Buckberg Gerald, Athanasuleas Constantine, Saleh Saleh
Division of Cardiothoracic Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California 90095, USA.
Anadolu Kardiyol Derg. 2008 Nov;8 Suppl 2:108-16.
Postoperative right ventricular (RV) failure is difficult to treat and develops from functional impairment of the underlying free wall and septum. This report describes the vital importance of the ventricular septum in RV structure /function relationships, demonstrates how the helical ventricular myocardial band model defines spatial geometry of the free wall and septum to provide architectural reasons for RV dynamic action, and focuses upon pathophysiologic reasons for adverse perioperative events resulting in right ventricular failure. Myocyte fiber orientation is the key to ventricular performance in health and disease. The transverse geometry of the free wall allows constriction (bellows type motion), whereas oblique septal fiber orientation and midline septal position is essential for ventricular twisting, the vital mechanism for RV ejection against increased pulmonary vascular resistance. The septum is considered "the lion or motor of RV performance". This central muscle mass occupies approximately 40% of myocardial ventricular weight, and injury from impaired myocardial protection is a preventable event. Septal function should be the index of adequacy of myocardial protection and we will show echocardiographic evidence that the integrated cardioplegic method prevents its injury. Dysfunction of a normally functioning septum following surgical cardiac procedures calls for reevaluation of myocardial protection methods.
术后右心室（RV）衰竭难以治疗，是由潜在的游离壁和室间隔功能障碍发展而来。本报告描述了室间隔在右心室结构/功能关系中的至关重要性，展示了螺旋形心室心肌带模型如何定义游离壁和室间隔的空间几何结构，以提供右心室动态活动的结构学原因，并着重阐述导致右心室衰竭的围手术期不良事件的病理生理学原因。心肌纤维方向是健康和疾病状态下心室功能的关键。游离壁的横向几何结构允许收缩（波纹管式运动），而斜行的室间隔纤维方向和室间隔中线位置对于心室扭转至关重要，心室扭转是右心室在肺血管阻力增加时射血的关键机制。室间隔被认为是“右心室功能的关键或动力”。这个中央心肌团约占心室心肌重量的40%，心肌保护受损导致的损伤是可预防的事件。室间隔功能应作为心肌保护是否充分的指标，我们将展示超声心动图证据，证明综合心脏停搏方法可防止其损伤。心脏手术后正常功能的室间隔出现功能障碍，需要重新评估心肌保护方法。
