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Acute Right Ventricular Dysfunction in Intensive Care Unit. BIOMED RESEARCH INTERNATIONAL 2017; 2017:8217105. [PMID: 29201914 PMCID: PMC5671685 DOI: 10.1155/2017/8217105] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 08/13/2017] [Accepted: 09/18/2017] [Indexed: 02/07/2023]
Abstract
The role of the left ventricle in ICU patients with circulatory shock has long been considered. However, acute right ventricle (RV) dysfunction causes and aggravates many common critical diseases (acute respiratory distress syndrome, pulmonary embolism, acute myocardial infarction, and postoperative cardiac surgery). Several supportive therapies, including mechanical ventilation and fluid management, can make RV dysfunction worse, potentially exacerbating shock. We briefly review the epidemiology, pathophysiology, diagnosis, and recommendations to guide management of acute RV dysfunction in ICU patients. Our aim is to clarify the complex effects of mechanical ventilation, fluid therapy, vasoactive drug infusions, and other therapies to resuscitate the critical patient optimally.
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Buckberg G. The helical ventricular myocardial band during standard echocardiography: a structure-function relationship. Echocardiography 2015; 32:199-204. [PMID: 25677607 DOI: 10.1111/echo.12847] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Gerald Buckberg
- Department of Cardiothoracic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California
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Buckberg GD, Hoffman JI, Coghlan HC, Nanda NC. Ventricular structure–function relations in health and disease: Part I. The normal heart. Eur J Cardiothorac Surg 2014; 47:587-601. [DOI: 10.1093/ejcts/ezu278] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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Buckberg GD, Hoffman JIE, Coghlan HC, Nanda NC. Ventricular structure-function relations in health and disease: part II. Clinical considerations. Eur J Cardiothorac Surg 2014; 47:778-87. [PMID: 25082144 DOI: 10.1093/ejcts/ezu279] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Accepted: 06/02/2014] [Indexed: 12/15/2022] Open
Abstract
Normal cardiac function of the left and right ventricles, together with the septum, is related to form/function interactions within the helical ventricular myocardial band. This knowledge is a prerequisite to understanding form/function interactions in diseases and for planning new treatments. Topics discussed include congestive heart failure in dilated hearts of ischaemic, valvar or nonischaemic origin as well as diastolic dysfunction. Similar thinking underlies novel treatments for dyssynchrony in pacing, together with focusing upon varying global left or right ventricular anatomy to correct mitral and tricuspid insufficiency caused by tethering of the leaflets. The septum is the lion of the right ventricle and insight is provided into offsetting septal damage during cardiac surgery, rebuilding its anatomical structure in post-tetralogy pulmonary insufficiency, as well as rectifying its dysfunction by decompression in patients with a left ventricular assist device.
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Affiliation(s)
- Gerald D Buckberg
- Department of Cardiothoracic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Julien I E Hoffman
- Department of Pediatrics and Cardiovascular Research Institute, University of California, San Francisco, CA, USA
| | - H Cecil Coghlan
- Division of Cardiovascular Diseases, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Navin C Nanda
- Division of Cardiovascular Diseases, University of Alabama at Birmingham, Birmingham, AL, USA
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Zhuang Y, Yong YH, Yao J, Ji L, Xu D. Left Ventricular Rotation and Torsion in Patients with Perimembranous Ventricular Septal Defect. Echocardiography 2013; 31:362-9. [PMID: 24102668 DOI: 10.1111/echo.12374] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Yan Zhuang
- Intensive Care Unit; Jiangsu Province Hospital of Traditional Chinese Medcine; Nanjing China
| | - Yong-hong Yong
- Department of Cardiology; the First Affiliated Hospital of Nanjing Medical University; Nanjing China
| | - Jing Yao
- Department of Cardiology; the First Affiliated Hospital of Nanjing Medical University; Nanjing China
| | - Ling Ji
- Department of Cardiology; the First Affiliated Hospital of Nanjing Medical University; Nanjing China
| | - Di Xu
- Intensive Care Unit; Jiangsu Province Hospital of Traditional Chinese Medcine; Nanjing China
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Boissière J, Maufrais C, Baquet G, Schuster I, Dauzat M, Doucende G, Obert P, Berthoin S, Nottin S. Specific left ventricular twist-untwist mechanics during exercise in children. J Am Soc Echocardiogr 2013; 26:1298-305. [PMID: 23972490 DOI: 10.1016/j.echo.2013.07.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND In adults, left ventricular (LV) systolic twist is an important factor that determines LV filling, both at rest and during exercise. In children, lower LV twist has been demonstrated at rest, but its adaptation during exercise and its functional consequences on LV filling are unknown. METHODS Using speckle-tracking echocardiography, LV twist-untwist mechanics were studied in 25 children (aged 10-12 years) and 20 young adults (aged 18-44 years) at rest and during three exercise workloads performed at 20%, 30%, and 40% of their maximal aerobic power. RESULTS At rest, LV twist was lower in children, because of a higher temporal dispersion of peak rotation between base and apex. During exercise, the increase of basal rotation was blunted in children compared with adults (-6.7 ± 2.7° vs -9.0 ± 2.0° at 40% of maximal aerobic power, P < .05). Consequently, LV twist increased to a lesser extent (13.0 ± 5.0° vs 15.8 ± 4.5° at 40% of maximal aerobic power, P < .05). The increase in LV untwisting rates during exercise was also lower in children, leading to a lower percentage of untwisting during early diastole (8 ± 8% vs 29 ± 20% at 40% of maximal aerobic power, P < .001). Consequently, during early diastole, the normal timing of diastolic events observed in young adults, with untwist occurring before radial displacement, was blunted in children. Nevertheless, children exhibited normal LV filling due to higher diastolic radial and longitudinal strain rates. CONCLUSIONS Twist-untwist mechanics may evolve with advancing age. In children, early diastolic LV untwisting appears to be less important than in adults. Their better LV intrinsic myocardial relaxation may ensure adequate LV filling during exercise without dependence on the additional effect of suction resulting from LV energy recoil.
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Affiliation(s)
- Julien Boissière
- EA 4488-Activité Physique-Muscle-Santé, Université Lille Nord de France, Faculté des Sciences du Sport et de l'Education Physique, Lille, France
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Buckberg G, Hoffman JI, Nanda NC, Coghlan C, Saleh S, Athanasuleas C. Ventricular Torsion and Untwisting: Further Insights into Mechanics and Timing Interdependence: A Viewpoint. Echocardiography 2011; 28:782-804. [DOI: 10.1111/j.1540-8175.2011.01448.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Cazorla O, Lacampagne A. Regional variation in myofilament length-dependent activation. Pflugers Arch 2011; 462:15-28. [DOI: 10.1007/s00424-011-0933-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Revised: 02/01/2011] [Accepted: 02/03/2011] [Indexed: 12/17/2022]
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Abstract
The keynote to understanding cardiac function is recognizing the underlying architecture responsible for the contractile mechanisms that produce the narrowing, shortening, lengthening, widening, and twisting disclosed by echocardiographic and magnetic resonance technology. Despite background knowledge of a spiral clockwise and counterclockwise arrangement of muscle fibers, issues about the exact architecture, interrelationships, and function of the different sets of muscle fibers remain to be resolved. This report (1) details observed patterns of cardiac dynamic directional and twisting motions via multiple imaging sources; (2) summarizes the deficiencies of correlations between ventricular function and known ventricular muscle architecture; (3) correlates known cardiac motions with the functional anatomy within the helical ventricular myocardial band; and (4) defines an innovative muscular systolic mechanism that challenges the previously described concept of “isovolumic relaxation.” This new knowledge may open new doors to treating heart failure due to diastolic dysfunction.
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Affiliation(s)
- Gerald Buckberg
- From the Departments of Cardiothoracic Surgery (G.B.), Medicine (S.S.), and Anesthesiology (A.M.), David Geffen School of Medicine at UCLA, Los Angeles, Calif; Department of Pediatrics and Cardiovascular Research Institute, University of California at San Francisco, San Francisco (J.I.E.H.); and Division of Cardiovascular Diseases, University of Alabama at Birmingham, Birmingham (C.C.)
| | - Julien I.E. Hoffman
- From the Departments of Cardiothoracic Surgery (G.B.), Medicine (S.S.), and Anesthesiology (A.M.), David Geffen School of Medicine at UCLA, Los Angeles, Calif; Department of Pediatrics and Cardiovascular Research Institute, University of California at San Francisco, San Francisco (J.I.E.H.); and Division of Cardiovascular Diseases, University of Alabama at Birmingham, Birmingham (C.C.)
| | - Aman Mahajan
- From the Departments of Cardiothoracic Surgery (G.B.), Medicine (S.S.), and Anesthesiology (A.M.), David Geffen School of Medicine at UCLA, Los Angeles, Calif; Department of Pediatrics and Cardiovascular Research Institute, University of California at San Francisco, San Francisco (J.I.E.H.); and Division of Cardiovascular Diseases, University of Alabama at Birmingham, Birmingham (C.C.)
| | - Saleh Saleh
- From the Departments of Cardiothoracic Surgery (G.B.), Medicine (S.S.), and Anesthesiology (A.M.), David Geffen School of Medicine at UCLA, Los Angeles, Calif; Department of Pediatrics and Cardiovascular Research Institute, University of California at San Francisco, San Francisco (J.I.E.H.); and Division of Cardiovascular Diseases, University of Alabama at Birmingham, Birmingham (C.C.)
| | - Cecil Coghlan
- From the Departments of Cardiothoracic Surgery (G.B.), Medicine (S.S.), and Anesthesiology (A.M.), David Geffen School of Medicine at UCLA, Los Angeles, Calif; Department of Pediatrics and Cardiovascular Research Institute, University of California at San Francisco, San Francisco (J.I.E.H.); and Division of Cardiovascular Diseases, University of Alabama at Birmingham, Birmingham (C.C.)
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Buckberg G. Cardiac structure/function relationships: Reality or deduction? J Thorac Cardiovasc Surg 2008; 136:19-20. [DOI: 10.1016/j.jtcvs.2007.10.086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2007] [Accepted: 10/21/2007] [Indexed: 10/22/2022]
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Buckberg G, Mahajan A, Saleh S, Hoffman JIE, Coghlan C. Structure and function relationships of the helical ventricular myocardial band. J Thorac Cardiovasc Surg 2008; 136:578-89, 589.e1-11. [PMID: 18805255 DOI: 10.1016/j.jtcvs.2007.10.088] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2007] [Revised: 08/29/2007] [Accepted: 10/19/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Understanding cardiac function requires knowledge of the architecture responsible for the normal actions of emptying and filling. Newer imaging methods are surveyed to characterize directional (narrowing, shortening, lengthening, and widening) and twisting motions. METHODS These movements are defined and then compared with a spectrum of models to introduce a useful "functional anatomy" that explains cardiac spatial and temporal relationships. The sequential nature of normal contraction differs from a synchronous beat. RESULTS The prior concept of constriction is replaced by understanding that clockwise and counterclockwise helical motions are necessary to cause the predominant twisting motion. The helical ventricular myocardial band model of Torrent-Guasp fulfills the architectural structure to define normal function. Expansion of information from this model allows novel understanding of mechanisms that explains why a component of ventricular suction involves a systolic event, clarifies septum function, determines diastolic dysfunction, introduces new treatments, shows how knowledge of the helical structure influences understanding of atrioventricular and biventricular pacing, and creates novel methods for introducing septal pacing stimuli. CONCLUSION Further testing of these spatial anatomic concepts is needed to create a more accurate understanding of the architectural mechanisms that underlie cardiac dynamics to address future problems in unhealthy hearts.
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Affiliation(s)
- Gerald Buckberg
- Option on Bioengineering, California Institute of Technology, Pasadena, Calif, USA
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Buckberg GD. Ventricular structures must be understood during surgical restoration for heart failure. Scand J Surg 2007; 96:164-76. [PMID: 17679359 DOI: 10.1177/145749690709600212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- G D Buckberg
- David Geffen School of Medicine at UCLA, Division of Cardiothoracic Surgery, 62-258 Center for the Health Sciences, Los Angeles, CA 90095-1701, USA.
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Austin EH. The ventricular myocardial band of Torrent-Guasp - the controversy: an editorial. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2007:87-8. [PMID: 17433997 DOI: 10.1053/j.pcsu.2007.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
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Kocica MJ, Corno AF, Lackovic V, Kanjuh VI. The helical ventricular myocardial band of Torrent-Guasp. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2007:52-60. [PMID: 17433993 DOI: 10.1053/j.pcsu.2007.01.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
We live in an era of substantial progress in understanding myocardial structure and function at genetic, molecular, and microscopic levels. Yet, ventricular myocardium has proven remarkably resistant to macroscopic analyses of functional anatomy. Pronounced and practically indefinite global and local structural anisotropy of its fibers and other ventricular wall constituents produces electrical and mechanical properties that are nonlinear, anisotropic, time varying, and spatially inhomogeneous. The helical ventricular myocardial band of Torrent-Guasp is a revolutionary new concept in understanding global, 3-dimensional, functional architecture of the ventricular myocardium. This concept defines the principal, cumulative vectors, integrating the tissue architecture (ie, form) and net forces developed (ie, function) within the ventricular mass. The primary purpose of this review is to emphasize the importance of this concept, in the light of collaborative efforts to establish an integrative approach, defining ventricular form and function by linking across multiple scales of biological organization, as explained in the ongoing Physiome project. Because one of the most important scientific missions in this century is integration of basic research with clinical medicine, we believe that this knowledge is not of merely academic importance, but is also the essential prerequisite in clinical evaluation and treatment of different heart diseases.
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Affiliation(s)
- Mladen J Kocica
- Clinic for Cardiac Surgery, Institute for Cardiovascular Diseases, UC Clinical Centre of Serbia, Belgrade, Serbia.
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Sengupta PP, Korinek J, Belohlavek M, Narula J, Vannan MA, Jahangir A, Khandheria BK. Left ventricular structure and function: basic science for cardiac imaging. J Am Coll Cardiol 2006; 48:1988-2001. [PMID: 17112989 DOI: 10.1016/j.jacc.2006.08.030] [Citation(s) in RCA: 325] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2006] [Revised: 08/29/2006] [Accepted: 08/30/2006] [Indexed: 12/11/2022]
Abstract
The myofiber geometry of the left ventricle (LV) changes gradually from a right-handed helix in the subendocardium to a left-handed helix in the subepicardium. In this review, we associate the LV myofiber architecture with emerging concepts of the electromechanical sequence in a beating heart. We discuss: 1) the morphogenesis and anatomical arrangement of muscle fibers in the adult LV; 2) the sequence of depolarization and repolarization; 3) the physiological inhomogeneity of transmural myocardial mechanics and the apex-to-base sequence of longitudinal and circumferential deformation; 4) the sequence of LV rotation; and 5) the link between LV deformation and the intracavitary flow direction observed during each phase of the cardiac cycle. Integrating the LV structure with electrical activation and motion sequences observed in vivo provides an understanding about the spatiotemporal sequence of regional myocardial performance that is essential for noninvasive cardiac imaging.
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Affiliation(s)
- Partho P Sengupta
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
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