Interventricular dyssynchrony in a patient with a biventricular physiology and a systemic right ventricle
- 215 Downloads
We describe of a unique pattern of cardiac dyssynchrony in a patient with a biventricular physiology and systemic right ventricle (RV): the interventricular dyssynchrony due to a contraction delay between the left ventricle and RV. In the present case, the cineangiography and intracardiac electrocardiography of the RV did not reveal intraventricular dyssynchrony of the RV, but revealed interventricular dyssynchrony. In addition, the pressure curves of the ventricles exhibited time phase differences between the two ventricles. The cardiac resynchronization therapy determining the pacing lead positions based on the idea of interventricular dyssynchrony induced reverse cardiac remodeling in this patient with systemic RV dysfunction.
KeywordsCongenital heart disease Systemic right ventricle Interventricular dyssynchrony Cardiac resynchronization therapy Atrioventricular discordance
The authors wish to express their gratitude to Mr. John Martin for his assistance in preparing the manuscript.
Compliance with ethical standards
All procedures contributing to this work were performed under given the informed consent, and were complied with the ethical standards of the relevant national guidelines on human experimentation (Japan) and with the Helsinki Declaration of 1975 (as revised in 2008). Also this study was approved by the institutional ethics committees (M25-021). The authors have no financial conflicts of interest to disclose concerning this study.
Supplementary file 1A. The anteroposterior view of the right ventriculography before the cardiac resynchronization therapy (MPG 2675 kb)
Supplementary file 1B. The lateral view of the right ventriculography before the cardiac resynchronization therapy (MPG 2675 kb)
Supplementary file 2A. The anteroposterior view of the right ventriculography 6 months after the cardiac resynchronization therapy (MPG 2996 kb)
Supplementary file 2B. The lateral view of the right ventriculography 6 months after the cardiac resynchronization therapy (MPG 2996 kb)
- 1.Yu CM, Chau E, Sanderson JE, Fan K, Tang MO, Fung WH, Lin H, Kong SL, Lam YM, Hill MR, Lau CP (2002) Tissue Doppler echocardiographic evidence of reverse remodeling and improved synchronicity by simultaneously delaying regional contraction after biventricular pacing therapy in heart failure. Circulation 105:438–445CrossRefPubMedGoogle Scholar
- 2.Fujiwara S, Komamura K, Nakabo A, Masaki M, Fukui M, Sugahara M, Itohara K, Soyama Y, Goda A, Hirotani S, Mano T, Masuyama T (2016) The association between left ventricular twisting motion and mechanical dyssynchrony: a three-dimensional speckle tracking study. Heart Vessel 31:158–164CrossRefGoogle Scholar
- 3.Miyazaki A, Sakaguchi H, Kagisaki K, Tsujii N, Matsuoka M, Yamamoto T, Hoashi T, Noda T, Ohuchi H (2016) Optimal pacing sites for cardiac resynchronization therapy for patients with a systemic right ventricle with or without a rudimentary left ventricle. Europace 18:100–112CrossRefPubMedGoogle Scholar
- 8.Diller GP, Radojevic J, Kempny A, Alonso-Gonzalez R, Emmanouil L, Orwat S, Swan L, Uebing A, Li W, Dimopoulos K, Gatzoulis MA, Baumgartner H (2012) Systemic right ventricular longitudinal strain is reduced in adults with transposition of the great arteries, relates to subpulmonary ventricular function, and predicts adverse clinical outcome. Am Heart J 163:859–866CrossRefPubMedGoogle Scholar
- 11.Pettersen E, Helle-Valle T, Edvardsen T, Lindberg H, Smith HJ, Smevik B, Smiseth OA, Andersen K (2007) Contraction pattern of the systemic right ventricle shift from longitudinal to circumferential shortening and absent global ventricular torsion. J Am Coll Cardiol 49:2450–2456CrossRefPubMedGoogle Scholar
- 13.Jauvert G, Rousseau-Paziaud J, Villain E, Iserin L, Hidden-Lucet F, Ladouceur M, Sidi D (2009) Effects of cardiac resynchronization therapy on echocardiographic indices, functional capacity, and clinical outcomes of patients with a systemic right ventricle. Europace 11:184–190CrossRefPubMedGoogle Scholar
- 15.Miyamoto K, Takeuchi D, Inai K, Shinohara T, Nakanishi T (2016) Prognostic value of multiple biomarkers for cardiovascular mortality in adult congenital heart disease: comparisons of single-/two-ventricle physiology, and systemic morphologically right/left ventricles. Heart Vessel. doi: 10.1007/s00380-016-0807-0 Google Scholar