Acute loads applied to the right ventricle: Effect on left ventricular filling dynamics in the presence of an open pericardium

Abstract

To determine whether diastolic ventricular interdependence mechanisms would act in the presence of an open pericardial sac, as during cardiac surgery, moderate acute right ventricle afterload increases were applied to eight dogs with the chest and pericardium open while left ventricular filling dynamics were being assessed by Doppler echcardiography. Dogs were studied under basal conditions and after acute banding of the main pulmonary artery tightened to produce a 100% increase in right ventricular systolic pressure. With banding, the left ventricular filling velocity ratio (E/A), as assessed by Doppler echocardiography of mitral inflow, changed from a baseline value of 1.32±0.05 to 1.16±0.03 (p<0.02), suggesting a restrictive pattern to early left ventricular filling, which is differed to that during the second half of diastole. Isovolumic relaxation time, measured as the time interval between aortic valve closure and mitral valve opening, assessed by M-mode echocardiography of both valves, was prolonged, though not significantly, from 63.3±2.5 ms to 69.4±2.9 ms, by banding of the pulmonary artery. E wave deceleration time, a filling variable influenced by chamber pressure/volume relations, was shortened by pulmonary artery banding, changing from 75.1±1.7 ms to 68.0±1.8 ms (p<0.01). It was concluded that pressure loads applied to the right ventricle restricted early left ventricular filling. Prolonged relaxation and altered pressure-volume chamber relations were the diastolic interdependence mechanisms involved that proved to be acting even under open pericardium conditions.