of quantitative cardiac CT parameters alone and in combination with troponin I for the assessment of right ventricular dysfunction (RVD) and adverse clinical events in patients with acute pulmonary embolism (PE). Materials and results: This prospective study had institutional review board approval and was HIPAA compliant. In total 83 patients with confirmed PE underwent echocardiography and troponin I serum level measurements within 24 h. Three established cardiac CT measurements for the assessment of RVD were obtained (RV/LVaxial, RV/LV4-CH, and RV/LVvolume). CT measurements and troponin I serum levels were correlated with RVD found on echocardiography and adverse clinical events according to Management Strategies and Prognosis in Pulmonary Embolism Trial-3 (MAPPET-3 criteria. 31 of 83 patients with PE had RVD on echocardiography and 39 of 83 patients had adverse clinical events. A RV/LVvolume ratio > 1.43 showed the highest area under the curve (AUC) (0.65) for the prediction of adverse clinical events when compared to RV/LVaxial, RV/LV4Ch and troponin I. The AUC for the detection of RVD of RV/LVaxial, RV/LV4Ch, RV/LVvolume, and troponin I were 0.86, 0.86, 0.92, and 0.69, respectively. Combination of RV/LVaxial, RV/LV4Ch, RV/LVvolume with troponin I increased the AUC to 0.87, 0.87 and 0.93, respectively. Conclusion: A combination of cardiac CT parameters and troponin I measurements improves the diagnostic accuracy for detecting RVD and predicting adverse clinical events if compared to either test alone.

  10. Intrauterine endotoxin-induced impairs pulmonary vascular function and right ventricular performance in infant rats and improvement with early vitamin D therapy.

    Science.gov (United States)

    Mandell, Erica; Powers, Kyle N; Harral, Julie W; Seedorf, Gregory J; Hunter, Kendall S; Abman, Steven H; Dodson, R Blair

    2015-12-15

    High pulmonary vascular resistance (PVR), proximal pulmonary artery (PA) impedance, and right ventricular (RV) afterload due to remodeling contribute to the pathogenesis and severity of pulmonary hypertension (PH). Intra-amniotic exposure to endotoxin (ETX) causes sustained PH and high mortality in rat pups at birth, which are associated with impaired vascular growth and RV hypertrophy in survivors. Treatment of ETX-exposed pups with antenatal vitamin D (vit D) improves survival and lung growth, but the effects of ETX exposure on RV-PA coupling in the neonatal lung are unknown. We hypothesized that intrauterine ETX impairs RV-PA coupling through sustained abnormalities of PA stiffening and RV performance that are attenuated with vit D therapy. Fetal rats were exposed to intra-amniotic injections of ETX, ETX+vit D, or saline at 20 days gestation (term = 22 days). At postnatal day 14, pups had pressure-volume measurements of the RV and isolated proximal PA, respectively. Lung homogenates were assayed for extracellular matrix (ECM) composition by Western blot. We found that ETX lungs contain decreased α-elastin, lysyl oxidase, collagen I, and collagen III proteins (P < 0.05) compared control and ETX+vit D lungs. ETX-exposed animals have increased RV mechanical stroke work (P < 0.05 vs. control and ETX+vit D) and elastic potential energy (P < 0.05 vs. control and ETX+vit D). Mechanical stiffness and ECM remodeling are increased in the PA (P < 0.05 vs. control and ETX+vit D). We conclude that intrauterine exposure of fetal rats to ETX during late gestation causes persistent impairment of RV-PA coupling throughout infancy that can be prevented with early vit D treatment.

  11. 17β-Estradiol mediates superior adaptation of right ventricular function to acute strenuous exercise in female rats with severe pulmonary hypertension.

    Science.gov (United States)

    Lahm, Tim; Frump, Andrea L; Albrecht, Marjorie E; Fisher, Amanda J; Cook, Todd G; Jones, Thomas J; Yakubov, Bakhtiyor; Whitson, Jordan; Fuchs, Robyn K; Liu, Aiping; Chesler, Naomi C; Brown, M Beth

    2016-08-01

    17β-Estradiol (E2) exerts protective effects on right ventricular (RV) function in pulmonary arterial hypertension (PAH). Since acute exercise-induced increases in afterload may lead to RV dysfunction in PAH, we sought to determine whether E2 allows for superior RV adaptation after an acute exercise challenge. We studied echocardiographic, hemodynamic, structural, and biochemical markers of RV function in male and female rats with sugen/hypoxia (SuHx)-induced pulmonary hypertension, as well as in ovariectomized (OVX) SuHx females, with or without concomitant E2 repletion (75 μg·kg(-1)·day(-1)) immediately after 45 min of treadmill running at 75% of individually determined maximal aerobic capacity (75% aerobic capacity reserve). Compared with males, intact female rats exhibited higher stroke volume and cardiac indexes, a strong trend for better RV compliance, and less pronounced increases in indexed total pulmonary resistance. OVX abrogated favorable RV adaptations, whereas E2 repletion after OVX markedly improved RV function. E2's effects on pulmonary vascular remodeling were complex and less robust than its RV effects. Postexercise hemodynamics in females with endogenous or exogenous E2 were similar to hemodynamics in nonexercised controls, whereas OVX rats exhibited more severely altered postexercise hemodynamics. E2 mediated inhibitory effects on RV fibrosis and attenuated increases in RV collagen I/III ratio. Proapoptotic signaling, endothelial nitric oxide synthase phosphorylation, and autophagic flux markers were affected by E2 depletion and/or repletion. Markers of impaired autophagic flux correlated with endpoints of RV structure and function. Endogenous and exogenous E2 exerts protective effects on RV function measured immediately after an acute exercise challenge. Harnessing E2's mechanisms may lead to novel RV-directed therapies. PMID:27288487

  12. Helical computerized tomography and NT-proBNP for screening of right ventricular overload on admission and at long term follow-up of acute pulmonary embolism

    Directory of Open Access Journals (Sweden)

    Laiho Mia K

    2012-05-01

    Full Text Available Abstract Background Right ventricular dysfunction (RVD in acute pulmonary embolism (APE can be assessed with helical computerized tomography (CT and transthoracic echocardiography (TTE. Signs of RVD and elevated natriuretic peptides like NT-proBNP and cardiac troponin (TnT are associated with increased risk of mortality. However, the prognostic role of both initial diagnostic strategy and the use of NT-proBNP and TnT for screening for long-term probability of RVD remains unknown. The aim of the study was to determine the role of helical CT and NT-proBNP in detection of RVD in the acute phase. In addition, the value of NT-proBNP for ruling out RVD at long-term follow-up was assessed. Methods Sixty-three non-high risk APE patients were studied. RVD was assessed at admission in the emergency department by CT and TTE, and both NT-proBNP and TnT samples were taken. These, excepting CT, were repeated seven months later. Results At admission RVD was detected by CT in 37 (59 % patients. RVD in CT correlated strongly with RVD in TTE (p Conclusions TTE does not confer further benefit when helical CT is used for screening for RVD in non-high risk APE. All the patients who were found to have RVD in TTE at seven months follow-up had had RVD in the acute phase CT as well. Thus, patients without RVD in diagnostic CT do not seem to require further routine follow-up to screen for RVD later. On the other hand, persistent RVD and thus need for TTE control can be ruled out by assessment of NT-proBNP at follow-up. A follow-up protocol based on these findings is suggested.

  13. Altered Right Ventricular Kinetic Energy Work Density and Viscous Energy Dissipation in Patients with Pulmonary Arterial Hypertension: A Pilot Study Using 4D Flow MRI.

    Directory of Open Access Journals (Sweden)

    Q Joyce Han

    Full Text Available Right ventricular (RV function has increasingly being recognized as an important predictor for morbidity and mortality in patients with pulmonary arterial hypertension (PAH. The increased RV after-load increase RV work in PAH. We used time-resolved 3D phase contrast MRI (4D flow MRI to derive RV kinetic energy (KE work density and energy loss in the pulmonary artery (PA to better characterize RV work in PAH patients.4D flow and standard cardiac cine images were obtained in ten functional c