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Ann Thorac Surg 1988;46:324-330
© 1988 The Society of Thoracic Surgeons

Articles

Hemodynamic Consequences of Right Ventricular Isolation: The Contribution of the Right Ventricular Free Wall to Cardiac Performance

Ralph J. Damiano, Jr., M.D., Tetsuo Asano, M.D., Peter K. Smith, M.D., T. Bruce Ferguson, M.D., James L. Cox, M.D.*

From the Department of Surgery, Duke University Medical Center, Durham, NC, and the Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, Barnes Hospital, St. Louis, MO

Accepted for publication March 18, 1988.

* Address reprint requests to Dr. Cox, Division of Cardiothoracic Surgery, Washington University Medical Center, Suite 3108, Queeny Tower, 4989 Barnes Hospital Plaza, St. Louis, MO 63110.

Surgical isolation of the right ventricular free wall was performed in 10 dogs to evaluate both the hemodynamic effects of the procedure and the postoperative contribution of right ventricular free wall contraction to overall cardiac performance. Following the procedure, there were no significant differences in peak right ventricular systolic pressure, right atrial pressure, right ventricular stroke volume, or cardiac index. Cardiac index remained at preoperative levels over a wide range of filling pressures. However, there was a significant decrease in right ventricular stroke work (6.0 ± 1.3 gm-m/m2 to 5.1 ± 0.5 gm-m/m2; p < 0.05). Pacing the isolated right ventricular free wall resulted in marked hemodynamic improvement compared with an electrically silent right ventricular free wall. Cardiac index increased from 1.7 ± 0.2 L/min/m2 to 2.6 ± 0.2 L/min/m2 (p < 0.0005), and right ventricular stroke work went from 3.0 ± 0.6 gm-m/m2 to 6.4 ± 0.9 gm-m/m2 (p < 0.0005). Right ventricular performance was also significantly related to the timing of right ventricular free wall contraction. Thus, the right ventricular free wall played an important role in the maintenance of normal cardiac hemodynamics.




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