LEFTWARD SEPTAL DISPLACEMENT DURING RIGHT VENTRICULAR LOADING IN MAN
LEFTWARD SEPTAL DISPLACEMENT DURING RIGHT VENTRICULAR LOADING IN MAN
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DOI：
10.1161/01.cir.61.3.626
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发表时间：
1980-01-01
期刊：
影响因子：
37.8
通讯作者：
WEISFELDT, ML
中科院分区：
文献类型：
--
作者：
BRINKER, JA;WEISS, JL;WEISFELDT, ML
几乎没有直接证据表明急性右心室负荷改变了左心室构型。Mueller动作（对封闭的气道强制吸气）用于增加右心室负荷，并评估了9名正常，半仰卧男性的间隔形状和右心室和左心室大小的相控阵，二维超声心动图。在静息时和Mueller期（40-60 mm Hg负压的峰值吸气努力）的各个阶段记录心室横截面和纵向视图中的收缩末期和舒张末期帧。在最大早期Mueller期（Mueller动作开始后的第1、2或3次搏动），横截面上的终末室间隔处的急性室间隔移位可通过间隔段曲率半径的显著增加（3.72 ± 0.001）来证明。0.25 cm与对照组相比，为2.49 . ±. 0.12 cm，P < 0.001）。这种室间隔移位不仅在舒张末期持续存在，而且在收缩末期也持续存在（3.58 ± 0.01）。0.45与2.04 . ±. 0.16 cm; P < 0.01）。在静息状态下，室间隔的曲率半径与左心室其余部分的曲率半径在收缩期或舒张期没有差异（1.94 ± 0.05）。0.11和2.48 .+-。0.09 cm），但在收缩期早期Mueller相（3.58 ± 0.5cm）显著不同。0.45对比1.9 .+-。0.07 cm; P < 0.005）; 0.25与2.36 .+-相比。0.07 cm; P < 0.001）。与此同时，在19.14 ±-的横截面视图上，左心室舒张末期腔面积从对照组减少到早期Mueller相。1.08 cm 2至15.73 ±. 0.65 cm ~ 2（P < 0.005），纵切面为29.83 ± 0.05。2.08至20.74 ±。1.46 cm ~ 2，P < 0.001。在该视图中，收缩末期腔面积显著减小（19.72 ± 0.001）。2.0至15.23 .+-。1.98 cm 2; P < 0.05）。在横截面视图中，右心室舒张末期直径从对照组增加到早期Mueller相位（1.06 ± 0.05）。0.14至1.31 .+-。0.17 cm; P < 0.02）和纵切面（1.14 ± 0.01）。0.23到1.80 .+-。0.43 cm; P < 0.05）。左心室容积减少而形状保持不变应导致心室所有部分的曲率半径缩短，因此，在左心室尺寸总体减小的情况下室间隔曲率半径增加意味着右心室负荷通过使室间隔变平而改变左心室形状。这种间隔扁平化在收缩期持续存在。室间隔形态的改变可能是正常人心室相互依赖的重要机制和证据。
Little direct evidence in man implies acute right ventricular loading alters left ventricular configuration. The Mueller maneuver (forced inspiration against a closed airway) was used to increase right ventricular loading and evaluated septal shape and right and left ventricular size in 9 normal, semisupine men with phased-array, 2-dimensional echocardiography. End-systolic and end-diastolic frames in cross-sectional and longitudinal views of the ventricles were recorded at rest and at various phases during the Mueller period (peak inspiratory effort of 40-60 mm Hg negative pressure). Acute leftward displacement of the septum at end-diastole on cross section during the maximal early Mueller period (1st 2 or 3 beats after the onset of Mueller maneuver) was evidenced by a substantial increase in the radius of curvature of the septal segment (3.72 .+-. 0.25 cm vs. control, 2.49 .+-. 0.12 cm, P < 0.001). This leftward septal displacement persisted not only during end-diastole, but during end-systole (3.58 .+-. 0.45 vs. 2.04 .+-. 0.16 cm; P < 0.01). The septal radius of curvature did not differ from the radius of curvature of the remainder of the left ventricle at rest for systole or diastole (1.94 .+-. 0.11 and 2.48 .+-. 0.09 cm, respectively), but differed markedly during the early Mueller phase in systole (3.58 .+-. 0.45 vs. 1.9 .+-. 0.07 cm; P < 0.005) and diastole (3.72 .+-. 0.25 vs. 2.36 .+-. 0.07 cm; P < 0.001). Simultaneously, left ventricular end-diastolic cavity areas decreased from control to the early Mueller phase on cross-sectional view from 19.14 .+-. 1.08 cm2 to 15.73 .+-. 0.65 cm2 (P < 0.005), and longitudinal view from 29.83 .+-. 2.08 to 20.74 .+-. 1.46 cm2; P < 0.001. A significant decrease in end-systolic cavity area was noted in this view (19.72 .+-. 2.0 to 15.23 .+-. 1.98 cm2; P < 0.05). Right ventricular end-diastolic diameter increased from control to the early Mueller phase in the cross-sectional view (1.06 .+-. 0.14 to 1.31 .+-. 0.17 cm; P < 0.02) and in the longitudinal view (1.14 .+-. 0.23 to 1.80 .+-. 0.43 cm; P < 0.05). A decrease in left ventricular volume with maintenance of constant shape should result in a shortened radius of curvature for all portions of the ventricle, so the increase in septal radius of curvature in the face of an overall decrease in left ventricular size implies right ventricular loading alters left ventricular shape by flattening the septum. This septal flattening persists during systole. Changed septal shape may be an important mechanism of, and evidence for, ventricular interdependence in normal man.