Multiplane Transesophageal Echocardiography with Dobutamine in Patients with Biventricular Inferior Myocardial Infarction

Right ventricular involvement in patients with coronary artery disease

PURPOSE OF REVIEW

RV involvement in coronary artery disease (CAD) includes isolated infarction and involvement in left ventricular infarction. Right ventricular involvement with left ventricular infarction has unique clinical signs and symptoms, requires different management, and has worse prognosis than left ventricular infarcts without right ventricular involvement. Although the right ventricle (RV) is geometrically complex, advances in echocardiography, nuclear imaging, computed tomography, and magnetic resonance imaging technologies have helped to optimally visualize its structure and function and to better elucidate its role in CAD.

RECENT FINDINGS

Newer noninvasive imaging modalities to visualize the RV are highlighted and their emerging clinical utilities are emphasized, including three-dimensional echocardiography, tissue Doppler velocity and strain imaging, computed tomography, and MRI.

SUMMARY

The RV is often involved in CAD. Available imaging modalities demonstrate different aspects of right ventricular involvement, yielding new insights into pathophysiology, clinical care, and management. As imaging technologies widen in their scope, cardiologists will increasingly have the imaging tools to integrate information on right ventricular morphology, hemodynamics, and function, enabling appropriate care for patients with right ventricular involvement in CAD.

The impact of right atrial ischemia on inferior myocardial infarction with extension to right ventricle: transesophageal echocardiographic examination

BACKGROUND

The role of the right atrium in adaptation to the hemodynamic changes produced by extension of myocardial infarction (MI) of the left ventricular inferior wall to the right ventricle is fundamental.

HYPOTHESIS

The aim of this study was analyze a group of patients with MI with extension of right chambers, and particularly right atrial alterations, by transesophageal echocardiography and to correlate it with clinical and angiographic variables.

METHODS

Thirty patients with right ventricular (RV) MI involving obstruction of the right coronary artery without stenosis of the left coronary artery were included; 18 underwent early reperfusion. Transesophageal echocardiography was performed on all within 5 days of coronary angiography. Follow-up was continued from hospitalization to the present.

RESULTS

When patients with right atrial ischemia were compared with those with normal right atrium, the RV wall movement score was significantly greater in the group with right atrial ischemia, severe RV dilatation was more frequent, and association with proximal occlusion of the artery responsible for the MI, as well as absence of right atrial branches and poor collateral circulation, were significant. Hospitalization was more prolonged in this group, and there was a higher incidence of arrhythmias, complete atrioventricular block, and mortality.

CONCLUSIONS

Right atrial ischemia associated with RV infarction leads to a higher incidence of complications and higher mortality. Transesophageal echocardiography is a safe, reproducible technique that provides detailed anatomic information about right chambers and aids in the determination of prognosis and therapeutic decisions.

Echocardiographic Evaluation of Patients with Primary Pulmonary Hypertension Before and After Atrial Septostomy

OBJECTIVES: To characterize the early changes in right ventricular [right ventricle (RV)] geometry and function, as assessed by two-dimensional (2-D) and Doppler echocardiography, after balloon-dilation atrial septostomy (BDAS) in patients with severe primary pulmonary hypertension (PPH). BACKGROUND: Survival in PPH is to a great extent dependent on the functional status of the RV. BDAS recently has been shown to improve functional class and hemodynamics in patients with PPH nonresponsive to conventional vasodilator treatment. METHODS: Ten patients with severe PPH who underwent BDAS were studied with transthoracic and transesophageal 2-D and Doppler echocardiography. RV dimensions were measured in the apical four-chamber view. Continuous-wave Doppler echocardiography was used to obtain peak velocity of tricuspid regurgitation. Transesophageal echocardiography (TEE) primarily was used for the follow-up of the atrial septal defects (ASDs). RESULTS: In the early post-BDAS studies, right atrial and ventricular dimensions significantly decreased in all patients (P < 0.05). Global right ventricular wall motion (RVWM) also improved. RV percent change in area after septostomy inversely correlated with the changes in RV systolic area (r = -0.75; P < 0.05) and also with the baseline (preprocedure) values of RV percent change in area (r = -0.77; P < 0.05). Neither RV wall thickness nor the degree of tricuspid regurgitation were modified significantly after the procedure. CONCLUSIONS: BDAS in the setting of severe PPH results in moderate and salutary changes in geometry and function of the RV as assessed by 2-D echocardiography. These changes mainly appear to be the result of the decompression effect of atrial septostomy.