Key result
In healthy sheep, acute mechanical left ventricular unloading increased end-diastolic right ventricular free wall to septum diameter without causing tricuspid insufficiency.
Why the study?
Does acute mechanical left ventricular unloading alter tricuspid annular geometry and dynamics in healthy sheep?
Does acute mechanical left ventricular unloading alter tricuspid annular geometry and dynamics in healthy sheep?
Acute left ventricular unloading in healthy sheep increases septal-free wall RV diameter but does not significantly perturb tricuspid annular dynamics or cause tricuspid insufficiency.
Answers are grounded in this paper and cite their sources.
Hypothesis-generating in healthy sheep; leaves open tricuspid effects of LV unloading in human heart failure.
OBJECTIVES: Left ventricular assist device (LVAD) implantation may alter right ventricular shape and function and lead to tricuspid regurgitation. This in turn has been reported to be a determinant of right ventricular (RV) failure after LVAD implantation, but the effect of mechanical left ventricular (LV) unloading on the tricuspid annulus is unknown. The aim of the study was to provide insight into the effect of LVAD support on tricuspid annular geometry and dynamics that may help to optimize LV unloading with the least deleterious effect on the right-sided geometry. METHODS: In seven open-chest anaesthetized sheep, nine sonomicrometry crystals were implanted on the right ventricle. Additional nine crystals were implanted around the tricuspid annulus, with one crystal at each commissure defining three separate annular regions: anterior, posterior and septal. Left ventricular unloading was achieved by connecting a cannula in the left atrium and the aorta to a continuous-flow pump. The pump was used for 15 min at a full flow of 3.8 ± 0.3 l/min. Epicardial echocardiography was used to assess the degree of tricuspid insufficiency. Haemodynamic, echocardiographic and sonomicrometry data were collected before and during full unloading. Tricuspid annular area, and the regional and total perimeter were calculated from crystal coordinates, while 3D annular geometry was expressed as the orthogonal distance of each annular crystal to the least squares plane of all annular crystals. RESULTS: There was no significant tricuspid regurgitation observed either before or during LV unloading. Right ventricular free wall to septum diameter increased significantly at end-diastole during unloading from 23.6 ± 5.8 to 26.3 ± 6.5 mm (P = 0.009), but the right ventricular volume, tricuspid annular area and total perimeter did not change from baseline. However, the septal part of the annulus significantly decreased its maximal length (38.6 ± 8.1 to 37.9 ± 8.2 mm, P = 0.03). Annular contraction was not altered. The tricuspid annulus had a complex 3D saddle-shaped geometry that was unaffected during experimental conditions. CONCLUSIONS: In healthy sheep hearts, left ventricular unloading increased septal-free wall RV diameter and reduced the length of the septal annulus, without altering the motion or geometry of the tricuspid annulus. Acute left ventricular unloading alone in healthy sheep was not sufficient to significantly perturb tricuspid annular dynamics and result in tricuspid insufficiency.
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Malinowski et al. (2016) studied Healthy sheep hearts (n=7). Acute mechanical left ventricular unloading vs. Baseline (before unloading) was evaluated on Tricuspid annular geometry and dynamics (including RV diameter and tricuspid regurgitation) (p=0.009). In healthy sheep, acute mechanical left ventricular unloading increased end-diastolic right ventricular free wall to septum diameter without causing tricuspid insufficiency.
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