Ventricular Interaction and the Role of the Pericardium: Effects of Right Ventricular Loading
For several years, the concepts that left ventricular diastolic compliance and systolic performance might be influenced by alterations in right ventricular hemodynamics (ventricular interaction) or by the constraining effect of the pericardium have been recognized. However, to a considerable degree, these concepts have been examined and discussed in isolation. That is, it has often been implicitly assumed that ventricular interaction and pericardial constraint are independent phenomena. In this review of recent experimental studies which involve right ventricular dilation (pulmonary embolization, volume loading, and right ventricular infarction), we attempt to present an integrated view—increased right ventricular diastolic pressure both moves the septum leftward and, by raising pericardial pressure over the ventricles, augments pericardial constraint, thus diminishing left ventricular preload. Therefore, the pressure gradients both across the ventricular septum and across the left ventricular free wall are diminished. This concerted dual action is consistent with the definition of left ventricular transmural pressure proposed by Mirsky and Rankin.
KeywordsRight Ventricle Transmural Pressure Left Ventricular Free Wall Ventricular Interaction Left Ventricular Compliance
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