HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): John G. Byrne Kathryn Q. Flores Lawrence H. Cohn Lishan Aklog Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Danton, M. H. Articles by Aklog, L. Search for Related Content PubMed PubMed Citation Articles by Danton, M. H. Articles by Aklog, L. Related Collections Cardiac - physiology

J Thorac Cardiovasc Surg 2001;122:80-91
© 2001 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease (ACD)

Modified Glenn connection for acutely ischemic right ventricular failure reverses secondary left ventricular dysfunction

From the Department of Cardiac Surgery, Brigham and Women's Hospital/Harvard Medical School, Boston, Mass.

Received for publication May 4, 2000. Revisions requested July 11, 2000; revisions received Dec 13, 2000. Accepted for publication Jan 17, 2001. Address for reprints: Lishan Aklog, MD, Division of Cardiac Surgery, Brigham and Women's Hospital/Harvard Medical School, 75 Frances St, Boston, MA 02115 (E-mail: markdanton{at}yahoo.com).

Abstract

Background: Right heart failure after cardiopulmonary bypass can result in severe hemodynamic compromise with high mortality, but the underlying mechanisms remain poorly understood. After ischemia-induced right ventricular failure, alterations in the interventricular septal position decrease left ventricular compliance and limit filling but may also distort left ventricular geometry and compromise contractility and relaxation. This study investigated the effect of acute isolated right ventricular ischemia on biventricular performance and interaction and the response of subsequent right ventricular unloading by use of a modified Glenn shunt.
Methods: In 8 pigs isolated right ventricular ischemic failure was induced by means of selective coronary ligation. A modified Glenn circuit was then established by a superior vena cava–pulmonary artery connection. Ventricular performance was determined by conductance catheter–derived right ventricular pressure-volume loops and left ventricular pressure-segment length loops. Hemodynamic data at baseline, after right ventricular ischemia, and after institution of the Glenn circuit were obtained during inflow occlusion, and the load-independent contractile indices were derived.
Results: Right ventricular free-wall ischemia resulted in acute right ventricular dilation (118 ± 81 mL vs 169 ± 70 mL, P = .0008) and impairment of left ventricular contractility indicated by the reduced end-systolic pressure-volume relation slope (50.0 ± 19 mm Hg/mm vs 18.9 ± 8 mm Hg/mm, P = .002) and preload recruitable stroke work index slope (69.6 ± 26 erg · cm^–3 · 10³ vs 39.7 ± 13 erg · cm^–3 · 10³, P = .003). In addition, left ventricular relaxation () was significantly prolonged (33.3 ± 10 ms vs 53.0 ± 16 ms, P = .012). Right ventricular unloading with the Glenn shunt reduced right ventricular dilation and significantly improved left ventricular contraction, end-systolic pressure-volume relation slope (18.9 ± 8 mm Hg/mm vs 35.8 ± 18 mm Hg/mm, P = .002), preload recruitable stroke work index slope (39.7 ± 26 erg · cm^–3 · 10³ vs 63.0 ± 22 erg · cm^–3 · 10³, P = .003), and diastolic performance ( 53.0 ± 16 ms vs 43.5 ± 13 ms, P = .001).
Conclusions: Right ventricular ischemia-induced dilation resulted in acute impairment of left ventricular contractility and relaxation. A modified Glenn shunt attenuated the left ventricular dysfunction by limiting right ventricular dilation and restoring left ventricular cavity geometry.

This article has been cited by other articles:

				G. M. Succi, L. F. P. Moreira, A. A. Leirner, R. S. Silva, and N. A.G. Stolf Cavopulmonary anastomosis improves left ventricular assist device support in acute biventricular failure Eur. J. Cardiothorac. Surg., March 1, 2009; 35(3): 528 - 533. [Abstract] [Full Text] [PDF]

				A. D. Maslow, M. M. Regan, C. Schwartz, A. Bert, and A. Singh Inotropes Improve Right Heart Function in Patients Undergoing Aortic Valve Replacement for Aortic Stenosis Anesth. Analg., April 1, 2004; 98(4): 891 - 902. [Abstract] [Full Text] [PDF]

				H. A. Leather, P. Segers, Y.-Y. Sun, H. A. De Ruyter, E. Vandermeersch, and P. F. Wouters The Limitations of Preload-Adjusted Maximal Power as an Index of Right Ventricular Contractility Anesth. Analg., October 1, 2002; 95(4): 798 - 804. [Abstract] [Full Text] [PDF]