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J Thorac Cardiovasc Surg 2003;125:481-490
© 2003 The American Association for Thoracic Surgery
Surgery for Congenital Heart Disease |
From the Departments of Pediatric Cardiology,a Cardiology,b CardioThoracic Surgery,c Leiden University Medical Center, Leiden, and the Department of Pediatrics (subdivision of Cardiology),d Erasmus Medical Center—Sophia Children's Hospital, Rotterdam, The Netherlands.
Financial support by the Gisela Thier Foundation of the Department of Pediatrics of the Leiden University Medical Center is gratefully acknowledged.
Received for publication Feb 4, 2002. Revisions requested May 15, 2002; revisions received June 27, 2002. Accepted for publication Aug 2, 2002. Address for reprints: J. Baan, PhD, Leiden University Medical Center, Department of Cardiology, C-5-P, PO Box 9600, 2300 RC Leiden, The Netherlands (E-mail: J.Baan{at}lumc.nl).
Objective: Right ventricular pressure overload occurs in several types of (congenital) heart disease, as well as in pulmonary disease. Clinical outcome in some of these patient groups might in part be related to left ventricular loading conditions. The effects of left ventricular unloading on the function of the hypertrophic right ventricle have not been studied. We aimed to study the effects of left ventricular unloading on right ventricular hemodynamics and contractility in an animal model of chronic right ventricular pressure overload.
Methods: In lambs the pulmonary artery was chronically banded to increase right ventricular pressure to systemic levels. After 8 weeks, right ventricular contractility and hemodynamic function were assessed in these lambs, as well as in age-matched control animals, by using a combined pressure-conductance catheter in the right ventricle during baseline conditions and during complete bypass of the left ventricle.
Results: In both groups acute left ventricular unloading significantly decreased left ventricular pressure to low levels while aortic pressure was maintained. In the right ventricle of the control group, both end-systolic and end-diastolic volumes increased with left ventricular unloading (P < .01) while end-systolic pressure was maintained. Cardiac output was unchanged despite decreased right ventricular contractility. In the banding group acute left ventricular unloading also decreased right ventricular contractility but increased cardiac output. During acute left ventricular unloading, diastolic stiffness was unchanged in the control group, whereas it was significantly decreased in the banding group.
Conclusions: Both in normal hearts and in hearts subject to chronic right ventricular pressure overload, acute left ventricular unloading decreases right ventricular contractility. Although no effects on cardiac output are encountered in normal hearts during left ventricular bypass, cardiac output is improved in right ventricular pressure-overloaded hearts, most likely related to improved right ventricular diastolic compliance.
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