This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Laster, S. B. Articles by Goldstein, J. A. Search for Related Content PubMed PubMed Citation Articles by Laster, S. B. Articles by Goldstein, J. A.

Circulation, Vol 90, 1398-1409, Copyright © 1994 by American Heart Association

ARTICLES

Effects of reperfusion on ischemic right ventricular dysfunction. Disparate mechanisms of benefit related to duration of ischemia

SB Laster, Y Ohnishi, JE Saffitz and JA Goldstein
Department of Medicine, Washington University School of Medicine, St Louis, Mo. 63110.

BACKGROUND: Right ventricular free wall (RVFW) ischemia impairs global RV performance and may result in acute hemodynamic compromise. However, RV function and hemodynamic performance typically improve spontaneously over time. This study was designed to determine whether reperfusion facilitates recovery of function in the ischemic right ventricle. METHODS AND RESULTS: Closed chest dogs underwent right coronary balloon occlusion for 1 hour (n = 9), 4 hours (n = 6), or 8 hours (n = 7). In all animals, occlusion depressed RVFW function and global RV performance. After 1 hour of ischemia, reperfusion led to immediate improvement in RVFW function and consequently global RV performance, with complete recovery over 4 weeks and scar in < 1% of total RVFW area. Reperfusion after 4- and 8-hour occlusions resulted in acute improvement in global RV performance but to a lesser extent and by different mechanisms, since RVFW contraction remained severely impaired. This disproportionate recovery of global RV function was attributable to diminished RVFW dyskinesis associated with reperfusion- induced increments in RVFW diastolic thickness (characterized histopathologically in 6 additional animals subjected to 4-hour occlusions but killed 1 hour after reperfusion by interstitial edema, contraction band necrosis, and hemorrhage). Although later reperfusion was associated with a slower pace and lesser extent of recovery, RVFW contraction improved markedly over time. At 4 weeks, there was trivial RVFW scar in 4-hour animals (2% of total RVFW area), and, although fibrosis was significantly greater in 8-hour animals (7% of RVFW area), infarction was minimal relative to the extent of jeopardized myocardium. CONCLUSIONS: The responses of ischemic RV myocardium to reperfusion are complex, with disparate effects according to the duration of preceding ischemia. Early reperfusion results in prompt improvement in and subsequent complete recovery of RVFW contraction and global RV performance, with trivial or no RVFW scar. Late reperfusion leads to little acute recovery of RVFW function, but global performance improves owing to diminished RVFW dyskinesis associated with reperfusion-induced increments in RVFW diastolic thickness. Nevertheless, RVFW function improves over time, with minimal evidence of infarction. Therefore, reperfusion facilitates recovery of RV function and minimizes the extent of infarction even after prolonged ischemia.

This article has been cited by other articles:

				F. Sheehan and A. Redington The right ventricle: anatomy, physiology and clinical imaging Heart, November 1, 2008; 94(11): 1510 - 1515. [Full Text] [PDF]

				B A Popescu, F Antonini-Canterin, P L Temporelli, P Giannuzzi, E Bosimini, F Gentile, A P Maggioni, L Tavazzi, R Piazza, L Ascione, et al. Right ventricular functional recovery after acute myocardial infarction: relation with left ventricular function and interventricular septum motion. GISSI-3 echo substudy Heart, April 1, 2005; 91(4): 484 - 488. [Abstract] [Full Text] [PDF]

				J. A. Goldstein Right versus left ventricular shock: A tale of two ventricles J. Am. Coll. Cardiol., April 16, 2003; 41(8): 1280 - 1282. [Full Text] [PDF]

				J. A. Goldstein Pathophysiology and management of right heart ischemia J. Am. Coll. Cardiol., September 4, 2002; 40(5): 841 - 853. [Abstract] [Full Text] [PDF]

				T. R. Bowers, W. W. O'Neill, M. Pica, and J. A. Goldstein Patterns of Coronary Compromise Resulting in Acute Right Ventricular Ischemic Dysfunction Circulation, August 27, 2002; 106(9): 1104 - 1109. [Abstract] [Full Text] [PDF]

				K. Ohmori, B. Cotter, E. Leistad, V. Bhargava, P. L. Wolf, K. Mizushige, and A. N. DeMaria Assessment of Myocardial Postreperfusion Viability by Intravenous Myocardial Contrast Echocardiography : Analysis of the Intensity and Texture of Opacification Circulation, April 17, 2001; 103(15): 2021 - 2027. [Abstract] [Full Text] [PDF]

				J. G. Webb, L. A. Sleeper, C. E. Buller, J. Boland, A. Palazzo, E. Buller, H. D. White, J. S. Hochman, and for the SHOCK Investigators Implications of the timing of onset of cardiogenic shock after acute myocardial infarction: a report from the SHOCK Trial Registry J. Am. Coll. Cardiol., September 1, 2000; 36(3_Suppl_A): 1084 - 1090. [Abstract] [Full Text] [PDF]

				T. R. Bowers, W. W. O'Neill, C. Grines, M. C. Pica, R. D. Safian, and J. A. Goldstein Effect of Reperfusion on Biventricular Function and Survival after Right Ventricular Infarction N. Engl. J. Med., April 2, 1998; 338(14): 933 - 940. [Abstract] [Full Text] [PDF]

				V. G. Davila-Roman, A. D. Waggoner, W. E. Hopkins, and B. Barzilai Right Ventricular Dysfunction in Low Output Syndrome After Cardiac Operations: Assessment by Transesophageal Echocardiography Ann. Thorac. Surg., October 1, 1995; 60(4): 1081 - 1086. [Abstract] [Full Text]

				Y. Ohnishi, M. C. Butterfield, J. E. Saffitz, B. E. Sobel, P. B. Corr, and J. A. Goldstein Deleterious Effects of a Systemic Lytic State on Reperfused Myocardium : Minimization of Reperfusion Injury and Enhanced Recovery of Myocardial Function by Direct Angioplasty Circulation, August 1, 1995; 92(3): 500 - 510. [Abstract] [Full Text]