From the Division of Pediatric Cardiology, Department of Pediatrics
(M.A.F., P.M.W., J.R.), and the Department of Radiology (K.B.G., A.H., J.H.),
The University of Pennsylvania School of Medicine and The Children's
Hospital of Philadelphia, and the Department of Radiology (E.A.H.), University
of Iowa School of Medicine, Iowa City.
Correspondence to Mark A. Fogel, MD, Wyeth-Ayerst Research, Cardiovascular Division, C-2, 145 King of Prussia Road, Radnor, PA 19087. E-mail fogelm{at}war.wyeth.com
Background—Left
ventricular (LV) effects on right ventricular
(RV) function are well known. Less is understood about the effect of
the RV on systemic LV mechanics. To determine this interaction, we
compared systemic LVs with and without an RV mechanically coupled
to them.
Methods and Results—MR myocardial tagging was used to examine 18
subjects with systemic LVs: 10 with functional single LVs (SLV) and 8
normal subjects (NL). Tracking the systolic motion of the
intersecting stripes were used to determine regional twist and radial
motion. Finite strain analysis was applied to derive principal
strains at the atrioventricular valve (AVV) and apical
short-axis levels and in 4 anatomic wall regions. Similar
E1 (circumferential shortening) strain and
heterogeneity of strain were noted between SLV and NL
except in the septal wall. At the septal wall, NL displayed greater
absolute strain (AVV=-0.16±0.02, apex=-0.17±0.02) and less
heterogeneity of strain than SLV (AVV=-0.12±0.02,
apex=-0.13±0.02). Similar E2 (wall
thickening) strain and heterogeneity of
strain were also noted between SLV and NL except again at the septal
wall. At the septal wall, SLV displayed greater absolute
E2 strain (AVV=0.17±0.08, apex=0.19±0.09)
and less heterogeneity of strain than NL
(AVV=0.07±0.07, apex=0.05±0.05). SLV twisted significantly less
counterclockwise than NL in 6 of 8 wall regions and actually twisted
clockwise at the AVV lateral wall. Although there was no significant
difference between groups in radial wall motion, the septal and
inferior walls of SLV demonstrated significantly less
radial motion compared with other SLV walls.
Conclusions—A major influence of the RV on systemic LV strain and
radial motion occurs in the septal wall, whereas absence of the RV
causes marked differences in LV twist. These findings may yield clues
to the long-term functioning of the SLV and be useful in determining
strategies for RV augmentation of LV function.
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports
Mechanics of the Single Left Ventricle
A Study in Ventricular-Ventricular Interaction II
Key Words: contraction • ventricles • Fontan procedure • magnetic resonance imaging
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