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JACC. Cardiovascular Imaging May 2022
Topics: Algorithms; Artificial Intelligence; Heart Ventricles; Humans; Machine Learning; Predictive Value of Tests
PubMed: 35512950
DOI: 10.1016/j.jcmg.2022.01.019 -
The Journal of Thoracic and... Aug 2017Double-outlet right ventricle is a form of ventriculoarterial connection. The definition formulated by the International Society for Nomenclature of Paediatric and...
OBJECTIVES
Double-outlet right ventricle is a form of ventriculoarterial connection. The definition formulated by the International Society for Nomenclature of Paediatric and Congenital Heart Disease is based on hearts with both arterial trunks supported in their greater part by a morphologically right ventricle. Bilateral infundibula and ventricular septal defects are highly debated criteria. This study examines the anatomic controversies surrounding double-outlet right ventricle. We show that hearts with double-outlet right ventricle can have atrioventricular-to-arterial valvular continuity. We emphasize the difference between the interventricular communication and the zone of deficient ventricular septation.
METHODS
The hearts examined were from the University of Florida in Gainesville; Johns Hopkins All Children's Hospital, St Petersburg, Fla; and Lurie Children's Hospital, Chicago, Ill. Each specimen had at least 75% of both arterial roots supported by the morphologically right ventricle, with a total of 100 hearts examined. The morphologic method was used to assess anatomic features, including arterial-atrioventricular valvular continuity, subarterial infundibular musculature, and the location of the hole between the ventricles.
RESULTS
Most hearts had fibrous continuity between one of the arterial valves and an atrioventricular valve, with bilateral infundibula in 23%, and intact ventricular septum in 5%.
CONCLUSIONS
Bilateral infundibula are not a defining feature of double-outlet right ventricle, representing only 23% of the specimens in our sample. The interventricular communication can have a posteroinferior muscular rim or extend to become perimembranous (58%). Double-outlet right ventricle can exist with an intact ventricular septum.
Topics: Double Outlet Right Ventricle; Heart Ventricles; Humans; Ventricular Septum
PubMed: 28528718
DOI: 10.1016/j.jtcvs.2017.03.049 -
Journal of Cardiothoracic and Vascular... Nov 2021
Topics: COVID-19; Heart Ventricles; Humans; Respiratory Distress Syndrome; SARS-CoV-2; Ventricular Dysfunction, Right
PubMed: 34247924
DOI: 10.1053/j.jvca.2021.05.059 -
Journal of Cardiothoracic and Vascular... Aug 2022
Topics: Heart Failure; Heart Ventricles; Heart-Assist Devices; Humans
PubMed: 35581052
DOI: 10.1053/j.jvca.2022.04.020 -
Anesthesiology Jan 2018Regulation of blood flow to the right ventricle differs significantly from that to the left ventricle. The right ventricle develops a lower systolic pressure than the... (Review)
Review
Regulation of blood flow to the right ventricle differs significantly from that to the left ventricle. The right ventricle develops a lower systolic pressure than the left ventricle, resulting in reduced extravascular compressive forces and myocardial oxygen demand. Right ventricular perfusion has eight major characteristics that distinguish it from left ventricular perfusion: (1) appreciable perfusion throughout the entire cardiac cycle; (2) reduced myocardial oxygen uptake, blood flow, and oxygen extraction; (3) an oxygen extraction reserve that can be recruited to at least partially offset a reduction in coronary blood flow; (4) less effective pressure-flow autoregulation; (5) the ability to downregulate its metabolic demand during coronary hypoperfusion and thereby maintain contractile function and energy stores; (6) a transmurally uniform reduction in myocardial perfusion in the presence of a hemodynamically significant epicardial coronary stenosis; (7) extensive collateral connections from the left coronary circulation; and (8) possible retrograde perfusion from the right ventricular cavity through the Thebesian veins. These differences promote the maintenance of right ventricular oxygen supply-demand balance and provide relative resistance to ischemia-induced contractile dysfunction and infarction, but they may be compromised during acute or chronic increases in right ventricle afterload resulting from pulmonary arterial hypertension. Contractile function of the thin-walled right ventricle is exquisitely sensitive to afterload. Acute increases in pulmonary arterial pressure reduce right ventricular stroke volume and, if sufficiently large and prolonged, result in right ventricular failure. Right ventricular ischemia plays a prominent role in these effects. The risk of right ventricular ischemia is also heightened during chronic elevations in right ventricular afterload because microvascular growth fails to match myocyte hypertrophy and because microvascular dysfunction is present. The right coronary circulation is more sensitive than the left to α-adrenergic-mediated constriction, which may contribute to its greater propensity for coronary vasospasm. This characteristic of the right coronary circulation may increase its vulnerability to coronary vasoconstriction and impaired right ventricular perfusion during administration of α-adrenergic receptor agonists.
Topics: Animals; Coronary Circulation; Heart Ventricles; Humans; Myocardial Ischemia; Oxygen Consumption; Ventricular Function, Right
PubMed: 28984631
DOI: 10.1097/ALN.0000000000001891 -
Current Opinion in Cardiology May 2015Right ventricular failure (RVF) is associated with significant morbidity and mortality. There is an increasing interest in proper assessment of right ventricle (RV)... (Review)
Review
PURPOSE OF REVIEW
Right ventricular failure (RVF) is associated with significant morbidity and mortality. There is an increasing interest in proper assessment of right ventricle (RV) function as well as understanding mechanisms behind RVF.
RECENT FINDINGS
Within this article, we discuss the metabolic changes that occur in the RV in response to RVF, in particular, a shift toward glycolysis and increased glutaminolysis. We will detail the advances made in noninvasive imaging in assessing the function of the RV and review the methods to assess right ventricle-pulmonary artery coupling. We lastly investigate the role of new treatment options in the failing RV, such as β-blocker therapy.
SUMMARY
RVF is a complicated entity. Although some inferences on RV function and treatment can be made from our understanding of the left ventricle, the RV has unique features, anatomically, metabolically and embryologically, that require dedicated RV-directed research.
Topics: Adrenergic beta-Antagonists; Cardiac Catheterization; Echocardiography; Glucose; Glutamine; Glycolysis; Heart Failure; Heart Ventricles; Humans; Magnetic Resonance Imaging; Pulmonary Artery; Ventricular Dysfunction, Right
PubMed: 25807224
DOI: 10.1097/HCO.0000000000000164 -
Ultrasound in Medicine & Biology Apr 2024The right ventricle receives less attention than its left counterpart in echocardiography research, practice and development of automated solutions. In the work...
OBJECTIVE
The right ventricle receives less attention than its left counterpart in echocardiography research, practice and development of automated solutions. In the work described here, we sought to determine that the deep learning methods for automated segmentation of the left ventricle in 2-D echocardiograms are also valid for the right ventricle. Additionally, here we describe and explore a keypoint detection approach to segmentation that guards against erratic behavior often displayed by segmentation models.
METHODS
We used a data set of echo images focused on the right ventricle from 250 participants to train and evaluate several deep learning models for segmentation and keypoint detection. We propose a compact architecture (U-Net KP) employing the latter approach. The architecture is designed to balance high speed with accuracy and robustness.
RESULTS
All featured models achieved segmentation accuracy close to the inter-observer variability. When computing the metrics of right ventricular systolic function from contour predictions of U-Net KP, we obtained the bias and 95% limits of agreement of 0.8 ± 10.8% for the right ventricular fractional area change measurements, -0.04 ± 0.54 cm for the tricuspid annular plane systolic excursion measurements and 0.2 ± 6.6% for the right ventricular free wall strain measurements. These results were also comparable to the semi-automatically derived inter-observer discrepancies of 0.4 ± 11.8%, -0.37 ± 0.58 cm and -1.0 ± 7.7% for the aforementioned metrics, respectively.
CONCLUSION
Given the appropriate data, automated segmentation and quantification of the right ventricle in 2-D echocardiography are feasible with existing methods. However, keypoint detection architectures may offer higher robustness and information density for the same computational cost.
Topics: Humans; Heart Ventricles; Echocardiography; Ventricular Function, Right; Observer Variation; Thorax
PubMed: 38290912
DOI: 10.1016/j.ultrasmedbio.2023.12.018 -
The Journal of Thoracic and... Nov 2021
Topics: Heart Ventricles; Humans; Hypoplastic Left Heart Syndrome; Models, Statistical; Pulmonary Artery
PubMed: 33589314
DOI: 10.1016/j.jtcvs.2021.01.018 -
The Journal of General Physiology Mar 2022JGP study reveals that lower troponin expression in the right ventricle underlies interventricular differences in excitation-contraction coupling.
JGP study reveals that lower troponin expression in the right ventricle underlies interventricular differences in excitation-contraction coupling.
Topics: Excitation Contraction Coupling; Heart Ventricles; Myocardial Contraction; Troponin
PubMed: 35179560
DOI: 10.1085/jgp.202213119 -
Clinical Cardiology Aug 2017Interest in evaluation of the right ventricle (RV) has increased recently. With the growth of new echocardiographic techniques and technology, there has been a... (Review)
Review
Interest in evaluation of the right ventricle (RV) has increased recently. With the growth of new echocardiographic techniques and technology, there has been a corresponding increase in the ability to evaluate the RV, both qualitatively and quantitatively. Older echocardiographic techniques, such as right ventricular fractional area of change, tricuspid annular plane systolic excursion, and tissue S', and newer echocardiographic techniques including 3-dimensional evaluation and global longitudinal strain, can improve our evaluation of RV function. These techniques provide both diagnostic and prognostic data on a large variety of clinical diseases including pulmonary hypertension and congestive heart failure. With the continuing and exponential advances in technology, echocardiography is well poised to become the primary modality to evaluate the RV.
Topics: Biomechanical Phenomena; Echocardiography, Doppler; Echocardiography, Three-Dimensional; Heart Ventricles; Humans; Predictive Value of Tests; Prognosis; Risk Factors; Stress, Mechanical; Ventricular Dysfunction, Right; Ventricular Function, Right
PubMed: 28295398
DOI: 10.1002/clc.22694