Research and Innovation Unit, RHU BioArt Lung 2020, Marie Lannelongue Hospital, Paris-Sud University, Le Plessis-Robinson, France.
Cardiac Surgery, Marie Lannelongue Hospital, Paris-Sud University, Le Plessis-Robinson, France.
Biomed Res Int. 2018 Jan 17;2018:1981568. doi: 10.1155/2018/1981568. eCollection 2018.
Studies about pulmonary hypertension and congenital heart diseases have introduced the concept of right ventricular remodeling leading these pathologies to a similar outcome: right ventricular failure. However right ventricular remodeling is also a physiological process that enables the normal fetal right ventricle to adapt at birth and gain its adult phenotype. The healthy mature right ventricle is exposed to low pulmonary vascular resistances and is compliant. However, in the setting of chronic pressure overload, as in pulmonary hypertension, or volume overload, as in congenital heart diseases, the right ventricle reverts back to a fetal phenotype to sustain its function. Mechanisms include angiogenic changes and concomitant increased metabolic activity to maintain energy production. Eventually, the remodeled right ventricle cannot resist the increased afterload, leading to right ventricular failure. After comparing the fetal and adult healthy right ventricles, we sought to review the main metabolic and cellular changes occurring in the setting of PH and CHD. Their association with RV function and potential impact on clinical practice will also be discussed.
关于肺动脉高压和先天性心脏病的研究引入了右心室重构的概念，导致这些病理出现相似的结果：右心衰竭。然而，右心室重构也是一种生理过程，使正常胎儿右心室能够在出生时适应并获得其成人表型。健康成熟的右心室暴露于低肺血管阻力和顺应性。然而，在慢性压力超负荷的情况下，如肺动脉高压，或容量超负荷，如先天性心脏病，右心室恢复到胎儿表型以维持其功能。机制包括血管生成变化和伴随的代谢活性增加，以维持能量产生。最终，重构的右心室无法抵抗增加的后负荷，导致右心衰竭。在比较胎儿和成人健康右心室后，我们试图回顾在 PH 和 CHD 情况下发生的主要代谢和细胞变化。还将讨论它们与 RV 功能的关系及其对临床实践的潜在影响。
