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Role of myocardial hypertrophy on acute and chronic right ventricular performance in relation to chronic volume overload in a porcine model: relevance for the surgical management of tetralogy of Fallot.
J Thorac Cardiovasc Surg. 2014 Jun; 147(6):1956-65.JT

Abstract

OBJECTIVES

The age for correction of tetralogy of Fallot has progressively declined to the postnatal period, often despite an increased rate of transannular patch repair. However, the long-term effect of premature exposure to chronic pulmonary insufficiency on the right ventricle remains unknown. On the basis of the relationship between the duration of pressure overload and age, the role of previous pressure load-related hypertrophy on right ventricular (RV) performance after chronic volume overload was investigated in a porcine model.

METHODS

RV hypertrophy (RVH), induced by pulmonary artery banding, was studied in pigs with (RVH plus pulmonary insufficiency [PI]) and without (RVH) subsequent PI. The effect of volume overload was compared between these 2 groups and pigs without RVH but with PI and controls (sham). Both acute and chronic effects on RV function were studied using conductance technology and validated using echocardiography.

RESULTS

After chronic volume overload, the end-systolic and end-diastolic volumes were smaller in the RVH+PI group than in the PI group, including a lower pulmonary regurgitation fraction (25% ± 5% vs 35% ± 5%; P = .002). RVH resulted in better preserved systolic function, confirmed by an increased preload recruitable stroke work slope (14.7 ± 1.8 vs 9.3 ± 1.3 Mw.s/mL; P = .025) and higher RV ejection fraction (51% ± 3% vs 45% ± 4%; P = .05). Myocardial stiffness was impaired in the RVH+PI group versus the PI group (β, 0.19 ± 0.03 vs 0.12 ± 0.02 mL(-1); P = .001), presenting restrictive physiology only in the condition associating RVH and PI.

CONCLUSIONS

The results of the present study have demonstrated that RVH attenuates the RV remodeling process related to chronic PI. It enables better preservation of contractility but at the cost of sustained diastolic impairment. These findings might help to determine the timing and strategy for repair of tetralogy of Fallot when RV outflow tract morphology indicates a definite need for transannular reconstruction.

Authors+Show Affiliations

Department of Cardiac Surgery, University Hospital of Ghent, Ghent, Belgium. Electronic address: thierry.bove@ugent.be.Department of Pediatric Cardiology, University Hospital of Ghent, Ghent, Belgium.Department of Anesthesiology, University Hospital of Ghent, Ghent, Belgium.Department of Anesthesiology, University Hospital of Ghent, Ghent, Belgium.Department of Histology and Human Pathology, University Hospital of Ghent, Ghent, Belgium.Department of Cardiac Surgery, University Hospital of Ghent, Ghent, Belgium.

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

24280710

Citation

Bove, Thierry, et al. "Role of Myocardial Hypertrophy On Acute and Chronic Right Ventricular Performance in Relation to Chronic Volume Overload in a Porcine Model: Relevance for the Surgical Management of Tetralogy of Fallot." The Journal of Thoracic and Cardiovascular Surgery, vol. 147, no. 6, 2014, pp. 1956-65.
Bove T, Vandekerckhove K, Bouchez S, et al. Role of myocardial hypertrophy on acute and chronic right ventricular performance in relation to chronic volume overload in a porcine model: relevance for the surgical management of tetralogy of Fallot. J Thorac Cardiovasc Surg. 2014;147(6):1956-65.
Bove, T., Vandekerckhove, K., Bouchez, S., Wouters, P., Somers, P., & Van Nooten, G. (2014). Role of myocardial hypertrophy on acute and chronic right ventricular performance in relation to chronic volume overload in a porcine model: relevance for the surgical management of tetralogy of Fallot. The Journal of Thoracic and Cardiovascular Surgery, 147(6), 1956-65. https://doi.org/10.1016/j.jtcvs.2013.10.026
Bove T, et al. Role of Myocardial Hypertrophy On Acute and Chronic Right Ventricular Performance in Relation to Chronic Volume Overload in a Porcine Model: Relevance for the Surgical Management of Tetralogy of Fallot. J Thorac Cardiovasc Surg. 2014;147(6):1956-65. PubMed PMID: 24280710.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Role of myocardial hypertrophy on acute and chronic right ventricular performance in relation to chronic volume overload in a porcine model: relevance for the surgical management of tetralogy of Fallot. AU - Bove,Thierry, AU - Vandekerckhove,Kristof, AU - Bouchez,Stefaan, AU - Wouters,Patrick, AU - Somers,Pamela, AU - Van Nooten,Guido, Y1 - 2013/11/23/ PY - 2013/07/31/received PY - 2013/10/03/revised PY - 2013/10/11/accepted PY - 2013/11/28/entrez PY - 2013/11/28/pubmed PY - 2014/7/6/medline SP - 1956 EP - 65 JF - The Journal of thoracic and cardiovascular surgery JO - J. Thorac. Cardiovasc. Surg. VL - 147 IS - 6 N2 - OBJECTIVES: The age for correction of tetralogy of Fallot has progressively declined to the postnatal period, often despite an increased rate of transannular patch repair. However, the long-term effect of premature exposure to chronic pulmonary insufficiency on the right ventricle remains unknown. On the basis of the relationship between the duration of pressure overload and age, the role of previous pressure load-related hypertrophy on right ventricular (RV) performance after chronic volume overload was investigated in a porcine model. METHODS: RV hypertrophy (RVH), induced by pulmonary artery banding, was studied in pigs with (RVH plus pulmonary insufficiency [PI]) and without (RVH) subsequent PI. The effect of volume overload was compared between these 2 groups and pigs without RVH but with PI and controls (sham). Both acute and chronic effects on RV function were studied using conductance technology and validated using echocardiography. RESULTS: After chronic volume overload, the end-systolic and end-diastolic volumes were smaller in the RVH+PI group than in the PI group, including a lower pulmonary regurgitation fraction (25% ± 5% vs 35% ± 5%; P = .002). RVH resulted in better preserved systolic function, confirmed by an increased preload recruitable stroke work slope (14.7 ± 1.8 vs 9.3 ± 1.3 Mw.s/mL; P = .025) and higher RV ejection fraction (51% ± 3% vs 45% ± 4%; P = .05). Myocardial stiffness was impaired in the RVH+PI group versus the PI group (β, 0.19 ± 0.03 vs 0.12 ± 0.02 mL(-1); P = .001), presenting restrictive physiology only in the condition associating RVH and PI. CONCLUSIONS: The results of the present study have demonstrated that RVH attenuates the RV remodeling process related to chronic PI. It enables better preservation of contractility but at the cost of sustained diastolic impairment. These findings might help to determine the timing and strategy for repair of tetralogy of Fallot when RV outflow tract morphology indicates a definite need for transannular reconstruction. SN - 1097-685X UR - https://www.unboundmedicine.com/medline/citation/24280710/Role_of_myocardial_hypertrophy_on_acute_and_chronic_right_ventricular_performance_in_relation_to_chronic_volume_overload_in_a_porcine_model:_relevance_for_the_surgical_management_of_tetralogy_of_Fallot_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-5223(13)01247-6 DB - PRIME DP - Unbound Medicine ER -