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Article: Modified Glenn connection for acutely ischemic right ventricular failure reverses secondary left ventricular dysfunction

TitleModified Glenn connection for acutely ischemic right ventricular failure reverses secondary left ventricular dysfunction
Authors
Issue Date2001
Citation
Journal of Thoracic and Cardiovascular Surgery, 2001, v. 122 n. 1, p. 80-91 How to Cite?
AbstractBackground: Right heart failure after cardiopulmonary bypass can result in severe hemodynamic compromise with high mortality, but the underlying mechanisms remain poorly understood. After ischemia-induced right ventricular failure, alterations in the interventricular septal position decrease left ventricular compliance and limit filling but may also distort left ventricular geometry and compromise contractility and relaxation. This study investigated the effect of acute isolated right ventricular ischemia on biventricular performance and interaction and the response of subsequent right ventricular unloading by use of a modified Glenn shunt. Methods: In 8 pigs isolated right ventricular ischemic failure was induced by means of selective coronary ligation. A modified Glenn circuit was then established by a superior vena cava-pulmonary artery connection. Ventricular performance was determined by conductance catheter-derived right ventricular pressure-volume loops and left ventricular pressure-segment length loops. Hemodynamic data at baseline, after right ventricular ischemia, and after institution of the Glenn circuit were obtained during inflow occlusion, and the load-independent contractile indices were derived. Results: Right ventricular free-wall ischemia resulted in acute right ventricular dilation (118 ± 81 mL vs 169 ± 70 mL, P = .0008) and impairment of left ventricular contractility indicated by the reduced end-systolic pressure-volume relation slope (50.0 ± 19 mm Hg/mm vs 18.9 ± 8 mm Hg/mm, P = .002) and preload recruitable stroke work index slope (69.6 ± 26 erg · cm -3 · 10 3 vs 39.7 ± 13 erg · cm -3 · 10 3, P = .003). In addition, left ventricular relaxation (τ) was significantly prolonged (33.3 ± 10 ms vs 53.0 ± 16 ms, P = .012). Right ventricular unloading with the Glenn shunt reduced right ventricular dilation and significantly improved left ventricular contraction, end-systolic pressure-volume relation slope (18.9 ± 8 mm Hg/mm vs 35.8 ± 18 mm Hg/mm, P = .002), preload recruitable stroke work index slope (39.7 ± 26 erg · cm -3 · 10 3 vs 63.0 ± 22 erg · cm -3 · 10 3, P = .003), and diastolic performance (τ 53.0 ± 16 ms vs 43.5 ± 13 ms, P = .001). Conclusions: Right ventricular ischemia-induced dilation resulted in acute impairment of left ventricular contractility and relaxation. A modified Glenn shunt attenuated the left ventricular dysfunction by limiting right ventricular dilation and restoring left ventricular cavity geometry.
Persistent Identifierhttp://hdl.handle.net/10722/192656
ISSN
2015 Impact Factor: 3.494
2015 SCImago Journal Rankings: 2.369
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorDanton, MHen_US
dc.contributor.authorByrne, JGen_US
dc.contributor.authorFlores, KQen_US
dc.contributor.authorHsin, Men_US
dc.contributor.authorMartin, JSen_US
dc.contributor.authorLaurence, RGen_US
dc.contributor.authorCohn, LHen_US
dc.contributor.authorAklog, Len_US
dc.contributor.authorEmery, RWen_US
dc.date.accessioned2013-11-20T04:54:53Z-
dc.date.available2013-11-20T04:54:53Z-
dc.date.issued2001en_US
dc.identifier.citationJournal of Thoracic and Cardiovascular Surgery, 2001, v. 122 n. 1, p. 80-91en_US
dc.identifier.issn0022-5223en_US
dc.identifier.urihttp://hdl.handle.net/10722/192656-
dc.description.abstractBackground: Right heart failure after cardiopulmonary bypass can result in severe hemodynamic compromise with high mortality, but the underlying mechanisms remain poorly understood. After ischemia-induced right ventricular failure, alterations in the interventricular septal position decrease left ventricular compliance and limit filling but may also distort left ventricular geometry and compromise contractility and relaxation. This study investigated the effect of acute isolated right ventricular ischemia on biventricular performance and interaction and the response of subsequent right ventricular unloading by use of a modified Glenn shunt. Methods: In 8 pigs isolated right ventricular ischemic failure was induced by means of selective coronary ligation. A modified Glenn circuit was then established by a superior vena cava-pulmonary artery connection. Ventricular performance was determined by conductance catheter-derived right ventricular pressure-volume loops and left ventricular pressure-segment length loops. Hemodynamic data at baseline, after right ventricular ischemia, and after institution of the Glenn circuit were obtained during inflow occlusion, and the load-independent contractile indices were derived. Results: Right ventricular free-wall ischemia resulted in acute right ventricular dilation (118 ± 81 mL vs 169 ± 70 mL, P = .0008) and impairment of left ventricular contractility indicated by the reduced end-systolic pressure-volume relation slope (50.0 ± 19 mm Hg/mm vs 18.9 ± 8 mm Hg/mm, P = .002) and preload recruitable stroke work index slope (69.6 ± 26 erg · cm -3 · 10 3 vs 39.7 ± 13 erg · cm -3 · 10 3, P = .003). In addition, left ventricular relaxation (τ) was significantly prolonged (33.3 ± 10 ms vs 53.0 ± 16 ms, P = .012). Right ventricular unloading with the Glenn shunt reduced right ventricular dilation and significantly improved left ventricular contraction, end-systolic pressure-volume relation slope (18.9 ± 8 mm Hg/mm vs 35.8 ± 18 mm Hg/mm, P = .002), preload recruitable stroke work index slope (39.7 ± 26 erg · cm -3 · 10 3 vs 63.0 ± 22 erg · cm -3 · 10 3, P = .003), and diastolic performance (τ 53.0 ± 16 ms vs 43.5 ± 13 ms, P = .001). Conclusions: Right ventricular ischemia-induced dilation resulted in acute impairment of left ventricular contractility and relaxation. A modified Glenn shunt attenuated the left ventricular dysfunction by limiting right ventricular dilation and restoring left ventricular cavity geometry.en_US
dc.languageengen_US
dc.relation.ispartofJournal of Thoracic and Cardiovascular Surgeryen_US
dc.titleModified Glenn connection for acutely ischemic right ventricular failure reverses secondary left ventricular dysfunctionen_US
dc.typeArticleen_US
dc.description.naturelink_to_subscribed_fulltexten_US
dc.identifier.doi10.1067/mtc.2001.114632en_US
dc.identifier.pmid11436040-
dc.identifier.scopuseid_2-s2.0-0035412845en_US
dc.identifier.volume122en_US
dc.identifier.issue1en_US
dc.identifier.spage80en_US
dc.identifier.epage91en_US
dc.identifier.isiWOS:000169837100012-

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