Heart-lung interaction: effect on regional lung air content and total heart volume

To study the interactions between and within the heart and lungs, end-diastolic (ED) and end-systolic (ES) volumes and intrathoracic location of the heart, and the regional air content, volume and geometry of the lungs, were measured from three-dimensional image data generated with the Dynamic Spatial Reconstructor (DSR). The DSR was used to scan the full thoracic extent of anesthetized dogs and sloths at selected transpulmonary pressures. The results show that the dependent to nondependent gradient of regional lung opacity (or conversely regional air content) in the supine animal was not present in the prone animals. While the rib cage and diaphragm of the dog deformed markedly, the shape of the sloth's rib cage and diaphragm remained essentially constant with change in body orientation. As a consequence of these findings, we deduce that the observed change in gradient of regional lung air content in both dog and sloth are in response to changes in the intrathoracic position of the heart which alter ventral lung geometry and not a response to changes in rib cage or diaphragm geometry. In a second series of studies we reconstructed the 3-D extent of the heart at ED and ES in supine anesthetized dogs and demonstrated that the total heart volume (THV) (i.e. contained by the pericardial sac) during sinus rhythm differs by less than 5% between ED and ES. The DSR image data show that this is achieved by the epicardial apex remaining essentially fixed and that the plane containing the atrio-ventricular valves moves like a plunger towards the apex in systole. When atrial fibrillation is present, the THV no longer remains constant and decreases during systole, presumably because of increased stiffness of the atrial myocardium. We conclude from the experimental results that the heart plays an important role in determining regional differences in alveolar expansion, and that by maintaining a constant THV, the heart minimizes energy expenditure which would be caused by moving the lung.