Right ventricular function

Right ventricular function frequently is impaired, presumably as a result of preservation injury and elevated pulmonary vascular resistance. A restrictive hemodynamic pattern may be present initially, but it usually improves over the 6 weeks following transplantation. Donor-recipient size mismatch may contribute to early posttransplantation hemodynamic abnormalities characterized by higher right and left ventricular end-diastolic pressures. Supraventricular arrhythmias in the early posttransplant period usually are transient and may result from overvigorous use of catecholamines or milrinone later, they should raise suspicion for acute rejection. 

Kaul S, Tei C, Hopkins JM, et al. Assessment of right ventricular function using two-dimensional echocardiography. Am Heart J 1984 107(3) 526-31. 

Tei C, Dujardin KS, Hodge DO, et al. Doppler echocardiographic index for assessment of global right ventricular function./ Am Soc Echocardiogr 1996 9(6) 838-46. 

NO is able to cause vascular and bronchial smooth muscle relaxation. The principal mode of action is stimulation of soluble guanylate cyclase with consequent rises in intracellular cyclic GMP. Inhalation of NO gives selective reduction in pulmonary vascular resistance in pulmonary hypertension and in adult respiratory distress syndrome (ARDS). ° ARDS is a severe and often fatal condition associated with pulmonary oedema and reduced right ventricular function. It is often treated with vasodilators to reduce pulmonary artery press-... 

Al-Shafei AI, Wise RG, Grace AA, Carpenter TA, Hall LD, Huang CL. MRI analysis of right ventricular function in normal and spontaneously hypertensive rats. Magn Reson Imaging 2001 19(10) 1297-1304. 

Wiesmann F, Frydrychowicz A, Rautenherg J, lUinger R, Rommel E, Haase A, Neuhauer S. Analysis of right ventricular function in healthy mice and a murine model of heart failure by in vivo MRI. Am J Physiol Heart Circ Physiol 2002 283(3) H1065-H1071. 

Kasikcioglu E, Oflaz H, Umman B, Bugra Z. Androgenic anabolic steroids also impair right ventricular function. J Cardiol 2009 134 123-5. 

Horowitz SF, Fischbein A, Matza D Evaluation of right and left ventricular function in hard metal workers. Br J Ind Med 45 742-746, 1988... 

Diseases that directly affect hepatic integrity include cirrhosis, viral infections, and collagen vascular diseases. Diseases that indirectly affect function include metabolic disorders (e.g., azotemia secondary to renal insufficiency) and cardiac disease. Although decreased left ventricular output can result in a decrease in hepatic arterial flow, right ventricular failure causes hepatic congestion, reducing the first-pass effect and delaying biotransformation. 

Cardiac function may be evaluated by the determination of left (or right) ventricular ejection fraction (VEF). In this procedure, regions of interest are defined at the end diastolic and end systolic phases of heart beat. The ejection fraction is defined as the ratio of tracer (blood) in the heart in the contracted (systolic) versus the relaxed (diastolic) phases of the heart cycle with appropriate corrections for decay and gamma camera dead time. The value obtained provides a measure of the ability of the heart to pump blood through the lungs (RVEF) or the body (LVEF). A criticism of Ir-191m for this application has been that the half-life (4.96s) is too short to allow effective visualization and quantitation of left ventricular function in adults, particularly those with delayed transit times. A recent... 

Johnson, L.L. Seldin, D.W. TresgaUo, M.E. Bhatia, K. Rodney, R.A. Gibbons, J.F. Esser, P.D. Right ventricular infarction and function from dual isotope indium-111-anti-myosin/thalhum-201 sped and gated blood pool scintigraphy. J. Nucl. Med. 1991, 32 (Abstract), 1018. 

The response of the failing heart to ischemic stress appears to be variable. Increased incidence of ischemia and reperfusion arrhythmias is observed in hearts from rabbits with heart failure induced by pressure or volume overload.202 Furthermore, hearts from rats with heart failure are shown to be more vulnerable to ischemic injury and acute blockade of RAS with ACE inhibitors improved postischemic recovery of function.203 However, increased susceptibility to ischemia was not evident in specimens of right atrium from patients with impaired ventricular function.204 A number of changes occur in heart failure that potentially could influence the response of the heart to ischemia. Oxidative stress is increased, sustained overexpression of pro-inflammatory mediators is observed, and the activity of the renin-angiotensin system is enhanced. 

Nahlawi M, Waligora M, Spies SM, Bonow RO, Kadish AH, Goldberger J. Left ventricular function during and after right ventricular pacing. J Am Coll Cardiol 2004 44 1883-8. 

---