Circulation, Vol 63, 87-95, Copyright © 1981 by American Heart Association
GJ Vlahakes, K Turley and JI Hoffman
Acute right ventricular (RV) hypertension and failure occur clinically. In
this study we examined the mechanism of RV failure. Adult dogs were studied
acutely under anesthesia; dogs were instrumented for measurement of
pressures and right coronary artery blood flow. Myocardial blood flow and
cardiac output were determined with radionuclide-labeled microspheres, and
the presence of ischemia was determined by biochemical analysis of
ventricular biopsies. RV hypertension was produced by constricting the
pulmonary artery and was increased until RV failure occurred, as evidenced
by decreased aortic pressure and cardiac output and increased RV
end-diastolic pressure. With increasing RV systolic pressure, RV myocardial
blood flow failed to increase in proportion to demand. At the onset of RV
failure, there was no reactive hyperemia of right coronary flow compared
with control, indicating the absence of further coronary vascular reserve;
biochemical analysis demonstrated that the RV free wall was ischemic; the
LV free wall was not. Infusion of phenylephrine raised aortic pressure and
hence, myocardial perfusion pressure; RV failure reversed as shown by
decreased RV end-diastolic pressure and increased cardiac output and RV
systolic pressure; reactive hyperemia of right coronary flow was restored
and the biochemical indexes of ischemia were reversed, demonstrating that
ischemia is the cause of failure in acute RV hypertension.
ARTICLES
The pathophysiology of failure in acute right ventricular hypertension: hemodynamic and biochemical correlations
This article has been cited by other articles:
 |
|
 |
|
  H. J. Bogaard, R. Natarajan, S. C. Henderson, C. S. Long, D. Kraskauskas, L. Smithson, R. Ockaili, J. M. McCord, and N. F. Voelkel Chronic Pulmonary Artery Pressure Elevation Is Insufficient to Explain Right Heart Failure Circulation, November 17, 2009; 120(20): 1951 - 1960. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. Hekier and J. Mandel A 22-Year-Old Woman With Unexplained Dyspnea Chest, September 1, 2009; 136(3): 867 - 876. [Full Text] [PDF]
|
|
|
|
 |
|
 J. K. Ho, O. J. Liakopoulos, R. Crowley, A. B. Yezbick, E. Sanchez, K. Shivkumar, and A. Mahajan In Vivo Detection of Myocardial Ischemia in Pigs Using Visible Light Spectroscopy Anesth. Analg., April 1, 2009; 108(4): 1185 - 1192. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M P V Begieneman, F R W van de Goot, I A C van der Bilt, A V. Noordegraaf, M D Spreeuwenberg, W J Paulus, V W M van Hinsbergh, F C Visser, and H W M Niessen Pulmonary embolism causes endomyocarditis in the human heart Heart, April 1, 2008; 94(4): 450 - 456. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Zagorski, M. A. Gellar, M. Obraztsova, J. A. Kline, and J. A. Watts Inhibition of CINC-1 Decreases Right Ventricular Damage Caused by Experimental Pulmonary Embolism in Rats J. Immunol., December 1, 2007; 179(11): 7820 - 7826. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. S. Darze, A. L. Latado, A. G. Guimaraes, R. A. V. Guedes, A. B. Santos, S. S. de Moura, and L. C. S. Passos Acute Pulmonary Embolism Is an Independent Predictor of Adverse Events in Severe Decompensated Heart Failure Patients Chest, June 1, 2007; 131(6): 1838 - 1843. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. Kerbaul, S. Brimioulle, B. Rondelet, C. Dewachter, I. Hubloue, and R. Naeije How Prostacyclin Improves Cardiac Output in Right Heart Failure in Conjunction with Pulmonary Hypertension Am. J. Respir. Crit. Care Med., April 15, 2007; 175(8): 846 - 850. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Y. Jeon, J. H. Ryu, Y. J. Lim, C. S. Kim, J.-H. Bahk, S. Z. Yoon, and J. Y. Choi Comparative hemodynamic effects of vasopressin and norepinephrine after milrinone-induced hypotension in off-pump coronary artery bypass surgical patients. Eur. J. Cardiothorac. Surg., June 1, 2006; 29(6): 952 - 956. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Piazza and S. Z. Goldhaber The Acutely Decompensated Right Ventricle: Pathways for Diagnosis and Management Chest, September 1, 2005; 128(3): 1836 - 1852. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Dauphine and B. Omari Pulmonary Embolectomy for Acute Massive Pulmonary Embolism Ann. Thorac. Surg., April 1, 2005; 79(4): 1240 - 1244. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Jaillard, F. Elbaz, S. Bresson-Just, Y. Riou, V. Houfflin-Debarge, T. Rakza, B. Larrue, and L. Storme Pulmonary vasodilator effects of norepinephrine during the development of chronic pulmonary hypertension in neonatal lambs Br. J. Anaesth., December 1, 2004; 93(6): 818 - 824. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. M. Shors, C. W. Fung, C. J. Francois, J. P. Finn, and D. S. Fieno Accurate Quantification of Right Ventricular Mass at MR Imaging by Using Cine True Fast Imaging with Steady-State Precession: Study in Dogs Radiology, February 1, 2004; 230(2): 383 - 388. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Stratmann and G. A. Gregory Neurogenic and Humoral Vasoconstriction in Acute Pulmonary Thromboembolism Anesth. Analg., August 1, 2003; 97(2): 341 - 354. [Full Text] [PDF]
|
|
|
|
|
|
L. G. Fischer, H. V. Aken, and H. Burkle Management of Pulmonary Hypertension: Physiological and Pharmacological Considerations for Anesthesiologists Anesth. Analg., June 1, 2003; 96(6): 1603 - 1616. [Full Text] [PDF]
|
|
|
|
 |
|
 G. J. Vlahakes Reply J. Thorac. Cardiovasc. Surg., January 1, 2003; 125(1): 220 - 220. [Full Text] [PDF]
|
|
|
|
|
|
K. E. Wood Major Pulmonary Embolism : Review of a Pathophysiologic Approach to the Golden Hour of Hemodynamically Significant Pulmonary Embolism Chest, March 1, 2002; 121(3): 877 - 905. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. D. Douketis, M. A. Crowther, E. B. Stanton, and J. S. Ginsberg Elevated Cardiac Troponin Levels in Patients With Submassive Pulmonary Embolism Arch Intern Med, January 14, 2002; 162(1): 79 - 81. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
U. P. Klima, M.-Y. Lee, J. L. Guerrero, P. J. LaRaia, R. A. Levine, and G. J. Vlahakes Determinants of maximal right ventricular function: Role of septal shift J. Thorac. Cardiovasc. Surg., January 1, 2002; 123(1): 72 - 80. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Rich, V. V. McLaughlin, and W. O'Neill Stenting To Reverse Left Ventricular Ischemia Due To Left Main Coronary Artery Compression in Primary Pulmonary Hypertension Chest, October 1, 2001; 120(4): 1412 - 1415. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. M. Sullivan, J. A. Watts, and J. A. Kline Biventricular cardiac dysfunction after acute massive pulmonary embolism in the rat J Appl Physiol, May 1, 2001; 90(5): 1648 - 1656. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. De Vroomen, P. Steendijk, R. H. Lopes Cardozo, H. H. A. Brouwers, F. Van Bel, and J. Baan Enhanced systolic function of the right ventricle during respiratory distress syndrome in newborn lambs Am J Physiol Heart Circ Physiol, January 1, 2001; 280(1): H392 - H400. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
O. E. Arafa, O. R. Geiran, K. Andersen, E. Fosse, S. Simonsen, and J. L. Svennevig Intraaortic balloon pumping for predominantly right ventricular failure after heart transplantation Ann. Thorac. Surg., November 1, 2000; 70(5): 1587 - 1593. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. H. LOPES CARDOZO, P. STEENDIJK, J. BAAN, H. A. A. BROUWERS, M. DE VROOMEN, and F. VAN BEL Right Ventricular Function in Respiratory Distress Syndrome and Subsequent Partial Liquid Ventilation . Homeometric Autoregulation in the Right Ventricle of the Newborn Animal Am. J. Respir. Crit. Care Med., August 1, 2000; 162(2): 374 - 379. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Giannitsis, M. Muller-Bardorff, V. Kurowski, B. Weidtmann, U. Wiegand, M. Kampmann, and H. A. Katus Independent Prognostic Value of Cardiac Troponin T in Patients With Confirmed Pulmonary Embolism Circulation, July 11, 2000; 102(2): 211 - 217. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. S. Assad, M. Cardarelli, M. C. Abduch, V. D. Aiello, M. Maizato, M. Barbero-Marcial, and A. Jatene Reversible pulmonary trunk banding with a balloon catheterAssessment of rapid pulmonary ventricular hypertrophy J. Thorac. Cardiovasc. Surg., July 1, 2000; 120(1): 66 - 72. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. de Vroomen, R. H. L. Cardozo, P. Steendijk, F. van Bel, and J. Baan Improved contractile performance of right ventricle in response to increased RV afterload in newborn lamb Am J Physiol Heart Circ Physiol, January 1, 2000; 278(1): H100 - H105. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. L. Thornburg and M. D. Reller Coronary flow regulation in the fetal sheep Am J Physiol Regulatory Integrative Comp Physiol, November 1, 1999; 277(5): R1249 - R1260. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
U. Klima, J. Luis Guerrero, and G. J. Vlahakes Contribution of the interventricular septum to maximal right ventricular function Eur. J. Cardiothorac. Surg., September 1, 1999; 14(3): 250 - 255. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. L. Dickstein Anesthesia for Heart Transplantation Seminars in Cardiothoracic and Vascular Anesthesia, July 1, 1998; 2(2): 131 - 139. [Abstract] [PDF]
|
|
|
|
|
|
P. S. Myles Aspects of Anesthesia for Lung Transplantation Seminars in Cardiothoracic and Vascular Anesthesia, July 1, 1998; 2(2): 140 - 154. [Abstract] [PDF]
|
|
|
|
|
|
W. C. Darrah, M. D. Sharpe, G. M. Guiraudon, and A. Neal Intraaortic Balloon Counterpulsation Improves Right Ventricular Failure Resulting From Pressure Overload Ann. Thorac. Surg., December 1, 1997; 64(6): 1718 - 1723. [Abstract] [Full Text]
|
|
|
|
|
|
F. Waldenberger, Y.-I. Kim, S. Laycock, B. Meyns, and W. Flameng EFFECTS OF FAILURE OF THE RIGHT SIDE OF THE HEART AND INCREASED PULMONARY RESISTANCE ON MECHANICAL CIRCULATORY SUPPORT WITH USE OF THE MINIATURIZED HIA-VAD DISPLACEMENT PUMP SYSTEM J. Thorac. Cardiovasc. Surg., August 1, 1996; 112(2): 484 - 493. [Abstract] [Full Text]
|
|
|
|
|
|
D. A. Fullerton, S. D. Jones, J. Jaggers, F. Piedalue, RRT, F. L. Grover, and R. C. McIntyre Jr. EFFECTIVE CONTROL OF PULMONARY VASCULAR RESISTANCE WITH INHALED NITRIC OXIDE AFTER CARDIAC OPERATION J. Thorac. Cardiovasc. Surg., April 1, 1996; 111(4): 753 - 763. [Abstract] [Full Text]
|
|
|
|
|
|
G. J. Vlahakes Management of Pulmonary Hypertension and Right Ventricular Failure: Another Step Forward Ann. Thorac. Surg., April 1, 1996; 61(4): 1051 - 1052. [Full Text]
|
|
|
|
|
|
D. A. Fullerton, S. D. Jones, F. L. Grover, and R. C. McIntyre Jr Adenosine Effectively Controls Pulmonary Hypertension After Cardiac Operations Ann. Thorac. Surg., April 1, 1996; 61(4): 1118 - 1123. [Abstract] [Full Text]
|
|
|
|
|
|
D. A. Fullerton, R. C. McIntyre Jr, L. E. Kirson, J. A. St. Cyr, G. J. R. Whitman, and F. L. Grover Impact of Respiratory Acid-Base Status in Patients With Pulmonary Hypertension Ann. Thorac. Surg., February 1, 1996; 61(2): 696 - 701. [Abstract] [Full Text]
|
|
|
|
|
|
G. Pinelli, P.-M. Mertes, J.-P. Carteaux, T. Hubert, C. Dopff, P. Burtin, and J.-P. Villemot Inhaled Nitric Oxide as an Adjunct to Pulmonary Thromboendarterectomy Ann. Thorac. Surg., January 1, 1996; 61(1): 227 - 229. [Abstract] [Full Text]
|
|
|
|
|
|
I. Belenkie, S. G. Horne, R. Dani, E. R. Smith, and J. V. Tyberg Effects of Aortic Constriction During Experimental Acute Right Ventricular Pressure Loading : Further Insights Into Diastolic and Systolic Ventricular Interaction Circulation, August 1, 1995; 92(3): 546 - 554. [Abstract] [Full Text]
|
|
|
|
 |
|
 J. Ducas, S. Bhattacharya, and R. M. Prewitt The Differential Hemodynamic Effects of Norepinephrine and Methoxamine in Systemic Hypotension Complicating Pulmonary Hypertension Vascular and Endovascular Surgery, March 1, 1995; 29(2): 117 - 122. [Abstract] [PDF]
|
|
|
|
|
|
N. Ad, J. Barak, E. Birk, S. Diamant, and B. A. Vidne A one-way, valved, atrial septal patch in the management of postoperative right heart failure:An animal study J. Thorac. Cardiovasc. Surg., July 1, 1994; 108(1): 134 - 139. [Abstract] [Full Text]
|
|
|
|
 |
|
 R. Rossaint, K. J. Falke, F. Lopez, K. Slama, U. Pison, and W. M. Zapol Inhaled Nitric Oxide for the Adult Respiratory Distress Syndrome N. Engl. J. Med., February 11, 1993; 328(6): 399 - 405. [Abstract] [Full Text]
|
|
|
|
 |
|
 W. Seed Pulmonary embolism: Part 1 Vascular Medicine, March 1, 1991; 2(1): 71 - 83. [PDF]
|
|
|
|
 |
|
 V. Courtney Broaddus, Y. Berthiaume, J. W. Biondi, and M. A. Matthay Analytic Reviews : Hemodynamic Management of the Adult Respiratory Distress Syndrome J Intensive Care Med, August 1, 1987; 2(4): 190 - 213. [Abstract] [PDF]
|
|