Acute left ventricular unloading in chronic ovine biventricular failure with functional tricuspid regurgitation

Figures

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  Papillary muscle (PM) area during the cardiac cycle. ED, End diastole; EIVC, end-isovolumic contraction; EIVR, end-isovolumic relaxation; LVAD, left ventricular assist device; ES, end-systole; TIC, tachycardia-induced cardiomyopathy.

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  Figure 1. The LVAD (A) and location of the sonomicrometry crystals implanted on the heart (B and C) and the distance between the septal and posterior papillary muscles and ventricle free wall (D). Blue triangle in (C) illustrates papillary muscle area. PPM, Posterior papillary muscle; APM, anterior papillary muscle; SPM, septal papillary muscle; LV, left ventricle.

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  Figure 2. A, PM area during the cardiac cycle with TIC (black line) and LVAD (blue line). Black and blue lines present mean values. Shaded areas represent SD. B, Schematic representation of papillary muscle area as a blue triangle joining the 3 papillary muscles. LVAD, Left ventricular assist device; EIVC, end-isovolumetric contraction; ES, end systole; EIVR, end-isovolumetric relaxation; ED, end diastole; TIC, tachycardia-induced cardiomyopathy; APM, anterior papillary muscle; PPM, posterior papillary muscle; SPM, septal papillary muscle.

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  Figure 3. Two-dimensional (A) and 3-dimensional (B) tricuspid papillary muscle geometry at end-diastole in TIC (black line) and during LVAD (blue line). C, Schematic representation of papillary muscle area during TIC and LVAD. Viewed from the surgeon's perspective, looking from the atrium toward tricuspid valve. Black and blue lines present mean values. APM, Anterior papillary muscle; PPM, posterior papillary muscle; SPM, septal papillary muscle; LVAD, left ventricular assist device; TIC, tachycardia-induced cardiomyopathy.

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  Figure 4. RV-FAC of each level of the ventricle (basal-near annulus, mid-between basal and apex) between TIC and LVAD. The lower and upper borders of the box represent the lower and upper quartiles. The middle horizontal line represents the median. RV-FAC, Right ventricular fractional area contraction change; LVAD, left ventricle assist device; TIC, tachycardia-induced cardiomyopathy. ∗P < .05 by Student t test for dependent observations.

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  Figure 5. RV free wall regional cardiac strains during the cardiac cycle with TIC (black line) and during LVAD unloading (orange line). Area (left column), longitudinal (central column), and equatorial (column) cardiac strains for TIC and LVAD with the reference point at end-diastole. The brown and black lines present mean values. Shadowed areas represent SD. P > .05 for all comparisons. ED, End diastole; EIVC, end-isovolumic contraction; EIVR, end-isovolumic relaxation; ES, end systole; LVAD, left ventricular assist device; TIC, tachycardia-induced cardiomyopathy.

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  Figure E1. Echocardiographic view of the enlargement atriums and ventricles after pacing protocol.