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European Journal of Echocardiography Advance Access published online on October 6, 2009
European Journal of Echocardiography, doi:10.1093/ejechocard/jep149
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org

Impacts of acute severe pulmonary regurgitation on right ventricular geometry and contractility assessed by tissue-Doppler echocardiography{dagger}

Jesper Kjaergaard1,*, Kasper K. Iversen1, Niels G. Vejlstrup1, Julie Smith2, Philip Bonhoeffer3, Lars Søndergaard1 and Christian Hassager1

1 Department of Cardiology B2142, The Heart Centre, Rigshospitalet Copenhagen University Hospital, DK-2100 Copenhagen, Denmark
2 Department of Clinical Biochemistry, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
3 Department of Paediatric Cardiology, Great Ormond Street Hospital, London, UK

Received 19 April 2009; accepted after revision 8 September 2009.

* Corresponding author. Tel: +45 3545 3545; fax: +45 3545 2648. E-mail address: jesper.kjaergaard{at}rh.regionh.dk


  Abstract

Aims: Little is known of the impact of acute right ventricular (RV) volume overload on RV function. We assessed the impact of acute severe pulmonary regurgitation (PR) on global and regional RV function by applying novel quantitative echocardiographic markers of myocardial performance in an animal model.

Methods and results: Transthoracic echocardiography, including tissue-Doppler echocardiography for the evaluation of regional longitudinal function, was performed immediately before and after induction of severe PR by deployment of a stent in the pulmonary valve annulus of 32 farm pigs. Acute PR was associated with significant changes in RV geometry illustrated by an increase in RV diameter and area by 22 and 32%, respectively, P < 0.001 for both, and the eccentricity index increased by 21% in end-diastole, P < 0.0001. RV radial function as assessed by RV short-axis fractional shortening increased by 18%, P = 0.03, whereas other measures of RV ejection fraction by longitudinal function remained unchanged. There were no changes in the longitudinal basal myocardial isovolumic acceleration, peak systolic velocity, strain rate, or strain.

Conclusion: The RV seems to accommodate well to acute severe PR. No changes in global or regional longitudinal contractility or deformation were observed despite significant changes in the cardiac chamber geometry. An increase in radial shortening may imply that the RV compensates by increasing radial contraction as an adjunct to dilatation.

Keywords: Pulmonary regurgitation; Doppler echocardiography; Tissue-Doppler echocardiography; Right ventricle; Grown up congenital heart disease

{dagger} The work was performed at The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.


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