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Left-to-right ventricular interaction with a noncontracting right ventricle
D Hoffman1, D Sisto, R W Frater
1Department of Cardiothoracic Surgery, Albert Einstein College of Medicine, Bronx, N.Y.
The Journal of Thoracic and Cardiovascular Surgery
|June 1, 1994
Summary
Left ventricular contraction aids right ventricular function by transferring 24% of its stroke work, increasing to 35% with higher pulmonary afterload. This interventricular interaction is crucial for managing noncontractile right ventricles post-cardiac surgery.
Area of Science:
- Cardiovascular Physiology
- Cardiac Surgery
- Biomedical Engineering
Background:
- Left ventricular systole normally influences right ventricular pressure and stroke volume.
- Understanding these interactions is vital in noncontractile right ventricle scenarios post-cardiopulmonary bypass.
Purpose of the Study:
- To investigate interventricular interactions in a canine model with a surgically created noncontractile right ventricle (neo-right ventricle).
- To quantify the contribution of left ventricular contraction to right ventricular stroke work under varying conditions.
Main Methods:
- Created a neo-right ventricle by replacing the free wall with a xenograft pericardial patch in eight dogs.
- Instrumented animals to measure cardiac pressures and output.
- Assessed interactions during control conditions and partial pulmonary artery occlusion.
Main Results:
- Cardiac output decreased with increased neo-right ventricular size and pulmonary artery occlusion.
- Neo-right ventricular pressure and stroke work decreased with increasing neo-right ventricular size.
- Left ventricular stroke work linearly contributed to neo-right ventricular stroke work (24% control, 35% with increased afterload).
Conclusions:
- Left ventricular contraction significantly contributes to right ventricular stroke work via the septum, especially under increased pulmonary afterload.
- This interventricular mechanism supports global cardiac function when the right ventricle is noncontractile.
- Interventricular interactions must be considered in treating post-bypass right ventricular failure.