Ventricular restraint therapy for heart failure: The right ventricle is different from the left ventricle Lawrence S. Lee, MD, Ravi K. Ghanta, MD, Suyog.

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Presentation transcript:

Ventricular restraint therapy for heart failure: The right ventricle is different from the left ventricle Lawrence S. Lee, MD, Ravi K. Ghanta, MD, Suyog A. Mokashi, MD, Otavio Coelho-Filho, MD, Raymond Y. Kwong, MD, MPH, R. Morton Bolman, MD, Frederick Y. Chen, MD, PhD The Journal of Thoracic and Cardiovascular Surgery Volume 139, Issue 4, Pages 1012-1018 (April 2010) DOI: 10.1016/j.jtcvs.2009.09.064 Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Adjustable and measurable balloon ventricular restraint (AMVR) device: a half-ellipsoidal fluid-filled balloon. Restraint level may be quantified by measuring luminal pressure at end diastole. Restraint level may be adjusted by changing the volume of fluid instilled in balloon. The device is placed around both ventricles and secured to heart along the atrioventricular groove. The Journal of Thoracic and Cardiovascular Surgery 2010 139, 1012-1018DOI: (10.1016/j.jtcvs.2009.09.064) Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Cardiac magnetic resonance imaging of ovine model of heart failure. A, Four-chamber long-axis view showing position of heart within thoracic cavity. B, Short-axis views of heart. C, Short-axis views with left ventricular (LV, red) and right ventricular (RV, yellow) endocardial borders delineated at end diastole. The Journal of Thoracic and Cardiovascular Surgery 2010 139, 1012-1018DOI: (10.1016/j.jtcvs.2009.09.064) Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Acute effects of restraint on ventricular transmural and filling pressures. A, Ventricular transmural pressure (Ptm) as a function of restraint level. Left ventricular (LV) transmural pressure decreases with increasing restraint, whereas right ventricular (RV) transmural pressure remains unchanged. Asterisk indicates P < .05 for change from baseline. B, Changes in end-diastolic pressure (EDP) and central venous pressure (CVP) as a function of restraint level. Left ventricular end-diastolic pressure shows minimal changes with increasing restraint. Right ventricular end-diastolic pressure rises in a nearly linear manner with increases in restraint level. Central venous pressure increases at higher restraint levels, consistent with tamponade. The Journal of Thoracic and Cardiovascular Surgery 2010 139, 1012-1018DOI: (10.1016/j.jtcvs.2009.09.064) Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Long-term effect of simulated clinical ventricular restraint on end-diastolic volume (EDV) and ejection fraction (EF). A, Left ventricular (LV) end-diastolic volume decreases with time, whereas right ventricular (RV) end-diastolic volume remains unchanged. B, There is a trend toward improvement in left ventricular ejection fraction, although this change is not statistically significant. Right ventricular ejection fraction is unaffected. Time at 0 weeks represents time of restraint wrap implantation. Asterisk indicates P < .05 for change from baseline. The Journal of Thoracic and Cardiovascular Surgery 2010 139, 1012-1018DOI: (10.1016/j.jtcvs.2009.09.064) Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions