Effects of acute left ventricular unloading on right ventricular function in normal and chronic right ventricular pressure-overloaded lambs Boudewijn.

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Effects of acute left ventricular unloading on right ventricular function in normal and chronic right ventricular pressure-overloaded lambs Boudewijn P.J. Leeuwenburgh, MSca,b, Willem A. Helbing, MDa,d, Paul Steendijk, PhDb, Paul H. Schoof, MDc, Jan Baan, PhDb The Journal of Thoracic and Cardiovascular Surgery Volume 125, Issue 3, Pages 481-490 (March 2003) DOI: 10.1067/mtc.2003.28 Copyright © 2003 American Association for Thoracic Surgery Terms and Conditions

Helbing, Schoof, Steendijk, Leeuwenburgh, Baan (left to right). The Journal of Thoracic and Cardiovascular Surgery 2003 125, 481-490DOI: (10.1067/mtc.2003.28) Copyright © 2003 American Association for Thoracic Surgery Terms and Conditions

Fig. 1 Schematic representation of the instrumentation for total LHB. Blood is removed from the LV apex and collected in a temperature-controlled glass reservoir. Through a centrifugal pump, blood is propelled from the reservoir back to the ascending aorta. Before LV bypass, the reservoir was filled with donor blood from another sheep to a fixed reference level. Pump speed was adjusted to maintain this reference level in the reservoir. Note that because of the interpositioning of the open reservoir, blood was removed passively from the left ventricle both because of a height difference between the mid-left ventricle and the reservoir and by the pumping action of the left ventricle itself (no active LV suction by the bypass pump). AO, Aorta; PA, pulmonary artery; LA, left atrium; RA, right atrium; LV, left ventricle; RV, right ventricle. The Journal of Thoracic and Cardiovascular Surgery 2003 125, 481-490DOI: (10.1067/mtc.2003.28) Copyright © 2003 American Association for Thoracic Surgery Terms and Conditions

Fig. 2 Typical example of pressure tracings during LV bypass in the control (upper panel) and banding (lower panel) groups. The lower black line represents the RV pressure signal (RV), the gray line represents the LV pressure signal (LV), and the black line at the top represents aortic pressure (Ao). Note that the aortic pressure signal is flat, indicating a closed aortic valve during LV bypass. Although the diastolic pressure interval during LHB in the banding group suggests a positive pressure peak, calculated average LV pressures in these diastolic intervals in both groups indicate that this is an inconsistent finding (control group, −1.7 ± 1.1 mm Hg; banding group, −2.2 ± 4.7 mm Hg). The Journal of Thoracic and Cardiovascular Surgery 2003 125, 481-490DOI: (10.1067/mtc.2003.28) Copyright © 2003 American Association for Thoracic Surgery Terms and Conditions

Fig. 3 Typical recordings of RV PV loops during a vena caval occlusion in the control (top panel) and banding (lower panel) groups. Black loops indicate the baseline condition, whereas gray loops were recorded during acute decreases in LV pressure. ESPVRs are represented by straight black lines. The Journal of Thoracic and Cardiovascular Surgery 2003 125, 481-490DOI: (10.1067/mtc.2003.28) Copyright © 2003 American Association for Thoracic Surgery Terms and Conditions

Fig. 4 Schematic average RV PV loops and corresponding average ESPVRs (solid black lines) and EDPVRs (solid gray lines) showing the effects of LV bypass in the control group (left panel) and in the banding group (right panel). Solid loops represent the baseline condition, whereas dotted loops represent the LV bypass condition. The thin horizontal lines indicate the intercept with the ESPVR at an end-systolic pressure of 15 and 55 mm Hg, respectively. Note that in the control group the average PV loop shifts rightward along the same EDPVR during LV unloading, whereas in the banding group the average PV loop shifts to the right along a different EDPVR. The Journal of Thoracic and Cardiovascular Surgery 2003 125, 481-490DOI: (10.1067/mtc.2003.28) Copyright © 2003 American Association for Thoracic Surgery Terms and Conditions