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Erschienen in:
01.03.2003 | Physiological Note
Ventricular interdependence: how does it impact on hemodynamic evaluation in clinical practice?
Erschienen in: Intensive Care Medicine | Ausgabe 3/2003
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The left (LV) and right ventricles (RV) are enclosed in a stiff envelope, the pericardium. They have similar end-diastolic volumes, and there is no free space for acute ventricular dilatation within a normal pericardial space. Thus, when RV end-diastolic volume increases owing to increased RV loading, it can only occur at the expense of the space devoted to the left ventricle, which is prevented from dilating to as large an end-diastolic volume as it would otherwise given its distending pressure. From a practical point of view this reduced LV end-diastolic volume is accompanied by decreases in LV diastolic compliance, such that for the same LV distending pressure LV end-diastolic volume is less. This point was described in a previous Physiological Note [1]. LV impaired relaxation by RV enlargement is evidenced by Doppler examination of mitral flow velocity (Fig. 1).
Fig. 1.
Illustration of left ventricular (LV) relaxation impairment by right ventricular (RV) dilatation, in a mechanically ventilated patient with acute respiratory distress syndrome. During the first day of mechanical ventilation (left) a normal right ventricular size, observed in the two-dimensional view, was associated with a normal pattern of Doppler mitral flow velocity, with a preeminent peak velocity of the E wave (early filling) and a less marked peak velocity of the A wave (atrial systole). After 48 h of respiratory support (right) right ventricular dilatation, observed on the two-dimensional view, was associated with a modified pattern of Doppler mitral flow velocity, with equalization of peak velocities
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