Abstract 13950: Dynamic Myocardial Systolic and Diastolic Response to Exercise in Patients After the Fontan Operation
Boekhren Karyostyko BorhanuddinAndréea DragulescuCameron SlorachWei HuiChun‐Po Steve FanBrigitte MuellerBarbara CifraLuc Mertens
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Background: Exercise capacity is one of the predictors of morbidity and mortality in patients after the Fontan circulation. The influence of myocardial systolic and diastolic functional reserve on exercise performance has not been well established in this population. This study aimed at studying the myocardial response to exercise in Fontan patients using exercise echocardiography. Methods: Twenty-three Fontan patients with baseline ejection fraction >55% and 23 age and gender matched controls were included. A stepwise exercise stress echocardiography protocol was used. Tissue Doppler imaging (TDI) systolic (s’), and early diastolic (e’) velocities and myocardial acceleration during isovolumic contraction (IVA) were measured in the free wall of the dominant ventricle and interventricular septum and in the left ventricular free wall and septum of controls. Measurement was taken at rest and at incremental heart rate (HR). Changes in tissue Doppler velocities versus heart rate were studies and compared between patients and controls. Results: Resting HR was not significantly different between patients and controls but peak HR was lower in the Fontan group vs controls ( p <0.001). At rest patients had significantly lower lateral and septal e’ and s’ compared to controls (lateral s’: 6.35±1.05 vs. 14.41± 1.88 cm/s; lateral e’: 9.38±1.71 vs.20.66±2.55 cm/s; septal s’: 5.30±2.46 vs. 11.58±2.26 cm/s; septal e’: 10.45±2.46 vs. 17.80±1.58 cm/s P <0.001) except for IVA. At peak exercise, all variables were significantly lower in the patient group. During exercise, the slopes of lateral and septal s’ and IVA were significantly different between patients and controls except for e’. Conclusion: Our data suggest that patients with Fontan physiology have blunted systolic contractile response to exercise. Surprisingly our data suggest that the dynamic early diastolic myocardial reserve is preserved which suggest that early myocardial relaxation is not a limiting factor.Keywords:
Interventricular septum
Tissue Doppler echocardiography
To determine a role of the right ventricular free wall and the interventricular septum in performance of the right ventricule, either the former or the latter was replace with a non-contractile prosthesis (Teflon cloth) in normal adult dog. In the heart with a non-contractile right ventricular free wall performance of the right ventricle was fairly maintained when a prosthesis employed was identical to the free wall of the right ventricle in size. But function of the left ventricle was compromised. When a prosthesis employed was increased in size, performance of the right ventricle was well as the left ventricle was compromised. In the heart with a non-contractile septum performance of the right ventricle was compromised, but it resumed to norma as time passed. With the data obtained from these experiments it was concluded that a new pulsatile chamber could be constructed on the epicardium by suturing a non-contractile prosthesis as free wall in patients with a underdeveloped right ventricle. Performance of a newly constructed chamber was excellent in producing pressure, but expelling capacity was not satisfactory.
Interventricular septum
Ventricular Function
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Right ventricular loading/pressure influences left ventricular function because the two ventricles pump in series and because they are anatomically arranged in parallel, sharing the common ventricular septum. Flattening of the interventricular septum detected during echocardiographic examination is called D-shaped left ventricle. We present a case of an elderly male of African descent, who presented with increased shortness of breath. Transthoracic echocardiogram showed flattening and left sided deviation of interventricular septum causing a decreased size in left ventricle, secondary to volume/pressure overload in the right ventricle. While patient received hemodialysis therapy and intravascular volume was removed, patient blood pressure was noted to increase, paradox. Repeated transthoracic echocardiogram demonstrated less left deviation of interventricular septum compared with previous echocardiogram. We consider that it is important for all physicians to be aware of the anatomic and physiologic implication of D-shaped left ventricle and how right ventricle pressure/volume overload affects its function and anatomy.
Interventricular septum
Transthoracic echocardiogram
Pressure overload
Volume overload
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Thirty autopsied hearts with cor pulmonale and 20 experimental pulmonary hypertensive rat hearts were analysed macrosopically and hitometrically. In autopsied hearts with cor pulmonale, right ventricle dilatated in oblique length, and right ventricular wall thickness significantly increased at pulmonary conus (PC) and posterior wall of right ventricle (RVP) compared with that at anterior wall of right ventricle (RVA). Mean diameters of myocardial fibers at PC, RVP, right ventricular side of interventricular septum (IVR) and mid layer of interventricular septum (IVM) significantly increased compared with that at mid layer of left ventricular wall (LVM). The wet weight and the diameter of myocardial fibers in right ventricle (RV) significantly correlated with those in interventricular septum (IVS). In pulmonary hypertensive rats, wet weights of RV and IVS increased significantly with the elevation of mean pulmonary arterial pressure. The diameters of myocardial fibers increased at RVP, RVA, IVR and IVM. There was no significant cardiac hypertrophy in left ventricle (LV), either microscopically or macroscopically. These results suggest that IVS responded morphometrically rather than inconcord with RV but not with LV the cor pulmaonade heart.
Right ventricular hypertrophy
Pulmonary heart disease
Ventricular hypertrophy
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【The myocardial temperature was monitored in 19 patients of open heart surgery using the Shiley myocardial temperature probe in Department of Thoracic and Cardiovascular Surgery, Yeungnam University Hospital. The myocardial temperature were measured time-wise: initial and 15 minutes following the infusion of the cardioplegic solution into the aortic root and upon reinfusion, which is 30 minutes apart from the initial. The measurements were made in the anterior wall of the right ventricle, the posterior wall of the left ventricle and the interventricular septum. Immediately after initial infusion, the temperature of the right ventricle[10.7 $\pm$ 4.3oC] was the lowest and that of the left ventricle[12.9 $\pm$ 3.9 oC] the highest in the mean values among all 19 patients. However, no significant differences were noted among the different regions. At 15 minutes after infusion, the lowest temperature was in the right ventricle[17.5 $\pm$ 5.1 oC], followed by interventricular septum[17.9 $\pm$ 2.9 oC], and left ventricle[21.4 $\pm$ 2.5 oC]. At 30 minutes after infusion, the lowest temperature was measured in the interventricular septum[13.6 $\pm$ 2.7 oC ], followed by right ventricle[13.8 $\pm$ 4.0 oC] and left ventricle[14.5 $\pm$ 4.5 oC ]. Evaluating changes of myocardial temperature according to postinfusion time, the temperature at 15 minutes after infusion showed significant increase as compared with that immediately after the infusion in all three regions[p】
Interventricular septum
Anterior wall
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To assess wall thickness dynamics of the interventricular septum, ultrasonomicrometry was directly applied to measure wall thickness of the septum as well as the left ventricular free wall thickness in open chest dogs. In the control resting state, the end-diastolic wall thickness and magnitude of the systolic thickening of the septum were essentially equal to those of the left ventricular free wall. Acute interventions, such as pressure or volume overloading on the right or left ventricle, induced the same dynamic changes in the septum as in the left ventricular free wall. To evaluate the chronic changes in wall thickness dynamics of the interventricular septum, echocardiographic studies were conducted in patients with chronic pressure or volume overload in the right or left ventricle. While sustained pressure or volume overload in the left ventricle resulted in an increase in wall thickness of both the septum and left ventricular free wall, chronic pressure overload of the right ventricle induced the hypertrophy only in the septum but not in the left ventricular free wall. Thus, the interventricular septum can be regarded as a functional part of the left ventricle, and the mechanical loading on the left ventricle will ultimately induce proportional changes in the septum and the left ventricular free wall. Although the septal function is largely independent of acute changes in right ventricular loading, a chronic effect cannot be ignored.
Interventricular septum
Volume overload
Pressure overload
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Cardiac complications are the leading cause of death in β-thalassemia major (TM) patients. The aim of this study was to investigate the impact of iron overload on ventricular functions using conventional and tissue Doppler imaging (TDI) in patients with TM and compare them with children with thalassemia trait (TT) and healthy controls. This prospective study includes 3 groups: group 1: 29 patients with β-TM; group 2: 28 patients with TT; group 3: 29 healthy controls. Peak late relaxation velocity determined by conventional echocardiography for the right ventricle was significantly higher and the E/A ratio for the right ventricle and left ventricle were significantly lower in TM patients than the other groups (P < .05). Peak late relaxation velocity determined by TDI for the left ventricle, interventricular septum, and right ventricle were significantly higher in TM patients than the TT subjects and controls (P < .001). The E/A ratio determined by TDI for the left ventricle, interventricular septum, and right ventricle were significantly lower in group 1 than the other 2 groups (P < .001). There was a negative correlation between the ferritin level and E/A ratio for the left ventricle, interventricular septum, and right ventricle using TDI (P < .05). Conventional echocardiographic techniques have failed to distinguish ventricular functions of asymptomatic patients with TM from the subjects with TT and from normal controls when global functions were examined. The present study indicates that TDI should be used for screening of TM and TT subjects' cardiac functions.
Interventricular septum
Doppler imaging
Subclinical infection
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Interventricular septum
Pathognomonic
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Abstract Background and Aims Pathology of the cardiovascular system is the leading cause of death in patients with CKD, while determining the causes of the formation of cardiac events is often difficult. Method We conducted an analysis of echocardiography data performed by 50 children with CKD. On the echoCG, the final systolic and diastolic sizes of the left ventricle (FSS and FDS), the final systolic and diastolic volumes of the left ventricle (FSV and FDV) were determined; measured the thickness of the interventricular septum (IVS) and the posterior wall of the left ventricle (PWLV). Left ventricular myocardial mass (LVMM) was determined by the formula proposed by R. Devereux and N. Reichek: LVMM = 1.04x (/ IVS+PWLV+FDS/3-FDS3) - 13.6where, IVS - thickness of IVS in diastole,PWLV-thickness of PWLV in diastole, FDS-final diastolic size of the left ventricle. Results We conducted an analysis of echocardiography data performed by 50 children with CKD. On the echoCG, the final systolic and diastolic sizes of the left ventricle (FSS and FDS), the final systolic and diastolic volumes of the left ventricle (FSV and FDV) were determined; measured the thickness of the interventricular septum (IVS) and the posterior wall of the left ventricle (PWLV). Left ventricular myocardial mass (LVMM) was determined by the formula proposed by R. Devereux and N. Reichek: LVMM = 1.04x (/ IVS+PWLV+FDS/3-FDS3) - 13.6where, IVS - thickness of IVS in diastole,PWLV-thickness of PWLV in diastole, FDS-final diastolic size of the left ventricle. Conclusion The mechanisms of damage to the heart and blood vessels in patients with CKD begin to function already in the initial stage of renal failure and increase as it progresses. The need to know the data of clinical, laboratory and instrumental examination methods at the terminal stage of CKD is dictated, first of all, by the possibility of exposure to them. An important stimulus for conducting an echocardiographic examination is the early detection and correction of cardiovascular disorders, in connection with the prospect of increasing the survival of patients after kidney transplantation.
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The water, nitrogen, and electrolyte content of the normal canine myocardium partitioned as right ventricle, septum, and left ventricle are presented on a connective tissue-free basis as well as fat-free and blood-free. Considering the tissue on a fat-free, blood-free, connective tissue-free basis, the extracellular phase (expressed as g/kg heart muscle) of the left ventricle was 86% that of the right ventricle; that of the septum was 91% that of the right ventricle. In all three segments, cell water was constant at 77%. One kilogram of myocardial cells contains 29.7 g of noncollagenous protein nitrogen, 116 mEq of potassium, 26 mEq of magnesium, and is associated with 0.3 (septum and left ventricle) and 0.53 (right ventricle) mEq of calcium.
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A method for imaging the interventricular septum of the heart by digital subtraction ventriculography in the left oblique projection is proposed: 20 ml of contrast agent is injected in the right atrium, and the right ventricle is imaged, then the left ventricle is seen on the left phase. In order to discern the interventricular septum, the right ventricle image is taken as a "mask", then the left ventricle is fixed, and the interventricular septum is seen between two contrast cavities on the final image. The dual subtraction method by choosing the later "mask"-frame at the maximally contrast right ventricle for imaging the septum was used for the first time.
Interventricular septum
Subtraction
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