Low-flow support of the chronic pressure–overloaded right ventricle induces reversed remodeling
| Autor: | Marion Delcroix, Filip Rega, Karin R. Sipido, Bart Meyns, Chandan K. Nagaraju, Tom Verbelen, Piet Claus, Erik Verbeken, Daniel Burkhoff, Ronald B. Driesen |
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| Rok vydání: | 2018 |
| Předmět: |
Pulmonary and Respiratory Medicine
medicine.medical_specialty Cardiac output Ventricular Dysfunction Right Diastole Hemodynamics 030204 cardiovascular system & hematology Contractility 03 medical and health sciences 0302 clinical medicine Internal medicine medicine.artery medicine Animals Transplantation Sheep Ventricular Remodeling business.industry Central venous pressure medicine.anatomical_structure 030228 respiratory system Ventricle Chronic Disease Pulmonary artery Cardiology Female Surgery Heart-Assist Devices Tricuspid Valve Regurgitation Cardiology and Cardiovascular Medicine business |
| Zdroj: | The Journal of Heart and Lung Transplantation. 37:151-160 |
| ISSN: | 1053-2498 |
| Popis: | Background Mechanical right ventricular (RV) support in pulmonary arterial hypertension patients has been feared to cause pulmonary hemorrhage and to be detrimental for the after-load–sensitive RV. Continuous low-flow pumps offer promise but remain insufficiently tested. Methods The pulmonary artery was banded in 20 sheep in this study. Eight weeks later, a Synergy micro-pump (HeartWare International, Framingham MA) was inserted in 10 animals, driving blood from the right atrium to the pulmonary artery. After magnetic resonance imaging, hemodynamics and RV pressure–volume loop data were recorded. Eight weeks later, RV function was assessed in the same way, followed by histologic analysis of the ventricular tissue. Results During the 8 weeks of support, RV volumes and central venous pressure decreased significantly, whereas RV contractility increased. Pulmonary artery pressure increased modestly, particularly its diastolic component. RV contribution to total right-sided cardiac output increased from 12 ± 12% to 41 ± 9% ( p ). After pump inactivation, and compared with 8 weeks earlier, RV volumes had significantly decreased, tricuspid valve regurgitation had almost disappeared, and RV contractility had significantly increased, resulting in significantly increased RV forward power (0.25 ± 0.05 vs 0.16 ± 0.06 W, p = 0.014). Fulton index and RV myocyte size were significantly smaller, and without changes in fibrosis, when compared with controls. Conclusions Prolonged continuous low-flow RV mechanical support significantly unloads the chronic pressure–overloaded RV and improves cardiac output. After 8 weeks, RV hemodynamic recovery and reverse remodeling begin to occur, without increased fibrosis. |
| Databáze: | OpenAIRE |
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