A STUDY IN VENTRICULAR-VENTRICULAR INTERACTION - SINGLE RIGHT VENTRICLES COMPARED WITH SYSTEMIC RIGHT VENTRICLES IN A DUAL-CHAMBER CIRCULATION
A STUDY IN VENTRICULAR-VENTRICULAR INTERACTION - SINGLE RIGHT VENTRICLES COMPARED WITH SYSTEMIC RIGHT VENTRICLES IN A DUAL-CHAMBER CIRCULATION
复制标题
DOI：
10.1161/01.cir.92.2.219
复制
发表时间：
1995-07-15
期刊：
影响因子：
37.8
通讯作者：
HOFFMAN, EA
中科院分区：
文献类型：
--
作者：
FOGEL, MA;WEINBERG, PM;HOFFMAN, EA
背景 已知心室-心室相互作用发生在正常人的心脏中。为了确定它是否在单个右心室的功能中发挥作用，我们对全身右心室与机械耦合的左心室和不与左心室机械耦合的情况进行了比较。方法和结果使用在心肌上放置相交条纹的无创磁共振标记技术（磁化空间调制[SPAMM]）检查了 18 名全身性右心室患者：7 名接受过 Fontan 手术的单个右心室患者（年龄、年龄、年龄、年龄）。 38.8+/-8.9 个月）和 11 名接受过心房翻转手术的大动脉转位者（年龄，16.3+/-3.9 岁）。通过收缩期跟踪交点的运动以确定区域扭曲和径向缩短。还评估了缩短率。使用 Delaunay 三角测量对网格线进行有限应变分析，并导出各个解剖区域的二维应变张量和主 E1 应变。穿过心室壁的基底和顶端短轴平面被分为围绕切片圆周等距分布的四个不同区域。我们观察到以下结果。 (1) 在心房翻转手术后状态的大动脉转位患者中，应变最大，应变异质性最小（八个区域中的六个）。在患者亚型和具有正常左心室的患者亚型之间，从心内膜到心外膜、从房室瓣到心尖平面的应变分布存在显着差异。 (2)与使用相同方法研究的正常受试者相反，对于两种患者亚型，在一个区域存在逆时针扭曲，在后壁或下壁存在顺时针扭曲，以及两个扭曲区域交汇处的无扭曲过渡区。对正常成人左心室进行了研究，从心尖到基部观察，左心室呈逆时针方向均匀扭转。 (3)两种类型全身性右心室上壁的径向向内运动最大。 Fontan 患者的下壁和大动脉转位、心房翻转后状态的患者的后壁（即间隔）在收缩期发生矛盾运动。大动脉转位、心房倒转后状态患者的房室瓣缩短率显着低于心尖部或 Fontan 患者。 结论 全身性右心室的局部室壁运动和应变存在显着差异，具体取决于是否存在左心室以增强其功能。心室-心室相互作用似乎在影响全身右心室的生物力学方面发挥着重要作用。这些观察结果与正常全身左心室的观察结果明显不同。这些技术展示了我们可以开始使用局部心肌力学评估手术结果的工具，并可能为单右心室衰竭提供线索。
Background Ventricular-ventricular interaction is known to occur in the normal human heart. To determine whether it plays a role in the function of single right ventricles, systemic right ventricles were compared with and without a left ventricle mechanically coupled to it.Methods and Results A noninvasive magnetic resonance tagging technique (spatial modulation of magnetization [SPAMM]) that lays intersecting stripes down on the myocardium was used to examine 18 patients with systemic right ventricles: 7 with a single right ventricle who have undergone the Fontan procedure (age, 38.8+/-8.9 months) and 11 with transposition of the great arteries who have undergone an atrial inversion operation (age, 16.3+/-3.9 years). The motion of the intersection points was tracked through systole to determine regional twist and radial shortening. Shortening rates also were evaluated. Finite strain analysis was applied to the grid lines using Delaunay triangulation, and the two-dimensional strain tenser and principal E1 strains were derived for the various anatomic regions. Basal and apical short-axis planes through the ventricular wall were categorized into four distinct regions spaced equally around the circumference of the slice. We observed the following results. (1) Strain was greatest and heterogeneity of strain was least in patients with transposition of the great arteries who were status post atrial inversion operation (six of eight regions). Marked differences were noted in the distribution of strain within a given region, from endocardium to epicardium, and from atrioventricular valve to apical plane between patient subtypes and those with a normal left ventricle. (2) Contrary to the normal subject studied by the use of the same method, for both patient subtypes, there was counterclockwise twist in one region, clockwise twist in the posterior or inferior wall, and a transition zone of no twist at which the two regions of twist met. Normal human adult left ventricles studied in short-axis twist uniformly counterclockwise as viewed from apex to base. (3) Radial inward motion was greatest in the superior wall of both types of systemic right ventricle. The inferior walls of Fontan patients and the posterior (ie, septal) walls of patients with transposition of the great arteries, status post atrial inversion, moved paradoxically in systole. The shortening rate at the atrioventricular valve of patients with transposition of the great arteries, status post atrial inversion, was significantly lower than at the apex or in Fontan patients.Conclusions Marked differences in regional wall motion and strain were demonstrated in systemic right ventricles, depending on whether a left ventricle was present to augment its function. Ventricular-ventricular interaction appears to play an important role in affecting the biomechanics of systemic right ventricles. These observations were markedly different from those in the normal systemic left ventricle. These techniques demonstrate tools with which we can begin to evaluate surgical outcomes using regional myocardial mechanics and may provide a clue to single right ventricle failure.