Document Detail


Ischemia of the interventricular septum. A mechanism of right ventricular failure during mechanical left ventricular assist.
MedLine Citation:
PMID:  1597984     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Right ventricular failure has been noted in up to 25% of patients requiring a left ventricular assist device. Altered septal motion or function is one proposed mechanism of right ventricular failure during left heart bypass. We studied the effect of regional ischemia and reperfusion of the interventricular septum on right ventricular function during complete left heart bypass. In six calves the septal perforating branches of the proximal left anterior descending coronary artery were isolated for intermittent occlusion. Complete left heart bypass was established with a Pierce-Donachy left ventricular assist device. Right and left ventricular function were studied with two-dimensional echocardiography and with intraventricular pressure monitors. Establishment of left heart bypass did not significantly affect right ventricular developed pressure, right ventricular end-diastolic area, or right ventricular fractional change in area. Left heart bypass significantly (p less than 0.001) decreased percent systolic septal wall thickening. Septal ischemia during left heart bypass resulted in a decrease in right ventricular developed pressure (p = 0.09), significant increase in right ventricular end-diastolic area (p = 0.002) and significant decrease in right ventricular fractional change in area (p less than 0.001), and a further decrease in interventricular septal wall thickening (p = 0.016). The interventricular septum became thin with flattening of its normal contour. Septal reperfusion resulted in right ventricular recovery with significant improvement in all factors (p less than 0.02). Similar results were documented during a second episode of septal ischemia with recovery after septal reperfusion. In some cases, septal ischemia may be an important factor in the development of right ventricular failure during left heart bypass.
Authors:
R C Daly; K Chandrasekaran; N C Cavarocchi; A J Tajik; H V Schaff
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  103     ISSN:  0022-5223     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  1992 Jun 
Date Detail:
Created Date:  1992-07-06     Completed Date:  1992-07-06     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1186-91     Citation Subset:  AIM; IM    
Affiliation:
Division of Thoracic and Cardiovascular Surgery, Mayo Clinic, Rochester, MN 55905.
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MeSH Terms
Descriptor/Qualifier:
Animals
Cattle
Coronary Disease / complications,  physiopathology*,  therapy,  ultrasonography
Disease Models, Animal
Echocardiography
Heart Failure / etiology*,  physiopathology,  therapy,  ultrasonography
Heart Septum / physiopathology*,  ultrasonography
Heart Ventricles / physiopathology,  ultrasonography
Heart-Assist Devices*
Hemodynamics / physiology
Male
Myocardial Reperfusion
Ventricular Function, Left / physiology
Ventricular Function, Right / physiology

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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