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Serial evaluation of right ventricular function after right ventricular infarction
ASSTPACT.S
COMPUTERIZED AXIAL TOMOGRAPHY OF THE THORAX: SIZE OF RIGHT PULMONARY ARTERY IN RIGHT VENTRICULAR OUTFLOW TRACT OBSTRUCTION Citrol. M. Cottrill, M.D., FACC, Gregory L. Johnson, M.D., -__ FACC, Jacqueline A. Noonan, M.D., FACC, University of Kentucky, Lexington, Kentucky
WEDNESDAY, AM MYOCARDIAL SPECTRUM 10:30- 12:oo
Computerized Axial Tomography (CAT) scans of the thorax were performed in 22 children ranging in age from 7 weeks to 14 years (mean = 3.5 years) who weighed 6 pounds to 86 pounds (mean = 28 pounds). The children had these cardiac lesions:
RIGHT VENTRICULAR INFARCTION : CLINICAL COURSE AND FOLLOW-UP. Victor Learand, MD, Jean-Pierre meets, MD, Jean-Claude Demoulln, MD, Pierre R&o, MD, Henri E. Kulbertus, MD, FACC, Section of Cardiology. University of Liege, Belgium.
Structures were identified as follows: right pulmonary artery (RPA) 21/22, superior vena cava 21/22, right mainstem bronchus (RMB) 21/22, descending aorta 17/22, ascending aorta 10/22. These were measured and ratio of RPA diameter to RMS diameter was determined: 1.5 - 1.7 <, 1.5 > 1.8 > 1.8
CAT scanning permits identification and measurement of RPA. This information may help plan surgical intervention.
RADIONUCLIDE EVALUATION OF RV AND LV FUNCTION (FX) IN CHILDREN-CINEANGIOGRAPHlC VALIDATION AND OBSERVATIONS IN TRANSPOSITION OF THE GREAT ARTERIES (TGA) M.D. Parrish, MD, T.P. Graham, Jr.,MD, FACC, M.L. Bom,MD, F.D. Rollc, MD, .I.Weinberger,RN, O.H. Wolfe: Vanderbilt Univ. Med. CTR., Nashville, Tennessee 37232
February 1981
The American Journal of CARDIOLOGY
INFARCTION-A
CLINICAL
PATHOLOGIC
SERIAL EVALUATION OF RIGHT VENTRICULAR FUNCTION AFTER RIGHT VENTRICULAR INFARCTION. IaunebFrn_Xan.nPa~D; Robert Okada, MD, FACC; John B. Bingham. MB; Herman K. Gold. MD. FACC; Robert C. Leinbach. MD. FACC; Gerald M. Pohost. Strauss, MD, FACC. MD. FACC; H. William Massachusetts General Hospital, Boston, MA.
Validation of an equilibrium radionuclide technique for assessment of RV and LV FX has not been reported in chilren with congenital heart disease (CHD). We performed resting equilibrium radionuclide ventriculograms (RVG'S) in 19 children with diverse types of CHD (ages 4-19,mean lOyr), with exercise RVG's in 15 of the children. Cardiac catheterization (cath) was performed in 11 of 19 children within 2 weeks of RVG. Resting LV and RV ejection fractions (EF) from RVG and cath were compared by linear regression analysis: RVEF (cath vs RVG) r=O.83, S.E.E. 0.08, LVEF I= 0.88, S.E.E. 0.06, RVEF (TGA pts only) r= 0.98, S.E.E. 0.03. Inter observer correlations for RVand LV EF were 0.8land 0.98respectively. With exercise, the inter-observer correlations for RV and LV were 0.91md0.93. Five pts with TGA had exercise studies: 2 with congenitally corrected TGA (CCTGA) and 3 with a mustard repair. The three TGA pts were all asymptomatic but only one had a norms1 increase in RVEF with exercise (0.53 to 0.78). One 18yr old with CCTGA with VSD, pulmonary stenosis and a Blalock-Taussig. shunt had a normal exercise response, while an llyroldwith CCTGA and severe tricuspid incompetence had a fall,in RVEF with peak exercise. We conclude that RV and LV EFs showed good correlations with cath EF's. Furthermore, we were able to perform this study in exercising children with no deterioration in inter-observer correlations. These techniques can provide important information regarding systemic ventricular FX in TGA, and aid in the long term evaluation of current methods of treatment for TGA and CCTGA.
458
18, 1981
Of 146 consecutive patients with inferior wall myocardial infarction (IWMI) aubmitted to Tc 99 m pyrophosphate scintigraphy, 34 (23 46) had concomitant right ventricular infarction @VI) diagnosed by right ventricular Tc uptake. Gated blood pool acans (GBPS) performed in 14 cases showed right ventrlcular abnormalities in 12 (right ventricular asynergy : 8 ; right ventricular dilatation : 7 ; decreaeed right ventricular ejection fraction : 10). Complications were common in the acute &age. Shock was noted in 14 cases, atria1 fibrillation in 6, ventricular fibrillation in 6 and severe atrio-ventricular conduction disorders in 10. In-hospital mortality however was low (2 cases ; 5,9 %). All patients were followed up for one year. 6 additional deaths occurred during follow-up (2 from cardiac failure ; 2 from recurrent MI, 1 from pulmonary embolism). Repeat GBPS at 3 months showed improved right ventricular ejection fraction and size in all but one of 12 cases. However, all 4 patients with large right ventricular infarction as judged from Tc 99 m pyrophosphrite scintigraphy still had right ventricular enlargement and decreased right ventricular ejection fraction. Among 8 cases with smaller right ventricular infarction, only 2 still showed altered right ventricular function at 3 months. Conclusions : 1) In spite of frequent complications in the acute stage, patients with right ventricular infarcMon have an overall good prognosis and long term outcome ; 2) those with extensive scintigraphic right ventricular lesions have more impressive and longer lasting hemodynamic disturbances.
16 Tetralogy of Fall& (TOF), one post-op shunt 1 Pulmonary atresia with Intact Septum, post-op shunt 1 Complex RVCYPObstruction 1 Idiopathic Pulmonary Hypertension 3 No heart disease (NHD)
NHD RVOT Obstruction - no shunts RVOT Obstruction - with shunts Pulmonary Hypertension
MARCH
To define the course of right ventricular function after right ventricular myocardial infarction (MI), 61 patients with acute MI were studied initially within 18 hours after chest pain with multi-gated blood pool scans. Follow-up studies were performed at 90 minutes, 10 days and 3 months. In addition, symptom limited supine bicycle exercise was performed at 3 months post RV MI. Twenty of the 61 patients had abnormal RV regional wall motion on the initial multi-gated blood pool scan and were considered to have RV MI. The RV ejection fraction (EF) results are (mean + 1 SD): =NE BYEE 1) Initial 33.2 + 13.0 2) 90 minute 35.0 + 14.6 p<.os 3) 10 days 45.7 + 11.3 4) 3 months 41.0 + 16.6 5) Pre-exercise 8.82 39.1 + 6) Maximum exercise 39.5 + 12.0 These data show that (1) RVEF improves within the first 10 days following RV MI. (2) There is no significant further improvement in RVEF 10 days to 3 months following RV MI, (3) Despite the early improvement in RVEF following RV MI. RV function was still abnormal at 3 months as demonstrated by a failure to increase RVEF with exercise.
Volume 47
I
COMPUTERIZED AXIAL TOMOGRAPHY OF THE THORAX: SIZE OF RIGHT PULMONARY ARTERY IN RIGHT VENTRICULAR OUTFLOW TRACT OBSTRUCTION Citrol. M. Cottrill, M.D., FACC, Gregory L. Johnson, M.D., -__ FACC, Jacqueline A. Noonan, M.D., FACC, University of Kentucky, Lexington, Kentucky
WEDNESDAY, AM MYOCARDIAL SPECTRUM 10:30- 12:oo
Computerized Axial Tomography (CAT) scans of the thorax were performed in 22 children ranging in age from 7 weeks to 14 years (mean = 3.5 years) who weighed 6 pounds to 86 pounds (mean = 28 pounds). The children had these cardiac lesions:
RIGHT VENTRICULAR INFARCTION : CLINICAL COURSE AND FOLLOW-UP. Victor Learand, MD, Jean-Pierre meets, MD, Jean-Claude Demoulln, MD, Pierre R&o, MD, Henri E. Kulbertus, MD, FACC, Section of Cardiology. University of Liege, Belgium.
Structures were identified as follows: right pulmonary artery (RPA) 21/22, superior vena cava 21/22, right mainstem bronchus (RMB) 21/22, descending aorta 17/22, ascending aorta 10/22. These were measured and ratio of RPA diameter to RMS diameter was determined: 1.5 - 1.7 <, 1.5 > 1.8 > 1.8
CAT scanning permits identification and measurement of RPA. This information may help plan surgical intervention.
RADIONUCLIDE EVALUATION OF RV AND LV FUNCTION (FX) IN CHILDREN-CINEANGIOGRAPHlC VALIDATION AND OBSERVATIONS IN TRANSPOSITION OF THE GREAT ARTERIES (TGA) M.D. Parrish, MD, T.P. Graham, Jr.,MD, FACC, M.L. Bom,MD, F.D. Rollc, MD, .I.Weinberger,RN, O.H. Wolfe: Vanderbilt Univ. Med. CTR., Nashville, Tennessee 37232
February 1981
The American Journal of CARDIOLOGY
INFARCTION-A
CLINICAL
PATHOLOGIC
SERIAL EVALUATION OF RIGHT VENTRICULAR FUNCTION AFTER RIGHT VENTRICULAR INFARCTION. IaunebFrn_Xan.nPa~D; Robert Okada, MD, FACC; John B. Bingham. MB; Herman K. Gold. MD. FACC; Robert C. Leinbach. MD. FACC; Gerald M. Pohost. Strauss, MD, FACC. MD. FACC; H. William Massachusetts General Hospital, Boston, MA.
Validation of an equilibrium radionuclide technique for assessment of RV and LV FX has not been reported in chilren with congenital heart disease (CHD). We performed resting equilibrium radionuclide ventriculograms (RVG'S) in 19 children with diverse types of CHD (ages 4-19,mean lOyr), with exercise RVG's in 15 of the children. Cardiac catheterization (cath) was performed in 11 of 19 children within 2 weeks of RVG. Resting LV and RV ejection fractions (EF) from RVG and cath were compared by linear regression analysis: RVEF (cath vs RVG) r=O.83, S.E.E. 0.08, LVEF I= 0.88, S.E.E. 0.06, RVEF (TGA pts only) r= 0.98, S.E.E. 0.03. Inter observer correlations for RVand LV EF were 0.8land 0.98respectively. With exercise, the inter-observer correlations for RV and LV were 0.91md0.93. Five pts with TGA had exercise studies: 2 with congenitally corrected TGA (CCTGA) and 3 with a mustard repair. The three TGA pts were all asymptomatic but only one had a norms1 increase in RVEF with exercise (0.53 to 0.78). One 18yr old with CCTGA with VSD, pulmonary stenosis and a Blalock-Taussig. shunt had a normal exercise response, while an llyroldwith CCTGA and severe tricuspid incompetence had a fall,in RVEF with peak exercise. We conclude that RV and LV EFs showed good correlations with cath EF's. Furthermore, we were able to perform this study in exercising children with no deterioration in inter-observer correlations. These techniques can provide important information regarding systemic ventricular FX in TGA, and aid in the long term evaluation of current methods of treatment for TGA and CCTGA.
458
18, 1981
Of 146 consecutive patients with inferior wall myocardial infarction (IWMI) aubmitted to Tc 99 m pyrophosphate scintigraphy, 34 (23 46) had concomitant right ventricular infarction @VI) diagnosed by right ventricular Tc uptake. Gated blood pool acans (GBPS) performed in 14 cases showed right ventrlcular abnormalities in 12 (right ventricular asynergy : 8 ; right ventricular dilatation : 7 ; decreaeed right ventricular ejection fraction : 10). Complications were common in the acute &age. Shock was noted in 14 cases, atria1 fibrillation in 6, ventricular fibrillation in 6 and severe atrio-ventricular conduction disorders in 10. In-hospital mortality however was low (2 cases ; 5,9 %). All patients were followed up for one year. 6 additional deaths occurred during follow-up (2 from cardiac failure ; 2 from recurrent MI, 1 from pulmonary embolism). Repeat GBPS at 3 months showed improved right ventricular ejection fraction and size in all but one of 12 cases. However, all 4 patients with large right ventricular infarction as judged from Tc 99 m pyrophosphrite scintigraphy still had right ventricular enlargement and decreased right ventricular ejection fraction. Among 8 cases with smaller right ventricular infarction, only 2 still showed altered right ventricular function at 3 months. Conclusions : 1) In spite of frequent complications in the acute stage, patients with right ventricular infarcMon have an overall good prognosis and long term outcome ; 2) those with extensive scintigraphic right ventricular lesions have more impressive and longer lasting hemodynamic disturbances.
16 Tetralogy of Fall& (TOF), one post-op shunt 1 Pulmonary atresia with Intact Septum, post-op shunt 1 Complex RVCYPObstruction 1 Idiopathic Pulmonary Hypertension 3 No heart disease (NHD)
NHD RVOT Obstruction - no shunts RVOT Obstruction - with shunts Pulmonary Hypertension
MARCH
To define the course of right ventricular function after right ventricular myocardial infarction (MI), 61 patients with acute MI were studied initially within 18 hours after chest pain with multi-gated blood pool scans. Follow-up studies were performed at 90 minutes, 10 days and 3 months. In addition, symptom limited supine bicycle exercise was performed at 3 months post RV MI. Twenty of the 61 patients had abnormal RV regional wall motion on the initial multi-gated blood pool scan and were considered to have RV MI. The RV ejection fraction (EF) results are (mean + 1 SD): =NE BYEE 1) Initial 33.2 + 13.0 2) 90 minute 35.0 + 14.6 p<.os 3) 10 days 45.7 + 11.3 4) 3 months 41.0 + 16.6 5) Pre-exercise 8.82 39.1 + 6) Maximum exercise 39.5 + 12.0 These data show that (1) RVEF improves within the first 10 days following RV MI. (2) There is no significant further improvement in RVEF 10 days to 3 months following RV MI, (3) Despite the early improvement in RVEF following RV MI. RV function was still abnormal at 3 months as demonstrated by a failure to increase RVEF with exercise.
Volume 47
I