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Determinants of maximal right ventricular function.

R D Page¹, W Harringer, G T Hodakowski

¹Department of Surgery, Harvard Medical School, Boston, Mass.

The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation

|January 1, 1992

Summary

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Left ventricular pressure and the pericardium significantly influence right ventricular function after heart transplantation. The pericardium

Area of Science:

Cardiovascular Physiology
Cardiac Surgery

Background:

Right ventricular failure is a complication after heart transplantation due to increased afterload.
Previous research identified right ventricular perfusion pressure as the primary determinant of maximal right ventricular function.

Purpose of the Study:

To investigate the interaction of the pericardium and left ventricular pressure as determinants of maximal right ventricular function.
To determine if right coronary artery perfusion pressure is the sole determinant of maximal right ventricular function.

Main Methods:

Acute canine preparation with progressive pulmonary artery constriction.
Measurement of maximal generated right ventricular pressure across varying left ventricular systolic pressures.
Studies with constant right coronary artery perfusion pressure.

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Main Results:

Maximal right ventricular pressure generation was linearly related to left ventricular systolic pressure.
A closed pericardium significantly enhanced the influence of left ventricular pressure on right ventricular function.
Right coronary artery perfusion pressure did not alter the relationship between left ventricular pressure, pericardium, and right ventricular function.

Conclusions:

Right ventricular perfusion pressure is not the sole determinant of maximal right ventricular function.
The left ventricular contribution to right ventricular function is diminished with an open pericardium, increasing vulnerability to failure post-transplantation.