Научно-практический журнал
«Клиническая физиология кровообращения»

Главный редактор

Лео Антонович Бокерия, доктор медицинских наук, профессор, академик РАН и РАМН, директор ФГБУ «НМИЦССХ им. А.Н. Бакулева» МЗ РФ

Анатомия и функция правого желудочка. Этиология, патогенез и современные аспекты эхокардиографической оценки правожелудочковой недостаточности

Авторы: Сокольская Н.О., Копылова Н.С., Иванов А.В., Кокшенев И.В.

Организация:
ФГБУ «Национальный медицинский исследовательский центр сердечно-сосудистой хирургии им. А.Н. Бакулева» (президент – академик РАН и РАМН Л.А. Бокерия) Минздрава России, Рублевское ш., 135, Москва, 121552, Российская Федерация

Для корреспонденции: Сведения доступны для зарегистрированных пользователей.

Раздел: Обзоры

DOI: https://doi.org/10.24022/1814-6910-2020-17-4-266-283

УДК: 616.124.3-073.432.12

Библиографическая ссылка: Клиническая физиология кровообращения. 2020; 4 (17): 266-283

Цитировать как: Сокольская Н.О., Копылова Н.С., Иванов А.В., Кокшенев И.В.. Анатомия и функция правого желудочка. Этиология, патогенез и современные аспекты эхокардиографической оценки правожелудочковой недостаточности. Клиническая физиология кровообращения. 2020; 4 (17): 266-283. DOI: 10.24022/1814-6910-2020-17-4-266-283

Поступила / Принята к печати:  20.07.2020 / 24.07.2020

Полнотекстовая версия:
Оформить подписку 🔒

Аннотация

В обзоре представлены основы анатомического строения, физиологии и функции правого желудочка. Отмечена взаимосвязь и взаимозависимость правого и левого желудочков сердца. Концепция взаимозависимости желудочков заключается в том, что размер, форма, давление и объем одного желудочка посредством прямого механического взаимодействия влияют на эти же параметры другого.

Основными анатомическими составляющими, которые определяют зависимость желудочков друг от друга, являются межжелудочковая перегородка, перикард и межжелудочковая мышечная непрерывность. Систолическая желудочковая взаимозависимость определяется главным образом сокращением межжелудочковой перегородки.

В статье рассмотрены основные этиологические факторы и патогенетические механизмы развития правожелудочковой недостаточности. В зависимости от этиопатогенетических факторов описаны типы ремоделирования правой камеры сердца на фоне правожелудочковой недостаточности – адаптивный и дезадаптивный.

Также отражены методы комплексной эхокардиографии, которые применяются для оценки анатомических параметров и функции правого желудочка. Показаны возможности трехмерной эхокардиографии, методы оценки систолической и диастолической функции, современные технологии, характеризующие процессы деформации и скорости деформации миокарда правого желудочка сердца.

Литература

  1. Ho S.Y., Nihoyannopoulos P. Anatomy, echocardiography, and normal right ventricular dimensions. Heart. 2006; 92 (Suppl. 1): i2–i13. DOI: 10.1136/hrt.2005. 077875
  2. Jiang L. Right ventricle. In: Weyman A.E. (Ed). Principle and practice of echocardiography. Baltimore, Md: Lippincott Williams & Wilkins; 1994: 901–21.
  3. Goor D.A., Lillehei C.W. Congenital malformations of the heart. In: Congenital malformations of the heart: embryology, anatomy, and operative considerations. 1st ed. New York, NY: Grune & Stratton; 1975: 1–37.
  4. Spicer D.E., Anderson R.H. Methodological review of ventricular anatomy – the basis for understanding congenital cardiac malformations. J. Cardiovasc. Transl. Res. 2013; 6: 145–54. DOI: 10.1007/s12265-012-9432-1
  5. Duran C.M.G. Surgical treatment of the tricuspid valve. In: Selke F.W., del Nido P.J., Swanson S.J. (Eds) Sabiston and Spencer surgery of the chest. 8th ed. Philadelphia: Saunders; 2010: 1241–57.
  6. Aktas E.O., Govsa F., Kocak A., Boydak B., Yavuz I.C. Variations in the papillary muscles of normal tricuspid valve and their clinical relevance in medicolegal autopsies. Saudi Med. J. 2004; 25: 1176–85.
  7. Joudinaud T.M., Flecher E.M., Duran C.M.G. Functional terminology for the tricuspid valve. J. Heart Valve Dis. 2006; 15: 382–8.
  8. Barker T.A., Wilson I.C. Surgical anatomy of the mitral and tricuspid valve. In: Bonser R.S. et al. (Eds) Mitral valve surgery. London: Springer; 2011: 3–19.
  9. Salgo I.S., Gorman J.H., Gorman R.C., Jackon B.M., Bowen F.W., Plappert Th. et al. Effect of annular shape on leafl et curvature in reducing mitral leafl et stress. Circulation. 2002; 106: 711–7. DOI: 10.1161/01.cir. 0000025426.39426.83
  10. Hiro M.E., Jouan J., Pagel M.R., Lansac E., Lim K.H., Lim H.S. et al. Sonometric study of the normal tricuspid valve annulus in sheep. J. Heart Valve Dis. 2004; 13: 452–60.
  11. Tsakiris A.G., Mair D.D., Seki S., Titus J.L., Wood E.H. Motion of the tricuspid valve annulus in anesthetized intact dogs. Circ. Res. 1975; 36: 43–8. DOI: 10.1161/01.res.36.1.43
  12. Ton-Nu T.T., Levine R.A., Handschumacher M.D., Dorer D.J., Yosefy C., Fan D. et al. Geometric determinants of functional tricuspid regurgitation. Insights from 3-dimensional echocardiography. Circulation. 2006; 114: 143–9. DOI: 10.1161/CIRCULATIONAHA. 106.611889
  13. Lorenz C.H., Walker E.S., Morgan V.L., Klein S.S., Graham Jr T.P. Normal human right and left ventricular mass, systolic function, and gender differences by cine magnetic resonance imaging. J. Cardiovasc. Magn. Reson. 1999; 1: 7–21. DOI: 10.3109/10976649909080829
  14. Lang R.M., Bierig M., Devereux R.B., Flachskampf F.A., Foster E., Pellikka P.A. et al. Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantifi cation Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J. Am. Soc. Echocardiogr. 2005; 18: 1440–63. DOI: 10.1016/j.echo.2005.10.005
  15. Dell'Italia L.J. The right ventricle: anatomy, physiology, and clinical importance. Curr. Probl. Cardiol. 1991; 16: 653–720. DOI: 10.1016/0146-2806(91)90009-y
  16. Brown G.F. Vascular pattern of myocardium of right ventricle of human heart. Br. Heart J. 1968; 30: 679–86. DOI: 10.1136/hrt.30.5.679
  17. Haupt H.M., Hutchins G.M., Moore G.W. Right ventricular infarction: role of the moderator band artery in determining infarct size. Circulation. 1983; 67: 1268–72. DOI: 10.1161/01.cir.67.6.1268
  18. Petitjean C., Rougon N., Cluzel P. Assessment of myocardial function: a review of quantification methods and results using tagged MRI. J. Cardiovasc. Magn. Reson. 2005; 7: 501–16. DOI: 10.1081/jcmr-200053610 280 Reviews Clinical Physiology of Circulation. 2020; 17 (4). DOI: 10.24022/1814-6910-2020-17-4-266-283
  19. Santamore W.P., Dell'Italia L.J. Ventricular interdependence: significant left ventricular contributions to right ventricular systolic function. Prog. Cardiovasc. Dis. 1998; 40: 289–308.
  20. Hoffman D., Sisto D., Frater R.W., Nikolic S.D. Leftto-right ventricular interaction with a noncontracting right ventricle. J. Thorac. Cardiovasc. Surg. 1994; 107: 1496–502.
  21. Feneley M.P., Gavaghan T.P., Baron D.W., Branson J.A., Roy P.R., Morgan J.J. Contribution of left ventricular contraction to the generation of right ventricular systolic pressure in the human heart. Circulation. 1985; 71: 473–80. DOI: 10.1161/01.cir.71.3.473
  22. Efthimiadis G.K., Parharidis G.E., Gemitzis K.D., Nouskas I.G., Karvounis H.I., Styliadis I.K., Louridas G.E. Doppler echocardiographic evaluation of right ventricular diastolic function in isolated valvular aortic stenosis. J. Heart Valve Dis. 1999; 8: 261–9.
  23. Apostolakis S., Konstantinides S. The right ventricle in health and disease: insights into physiology, pathophysiology and diagnostic management. Cardiology. 2012; 121: 263–73. DOI: 10.1159/000338705
  24. Chin K.M., Kim N.H., Rubin L.J. The right ventricle in pulmonary hypertension. Coron. Artery Dis. 2005; 16: 13–8. DOI: 10.1097/00019501-200502000-00003 25. Yu C.M., Sanderson J.E., Chan S., Yeung L., Hung Y.T., Woo K.S. Right ventricular diastolic dysfunction in heart failure. Circulation. 1996; 93: 1509–14. DOI: 10.1161/01.cir.93.8.1509
  25. Burgess M.I., Mogulkoc N., Bright-Thomas R.J., Bishop P., Egan J.J., Ray S.G. Comparison of echocardiographic markers of right ventricular function in determining prognosis in chronic pulmonary disease. J. Am. Soc. Echocardiogr. 2002; 15: 633–9. DOI: 10.1067/mje.2002.118526
  26. Leyton R.A., Sonnenblick E.H. The sarcomere as the basis of Starling's law of the heart in the left and right ventricles. Methods Achiev. Exp. Pathol. 1971; 5: 22–59.
  27. Gaasch W.H., Cole J.S., Quinones M.A., Alexander J.K. Dynamic determinants of left ventricular diastolic pressure-volume relations in man. Circulation. 1975; 51: 317–23. DOI: 10.1161/01.cir.51.2.317
  28. Haddad F., Hunt S.A., Rosenthal D.N., Murphy D.J. Right ventricular function in cardiovascular disease. I. Anatomy, physiology, aging, and functional assessment of the right ventricle. Circulation. 2008; 117: 1436–48. DOI: 10.1161/CIRCULATIONAHA.107. 653576
  29. Fischer L.G., Van A.H., Burkle H. Management of pulmonary hypertension: physiological and pharmacological considerations for anesthesiologists. Anesth. Analg. 2003; 96: 1603–16. DOI: 10.1213/01.ane.0000062523.67426.0b
  30. Denault A.Y., Chaput M., Couture P., Hebert Y., Haddad F., Tardif J.C. Dynamic right ventricular outflow tract obstruction in cardiac surgery. J. Thorac. Cardiovasc. Surg. 2006; 132: 43–9. DOI: 10.1016/j.jtcvs.2006.03.014
  31. Nath J., Foster E., Heidenreich P.A. Impact of tricuspid regurgitation on long-term survival. J. Am. Coll. Cardiol. 2004; 43: 405–9. DOI: 10.1016/j.jacc.2003. 09.036
  32. Khan R., Sheppard R. Fibrosis in heart disease: understanding the role of transforming growth factor-β in cardiomyopathy, valvular disease and arrhythmia. Immunology. 2006; 118: 10–24. DOI: 10.1111/j.1365- 2567.2006.02336.x
  33. Hopkins W.E., Waggoner A.D. Severe pulmonary hypertension without right ventricular failure: the unique hearts of patients with Eisenmenger syndrome. Am. J. Cardiol. 2002; 89: 34–8. DOI: 10.1016/s0002- 9149(01)02159-2
  34. Hopkins W.E. The remarkable right ventricle of patients with Eisenmenger syndrome. Coron. Artery Dis. 2005; 16: 19–25. DOI: 10.1097/00019501-200502000-00004
  35. Sarnoff S.J., Mitchell J.H., Gilmore J.P., Remensnyder J.P. Homeometric autoregulation in the heart. Circ. Res. 1960; 8: 1077–91. DOI: 10.1161/01.res.8.5.1077
  36. Hon J.K., Steendijk P., Khan H., Wong K., Yacoub M. Acute effects of pulmonary artery banding in sheep on right ventricle pressure-volume relations: relevance to the arterial switch operation. Acta Physiol. Scand. 2001; 172 (2): 97–106. DOI: 10.1046/j.1365-201X. 2001.00844.x
  37. Campo A., Mathai S.C., Le Pavec J., Zaiman A.L., Hummers L.K., Boyce D. et al. Hemodynamic predictors of survival in scleroderma-related pulmonary arterial hypertension. Am. J. Respir. Crit. Care Med. 2010; 182: 252–60. DOI: 10.1164/rccm.200912-1820OC
  38. Chung L., Liu J., Parsons L., Hassoun P.M., McGoon M., Badesch D.B. et al. Characterization of connective tissue disease-associated pulmonary arterial hypertension from REVEAL: identifying systemic sclerosis as a unique phenotype. Chest. 2010; 138: 1383–94. DOI: 10.1378/chest.10-0260
  39. McIntyre K.M., Sasahara A.A. The hemodynamic response to pulmonary embolism in patients without prior cardiopulmonary disease. Am. J. Cardiol. 1971; 28: 288–94. DOI: 10.1016/0002-9149(71)90116-0
  40. McConnell M.V., Solomon S.D., Rayan M.E., Come P.C., Goldhaber S.Z., Lee R.T. Regional right ventricular dysfunction detected by echocardiography in acute pulmonary embolism. Am. J. Cardiol. 1996; 78: 469–73. DOI: 10.1016/s0002-9149(96)00339-6
  41. Wolde M., Söhne M., Quak E., Mac Gillavry M., Büller H.R. Prognostic value of echocardiographically assessed right ventricular dysfunction in patients with pulmonary embolism. Arch. Intern. Med. 2004; 164: 1685–9. DOI: 10.1001/archinte.164.15.1685
  42. Matthews J.C., McLaughlin V. Acute right ventricular failure in the setting if acute pulmonary embolism or chronic pulmonary hypertension: a detailed review of the pathophysiology, diagnosis, and management. Curr. Cardiol. Rev. 2008; 4 (1): 49–59. DOI: 10.2174/ 157340308783565384
  43. Douketis J.D. Prognosis in pulmonary embolism. Curr. Opin. Pulm. Med. 2001; 7: 354–9. DOI: 10.1097/00063198-200109000-00018
  44. Lahm T., McCaslin C.A., Wozniak T.C., Ghumman W., Fadl Y.Y., Obeidat O.S. et al. Medical and surgical treatment of acute right ventricular failure. J. Am. Coll. Cardiol. 2010; 56: 1435–46. DOI: 10.1097/00063198- 200109000-00018
  45. Vieillard-Baron A., Jardin F. Why protect the right ventricle in patients with acute respiratory distress syndrome? Curr. Opin. Crit. Care. 2003; 9: 15–21. DOI: 10.1097/00075198-200302000-00004
  46. Maeder M., Fehr T., Rickli H., Ammann P. Sepsisassociated myocardial dysfunction: diagnostic and prognostic impact of cardiac troponins and natriuretic peptides. Chest. 2006; 129: 1349–66. DOI: 10.1378/ chest.129.5.1349
  47. Kaul T.K., Fields B.L. Postoperative acute refractory right ventricular failure: incidence, pathogenesis, management and prognosis. Cardiovasc. Surg. 2000; 8: 1–9. DOI: 10.1016/s0967-2109(99)00089-7
  48. Lang R.M., Badano L.P., Mor-Avi V., Afilalo J., Armstrong A., Ernande L. et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J. Am. Soc. Echocardiogr. 2015; 28: 1–39.e14.
  49. Rudski L.G., Lai W.W., Afilalo J., Hua L., Handschumacher M.D., Chandrasekaran K. et al. Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J. Am. Soc. Echocardiogr. 2010; 23: 685–713. DOI: 10.1016/j.echo.2010.05.010
  50. Gopal A.S., Chukwu E.O., Iwuchukwu C.J., Katz A.S., Toole R.S., Schapiro W. et al. Normal values of right ventricular size and function by real-time 3-dimensional echocardiography: comparison with cardiac magnetic resonance imaging. J. Am. Soc. Echocardiogr. 2007; 20: 445–55. DOI: 10.1016/j.echo.2006.10.027
  51. Leibundgut G., Rohner A., Grize L., Bernheim A., Kessel-Schaefer A., Bremerich J. et al. Dynamic assessment of right ventricular volumes and function by realtime three-dimensional echocardiography: a comparison study with magnetic resonance imaging in 100 adult patients. J. Am. Soc. Echocardiogr. 2010; 23: 116–26. DOI: 10.1016/j.echo.2009.11.016
  52. Nosir Y.F., Fioretti P.M., Vletter W.B., Boersma E., Salustri A., Postma J.T. et al. Accurate measurement of left ventricular ejection fraction by three-dimensional echocardiography. A comparison with radionuclide angiography. Circulation. 1996; 94: 460–6. DOI: 10.1161/01.cir.94.3.460 54. Meyer P., Filippatos G.S., Ahmed M.I., Iskandrian A.E., Bittner V., Perry G.J. et al. Effects of right ventricular ejection fraction on outcomes in chronic systolic heart failure. Circulation. 2010; 121: 252–8. DOI: 10.1161/CIRCULATIONAHA.109.887570
  53. Anavekar N.S., Skali H., Bourgoun M., Ghali J.K., Kober L., Maggioni A.P. et al. Usefulness of right ventricular fractional area change to predict death, heart failure, and stroke following myocardial infarction (from the VALIANT ECHO Study). Am. J. Cardiol. 2008; 101 (5): 607–12. DOI: 10.1016/j.amjcard.2007.09.115
  54. Тakahashi K., Inage A., Rebeyka I.M., Ross D.B., Thompson R.B., Mackie A.S., Smallhorn J.F. Realtime 3-dimensional echocardiography provides new insight into mechanisms of tricuspid valve regurgitation in patients with hypoplastic left heart syndrome. Circulation. 2009; 120 (12): 1091–8. DOI: 10.1161/CIRCULATIONAHA.108.809566
  55. De Castro S., Cavarretta E., Milan A., Caselli S., Di Angelantonio E., Vizza Carmine D. et al. Usefulness of tricuspid annular velocity in identifying global RV dysfunction in patients with primary pulmonary hypertension: a comparison with 3D echo-derived right ventricular ejection fraction. Echocardiography. 2008; 25 (3): 289–93. DOI: 10.1111/j.1540-8175. 2007.00587.x
  56. Lindqvist P., Waldenström A., Henein M., Mörner S., Kazzam E. Regional and global right ventricular function in healthy individuals aged 20–90 years: a pulsed Doppler tissue imaging study: Umeå General Population Heart Study. Echocardiography. 2005; 22 (4): 305–14. DOI: 10.1111/j.1540-8175.2005.04023.x
  57. Meluzin J., Spinarová L., Bakala J., Toman J., Krejcí J., Hude P. et al. Pulsed Doppler tissue imaging of the velocity of tricuspid annular systolic motion; a new, rapid, and non-invasive method of evaluating right ventricular systolic function. Eur. Heart J. 2001; 22 (4): 340–8. DOI: 10.1053/euhj.2000.2296
  58. Sade L.E., Gülmez O., Ozyer U., Ozgül E., Aˇgildere M., Müderrisoˇglu H. Tissue Doppler study of the right ventricle with a multisegmental approach: comparison with cardiac magnetic resonance imaging. J. Am. Soc. Echocardiogr. 2009; 22 (4): 361–8. DOI: 10.1016/ j.echo.2009.01.018
  59. Chockalingam A., Gnanavelu G., Alagesan R., Subramaniam T. Myocardial performance index in evaluation of acute right ventricular myocardial infarction. Echocardiography. 2004; 21 (6): 487–94. DOI: 10.1111/j.0742-2822.2004.03139.x
  60. Yeo T.C., Dujardin K.S., Tei C., Mahoney D.W., McGoon M.D., Seward J.B. Value of a Dopplerderived index combining systolic and diastolic time intervals in predicting outcome in primary pulmonary hypertension. Am. J. Cardiol. 1998; 81 (9): 1157–61. DOI: 10.1016/s0002-9149(98)00140-4
  61. Eidem B.W., Tei C., O'Leary P.W., Cetta F., Seward J.B. Nongeometric quantitative assessment of right and left ventricular function: myocardial performance index in normal children and patients with Ebstein anomaly. J. Am. Soc. Echocardiogr. 1998; 11 (9): 849–56. DOI: 10.1016/s0894-7317(98)70004-5
  62. Dujardin K.S., Tei C., Yeo T.C., Hodge D.O., Rossi A., Seward J.B. Prognostic value of a Doppler index combining systolic and diastolic performance in idiopathicdilated cardiomyopathy. Am. J. Cardiol. 1998; 82 (9): 1071–6. DOI: 10.1016/s0002-9149(98)00559-1
  63. Abdel Rahman M.Y., Abdul-Khaliq H., Vogel M., Alexi-Meskischvili V., Gutberlet M., Hetzer R., Lange P.E. Value of the new Doppler-derived myocardial performance index for the evaluation of right and left ventricular function following repair of tetralogy of Fallot. Pediatr. Cardiol. 2002; 23 (5): 502–7. DOI: 10.1007/s00246-002-1469-5
  64. Morner S., Lindqvist P., Waldenström A., Kazzam E. Right ventricular dysfunction in hypertrophic cardiomyopathy as evidenced by the myocardial performance index. Int. J. Cardiol. 2008; 124 (1): 57–63. DOI: 10.1016/j.ijcard.2006.12.022
  65. Edvardsen T., Gerber B.L., Garot J., Bluemke D.A., Lima J.A., Smiseth O.A. Quantitative assessment of intrinsic regional myocardial deformation by Doppler strain rate echocardiography in humans: validation against three-dimensional tagged magnetic resonance imaging. Circulation. 2002; 106 (1): 50–6. DOI: 10.1161/01.cir.0000019907.77526.75
  66. Donal E., Roulaud M., Raud-Raynier P., De Bisschop C., Leclercq C., Derumeaux G. et al. Echocardiographic right ventricular strain analysis in chronic heart failure. Eur. J. Echocardiogr. 2007; 8 (6): 449–56. DOI: 10.1016/j.euje.2006.07.011
  67. Kjaergaard J., Sogaard P., Hassager C. Right ventricular strain in pulmonary embolism by Doppler tissue echocardiography. J. Am. Soc. Echocardiogr. 2004; 17: 1210–2. DOI: 10.1016/j.echo.2004.06.026
  68. Rajagopalan N., Dohi K., Simon M.A., Suffoletto M., Edelman K., Murali S., López-Candales A. Right ventricular dyssynchrony in heart failure: a tissue Doppler imaging study. J. Card. Fail. 2006; 12 (4): 263–7. DOI: 10.1016/j.cardfail.2006.02.008
  69. Hoffmann R., Altiok E., Nowak B., Heussen N., Kühl H., Kaiser H.J. et al. Strain rate measurement by Doppler echocardiography allows improved assessment of myocardial viability inpatients with depressed left ventricular function. J. Am. Coll. Cardiol. 2002; 39 (3): 443–9. DOI: 10.1016/s0735-1097(01)01763-6
  70. Smith B.C., Dobson G., Dawson D., Charalampopoulos A., Grapsa J., Nihoyannopoulos P. Threedimensional speckle tracking of the right ventricle: toward optimal quantification of right ventricular dysfunction in pulmonary hypertension. J. Am. Coll. Cardiol. 2014; 64 (1): 41–51. DOI: 10.1016/j.jacc.2014.01.084
  71. Atsumi A., Ishizu T., Kameda Y., Yamamoto M., Harimura Y., Machino-Ohtsuka T. et al. Application of 3-dimensional speckle tracking imaging to the assessment of right ventricular regional deformation. Circ. J. 2013; 77 (7): 1760–8. DOI: 10.1253/circj.cj12-1445

Об авторах

  • Сокольская Надежда Олеговна, доктор мед. наук, заведующая группой экстренной ультразвуковой и функциональной диагностики; ORCID
  • Копылова Наталья Сергеевна, канд. мед. наук, ст. науч. сотр.; ORCID
  • Иванов Алексей Вячеславович, врач ультразвуковой диагностики; ORCID
  • Кокшенев Игорь Валериевич, доктор мед. наук, профессор, гл. науч. сотр.; ORCID

 Если вы заметили опечатку, выделите текст и нажмите Alt+A