Limits...
Right ventricle-pulmonary circulation dysfunction: a review of energy-based approach.

Lee N, Taylor MD, Banerjee RK - Biomed Eng Online (2015)

Bottom Line: For example, the dysfunctional right ventricular-pulmonary circulation (RV-PC) adversely affects the RV myocardial performance resulting in decreased efficiency.As an alternative, analytical methods and computational fluid dynamics (CFD) have been used to compute energy endpoints, such as power loss or energy dissipation, in abnormal physiologies.Then, we describe the advantage of currently available energy-based endpoints and emerging energy endpoints, such as energy loss in the Pas or kinetic energy, obtained from a new non-invasive imaging technique, i.e. 4D phase contrast MRI.

View Article: PubMed Central - HTML - PubMed

ABSTRACT
Patients with repaired or palliated right heart congenital heart disease (CHD) are often left with residual lesions that progress and can result in significant morbidity. However, right ventricular-pulmonary arterial evaluation and the timing of reintvervention is still subjective. Currently, it relies on symptomology, or RV imaging-based metrics from echocardiography or MR derived parameters including right ventricular (RV) ejection fraction (EF), end-systolic pressure (ESP), and end-diastolic volume (EDV). However, the RV is coupled to the pulmonary vasculature, and they are not typically evaluated together. For example, the dysfunctional right ventricular-pulmonary circulation (RV-PC) adversely affects the RV myocardial performance resulting in decreased efficiency. Therefore, comprehensive hemodynamic assessment should incorporate changes in RV-PC and energy efficiency for CHD patients. The ventricular pressure-volume relationship (PVR) and other energy-based endpoints derived from PVR, such as stroke work (SW) and ventricular elastance (Ees), can provide a measure of RV performance. However, a detailed explanation of the relationship between RV performance and pulmonary arterial hemodynamics is lacking. More importantly, PVR is impractical for routine longitudinal evaluation in a clinical setting, because it requires invasive catheterization. As an alternative, analytical methods and computational fluid dynamics (CFD) have been used to compute energy endpoints, such as power loss or energy dissipation, in abnormal physiologies. In this review, we review the causes of RV-PA failure and the limitation of current clinical parameters to quantify RV-PC dysfunction. Then, we describe the advantage of currently available energy-based endpoints and emerging energy endpoints, such as energy loss in the Pas or kinetic energy, obtained from a new non-invasive imaging technique, i.e. 4D phase contrast MRI.

Show MeSH

Related in: MedlinePlus

3D gadolinium-enhanced magnetic resonance angiography (Gd-MRA) of PA for patient A, B and C. The patients have different levels of RV-PC dysfunction; A) MPA and LPA dilation and RPA stenosis causing severe pulmonary regurgitation and imbalance in pulmonary flows, B) pulmonary regurgitation and small narrowing in the branch PAs, and C) shortened and dilated MPA-LPA connection and mild RPA stenosis with pulmonary regurgitation [75].
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
getmorefigures.php?uid=PMC4306123&req=5

Figure 11: 3D gadolinium-enhanced magnetic resonance angiography (Gd-MRA) of PA for patient A, B and C. The patients have different levels of RV-PC dysfunction; A) MPA and LPA dilation and RPA stenosis causing severe pulmonary regurgitation and imbalance in pulmonary flows, B) pulmonary regurgitation and small narrowing in the branch PAs, and C) shortened and dilated MPA-LPA connection and mild RPA stenosis with pulmonary regurgitation [75].

Mentions: They showed that the total energy loss in the branch PAs for the patients with PA pathophysiology was an order of magnitude larger than the control subjects. More importantly, the total energy loss varied significantly among patients who had the different levels of RV-PC dysfunction (Figure 11 and 12). It can be noted that energy loss endpoint may be a sensitive measure in assessing the level of RV-PC dysfunction for CHD patients.


Right ventricle-pulmonary circulation dysfunction: a review of energy-based approach.

Lee N, Taylor MD, Banerjee RK - Biomed Eng Online (2015)

3D gadolinium-enhanced magnetic resonance angiography (Gd-MRA) of PA for patient A, B and C. The patients have different levels of RV-PC dysfunction; A) MPA and LPA dilation and RPA stenosis causing severe pulmonary regurgitation and imbalance in pulmonary flows, B) pulmonary regurgitation and small narrowing in the branch PAs, and C) shortened and dilated MPA-LPA connection and mild RPA stenosis with pulmonary regurgitation [75].
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4306123&req=5

Figure 11: 3D gadolinium-enhanced magnetic resonance angiography (Gd-MRA) of PA for patient A, B and C. The patients have different levels of RV-PC dysfunction; A) MPA and LPA dilation and RPA stenosis causing severe pulmonary regurgitation and imbalance in pulmonary flows, B) pulmonary regurgitation and small narrowing in the branch PAs, and C) shortened and dilated MPA-LPA connection and mild RPA stenosis with pulmonary regurgitation [75].
Mentions: They showed that the total energy loss in the branch PAs for the patients with PA pathophysiology was an order of magnitude larger than the control subjects. More importantly, the total energy loss varied significantly among patients who had the different levels of RV-PC dysfunction (Figure 11 and 12). It can be noted that energy loss endpoint may be a sensitive measure in assessing the level of RV-PC dysfunction for CHD patients.

Bottom Line: For example, the dysfunctional right ventricular-pulmonary circulation (RV-PC) adversely affects the RV myocardial performance resulting in decreased efficiency.As an alternative, analytical methods and computational fluid dynamics (CFD) have been used to compute energy endpoints, such as power loss or energy dissipation, in abnormal physiologies.Then, we describe the advantage of currently available energy-based endpoints and emerging energy endpoints, such as energy loss in the Pas or kinetic energy, obtained from a new non-invasive imaging technique, i.e. 4D phase contrast MRI.

View Article: PubMed Central - HTML - PubMed

ABSTRACT
Patients with repaired or palliated right heart congenital heart disease (CHD) are often left with residual lesions that progress and can result in significant morbidity. However, right ventricular-pulmonary arterial evaluation and the timing of reintvervention is still subjective. Currently, it relies on symptomology, or RV imaging-based metrics from echocardiography or MR derived parameters including right ventricular (RV) ejection fraction (EF), end-systolic pressure (ESP), and end-diastolic volume (EDV). However, the RV is coupled to the pulmonary vasculature, and they are not typically evaluated together. For example, the dysfunctional right ventricular-pulmonary circulation (RV-PC) adversely affects the RV myocardial performance resulting in decreased efficiency. Therefore, comprehensive hemodynamic assessment should incorporate changes in RV-PC and energy efficiency for CHD patients. The ventricular pressure-volume relationship (PVR) and other energy-based endpoints derived from PVR, such as stroke work (SW) and ventricular elastance (Ees), can provide a measure of RV performance. However, a detailed explanation of the relationship between RV performance and pulmonary arterial hemodynamics is lacking. More importantly, PVR is impractical for routine longitudinal evaluation in a clinical setting, because it requires invasive catheterization. As an alternative, analytical methods and computational fluid dynamics (CFD) have been used to compute energy endpoints, such as power loss or energy dissipation, in abnormal physiologies. In this review, we review the causes of RV-PA failure and the limitation of current clinical parameters to quantify RV-PC dysfunction. Then, we describe the advantage of currently available energy-based endpoints and emerging energy endpoints, such as energy loss in the Pas or kinetic energy, obtained from a new non-invasive imaging technique, i.e. 4D phase contrast MRI.

Show MeSH
Related in: MedlinePlus