Determinants of maximal right ventricular function: Role of septal shift
Determinants of maximal right ventricular function: Role of septal shift
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DOI：
10.1067/mtc.2002.118683
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发表时间：
2002-01-01
影响因子：
6
通讯作者：
Vlahakes, GJ
中科院分区：
文献类型：
--
作者：
Klima, UP;Lee, MY;Vlahakes, GJ
背景：原位心脏移植后可发生右心衰竭，并可使左心辅助装置的植入复杂化。右室功能的共同决定因素还不完全清楚。我们研究了左心室前负荷和后负荷、体循环压力和室间隔对右心功能的影响。方法和结果：在12只狗身上进行了体内研究，使用的是高分辨率、等容的右心标本。在任何给定的动脉压下，最大右室发展压不受左心输出量的影响；然而，在容量负荷和无负荷左室之间，右室发展压峰值出现的右室容量显著不同(P<；0.05)。右室发展压峰值与平均动脉压呈正相关。受左室容量负荷的影响，室间隔向左心室的移位延迟，但最大右室发展压时室间隔最大变形量无明显差异。灭活室间隔时，右室发展压峰值显著降低(P<；0.05)。结论：右室功能有多个决定因素，包括右室游离壁、左心室和室间隔。左室容量负荷和平均动脉压改变引起的右室功能改变部分是通过室间隔和右室游离壁的灌流来实现的；室间隔的失活会导致右室功能的显著下降。在紧张性心力衰竭的治疗中，维持左心室发展压以及室间隔对右室功能的贡献可能是重要的。
Background: Right heart failure can occur after orthotopic heart transplantation and can complicate implantation of left ventricular assist devices. The functional codeterminants of right ventricular function are not fully understood. We investigated the effects of left ventricular preload and afterload, systemic pressure, and the contribution of the interventricular septum to right ventricular function.Methods and Results: In vivo studies were conducted in 12 dogs by using a highly defined, isovolumic right heart preparation. At any given arterial pressure, maximal right ventricular developed pressure was not influenced by left heart output; however, right ventricular volumes at which peak right ventricular developed pressure occurred differed significantly between the volume-loaded versus the unloaded left ventricle (P < .05). A correlation was found between peak right ventricular developed pressure and mean arterial pressure. The shift of the interventricular septum toward the left ventricle is delayed under the influence of left ventricular volume load, but the maximal interventricular septal deformation does not differ at maximal fight ventricular developed pressure. There was a substantial and significant decrease in peak right ventricular developed pressure when the interventricular septum was inactivated (P < .05).Conclusions: Right ventricular function has multiple determinants, including the right ventricular free wall, the left ventricle, and the interventricular septum. Changes in right ventricular performance caused by alterations in left ventricular volume load and mean arterial pressure are mediated partially through the interventricular septum, as well as through perfusion of the right ventricular free wall; inactivation of the interventricular septum leads to a significant decrease in right ventricular function. Maintaining left ventricular developed pressure and hence the contribution of the interventricular septum to right ventricular function may be important in the management of tight ventricular failure.