Chronic septal infarction confers right ventricular protection during mechanical left ventricular unloading James Mau, BSc, MB, BS, Stuart Menzie, MB,

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Chronic septal infarction confers right ventricular protection during mechanical left ventricular unloading James Mau, BSc, MB, BS, Stuart Menzie, MB, BS, FRACS, Yifei Huang, MD, PhD, Michael Ward, MB, BS, PhD, FRACP, Stephen Hunyor, MB, BS, MD, MTM, FRACP, FACC The Journal of Thoracic and Cardiovascular Surgery Volume 138, Issue 1, Pages 172-178 (July 2009) DOI: 10.1016/j.jtcvs.2009.03.012 Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Cardiac long-axis and mid-papillary short axis sections showing implanted sonomicrometer crystal positions. Epicardial crystal placements: 1 and 2, base and apex dimension; 3 and 4, anterior and posterior midpapillary short axis dimension; 5 and 7, LV plus RV lateral mid-papillary short axis dimension. Endocardial crystal placements: 6 and 9, septal LV and RV mid-papillary surface; 8 and 10, free wall LV and RV mid-papillary surface. The Journal of Thoracic and Cardiovascular Surgery 2009 138, 172-178DOI: (10.1016/j.jtcvs.2009.03.012) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Load-independent hemodynamic effects of LV unloading in sham and PTSMA animals. RV PRSW, Right ventricular preload recruitable stroke work; RV Ees, right ventricular end-systolic elastance; RV Tau, time (ms) of RV diastolic relaxation constant; PTSMA, percutaneous transluminal septal myocardial ablation. The Journal of Thoracic and Cardiovascular Surgery 2009 138, 172-178DOI: (10.1016/j.jtcvs.2009.03.012) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 In-series hemodynamic effects of LV unloading in sham and PTSMA animals. RVEF, Right ventricular ejection fraction; CVP, central venous pressure; COp, pulmonary artery cardiac output; PTSMA, percutaneous transluminal septal myocardial ablation. The Journal of Thoracic and Cardiovascular Surgery 2009 138, 172-178DOI: (10.1016/j.jtcvs.2009.03.012) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 A, Chronic regional effects of PTSMA on interventricular septum and RV and LV free wall thickening. B, Effect of PTSMA on need for pacing. RV, Right ventricle; LV, left ventricle; PTSMA, percutaneous transluminal septal myocardial ablation. The Journal of Thoracic and Cardiovascular Surgery 2009 138, 172-178DOI: (10.1016/j.jtcvs.2009.03.012) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Figure 5 Sham (A, B) and PTSMA (C, D) postmortem hearts before removal of septal sonomicrometer crystals and after differential staining with 1% triphenyltetrazolium solution and methylene blue dye. Extensive fibrosis (white) is seen on the left (C) and right (D) septal surfaces after PTSMA, whereas undamaged triphenyltetrazolium stained red areas (A, B) are seen in the sham. The Journal of Thoracic and Cardiovascular Surgery 2009 138, 172-178DOI: (10.1016/j.jtcvs.2009.03.012) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions