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Determination of critical pericardial dimensions in patients with dilated cardiomyopathy
G M Pantalos1, W E Richenbacher, S V Karwande
1University of Utah, Department of Surgery, Salt Lake City.
Insights
This study measured pericardial dimensions in heart transplant patients with dilated cardiomyopathy. Findings reveal limited space for cardiac replacement devices, with chest X-ray measurements requiring correction factors.
Area of Science:
- Cardiovascular Surgery
- Biomedical Engineering
- Radiology
Background:
- Orthotopic cardiac replacement devices require precise knowledge of available pericardial space.
- Limited in vivo data exists for pericardial dimensions in patients with dilated cardiomyopathies.
- Understanding these dimensions is crucial for designing effective blood pumping systems.
Purpose of the Study:
- To determine critical in vivo pericardial dimensions in patients with dilated cardiomyopathies.
- To compare pre-operative radiographic measurements with intraoperative findings.
- To provide data for the design of orthotopic cardiac replacement devices.
Main Methods:
- Measured critical pericardial dimensions in 13 male cardiac transplant recipients.
- Compared chest radiograph pericardial axes with intraoperative measurements during total artificial heart fit trials.
- Utilized anteroposterior (AP) and lateral chest X-ray axes, correcting for reduction factors (0.92 for AP, 0.88 for lateral).
Main Results:
- Key intraoperative dimensions included T10 midline AP axis (12.3 cm), aortic root to diaphragm (9.7 cm), T10 total cardiac lateral axis (18.1 cm), and tricuspid annulus to left ventricular apex (12.1 cm).
- All patients exhibited cardiomegaly, indicated by an increased cardiothoracic ratio.
- Pericardial dimensions showed little to no correlation with patient body mass or cardiomyopathy diagnosis (ischemic vs. idiopathic).
Conclusions:
- The pericardial space in patients with dilated cardiomyopathies is significantly limited for orthotopic cardiac replacement devices.
- Chest radiograph dimensions can be used to estimate intraoperative space with established correction factors.
- These findings are vital for guiding the development and implantation of artificial heart systems.
Abstract:
The development of orthotopically positioned cardiac replacement devices requires a knowledge of the space available to guide the design of the blood pumping system. Pericardial dimensions from in vivo and cadaver studies of normal subjects have been reported, but little information is available on in vivo pericardial dimensions in patients with dilated cardiomyopathies. The critical pericardial dimensions were determined in 13 men who were cardiac transplant recipients (age, 42 +/- 13 years; body mass, 72 +/- 11 kg; three with ischemic and 10 with idiopathic cardiomyopathy) by comparison of corresponding pericardial axes on chest radiographs to measurements obtained during orthotopic cardiac transplant in the context of a total artificial heart fit trial. The main pericardial dimensions measured intraoperatively were found to be the T10 midline anteroposterior (AP) axis (12.3 +/- 1.4 cm), the aortic root to diaphragm length (9.7 +/- 1.5 cm), the T10 total cardiac lateral axis (18.1 +/- 2.3 cm), and the tricuspid annulus to left ventricular apex (12.1 +/- 1.7 cm). All patients had cardiomegaly as indicated by a greater than normal cardiothoracic ratio. These data described the limited dimensions of the pericardial space available for orthotopic cardiac replacement devices. Chest film dimensions can be corrected using 0.92 and 0.88 as reduction factors for the (AP) and lateral axis dimensions, respectively. In this patient sample, there was little or no correlation between pericardial dimension and patient body mass or diagnosis.(ABSTRACT TRUNCATED AT 250 WORDS)