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CLINICAL RESEARCH: CONGENITAL HEART DISEASE

Contraction Pattern of the Systemic Right Ventricle

Shift From Longitudinal to Circumferential Shortening and Absent Global Ventricular Torsion

Eirik Pettersen, MD^_*,1,_*, Thomas Helle-Valle, MD^,1, Thor Edvardsen, MD, PhD^_*, Harald Lindberg, MD, PhD, Hans-Jørgen Smith, MD, PhD, Bjarne Smevik, MD, Otto A. Smiseth, MD, PhD^_* and Kai Andersen, MD, PhD

^_* Department of Cardiology, Faculty of Medicine, University of Oslo and Rikshospitalet-Radiumhospitalet Medical Center, Oslo, Norway
Institute of Surgical Research, Faculty of Medicine, University of Oslo and Rikshospitalet-Radiumhospitalet Medical Center, Oslo, Norway
Department of Thoracic and Cardiovascular Surgery, University of Oslo and Rikshospitalet-Radiumhospitalet Medical Center, Oslo, Norway
Department of Radiology, Faculty of Medicine, University of Oslo and Rikshospitalet-Radiumhospitalet Medical Center, Oslo, Norway.

Manuscript received July 18, 2006; revised manuscript received February 12, 2007, accepted February 13, 2007.

^_* Reprint requests and correspondence: Dr. Eirik Pettersen, Department of Cardiology, Faculty of Medicine, University of Oslo and Rikshospitalet-Radiumhospitalet Medical Center, 0027 Oslo, Norway. (Email: eirik.pettersen{at}medisin.uio.no).

Objectives: The aim of the present study was to characterize the contraction pattern of the systemic right ventricle (RV).

Background: Reduced longitudinal function of the systemic RV compared with the normal RV has been interpreted as ventricular dysfunction. However, longitudinal shortening represents only one aspect of myocardial deformation, and changes in contraction in other dimensions have not previously been described.

Methods: Fourteen Senning-operated patients age 18.4 ± 0.9 years (mean ± SD) with transposition of the great arteries were studied. We compared the contraction pattern of the systemic RV with findings in the RV and left ventricle (LV) of normal subjects (n = 14) using tissue Doppler imaging and magnetic resonance imaging.

Results: In the systemic RV free wall, circumferential strain exceeded longitudinal strain (–23.3 ± 3.4% vs. –15.0 ± 3.0%, p < 0.001) as was also the case in the normal LV (–25.7 ± 3.1% vs. –16.5 ± 1.7%, p < 0.001), opposite from the findings in the normal RV (–15.8 ± 1.3% vs. –30.7 ± 3.3%, p < 0.001). Strain in the interventricular septum did not differ from normal. Ventricular torsion was essentially absent in the systemic RV (0.3 ± 1.8°), in contrast to a torsion of 16.7 ± 4.8° in the normal LV (p < 0.001).

Conclusions: In the systemic RV as in the normal LV, there was predominant circumferential over longitudinal free wall shortening, opposite from findings in the normal RV. This may represent an adaptive response to the systemic load. Noticeably, however, the systemic RV did not display torsion as found in the normal LV.

Abbreviations and Acronyms   EF = ejection fraction   IVS = interventricular septum   LV = left ventricle   MRI = magnetic resonance imaging   RV = right ventricle   TDI = tissue Doppler imaging   TGA = transposition of the great arteries

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