Chapter category: Heart
Regional Differences and Variability in Left Ventricular Wall Motion
Coronary Sinus Intervention in Cardiac Surgery, Second Edition
Edited by: Werner MohlISBN: 1-58706-006-X
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Chapter authors:
Werner Heimisch
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In our understanding of the mechanical performance of the heart as a pump we mostly rely on the famous studies of Otto Frank1 and Ernest Starling2 whose observations have been widely accepted for a century. Thus, the clinical therapeutic regimens contain volume substitution (preload), antihypertensive therapy (afterload), bradycardic agent (heart rate) and positive inotropic agent (contractility) drug administration. All these maneuvers involve the heart as a whole. In most of our patients, however, just parts of the ventricle are injured by insufficient energy supply. Therefore, if we treat the ventricle as a whole we may ask whether all the parts of the ventricle act in unison. When we look at heart preparations for morphological analyses (Fig. 1) it becomes obvious from the global as well as local anisotropy that there must be an inhomogeneity in myocardial contraction i) across the ventricular wall, ii) from site to site from apex to the base, and, moreover, iii) at any site along different angular orientations.
Regional blood supply measured by antegrade volume-flow through the coronary arteries may cause differential effects on the dependent myocardium. This will primarily be according to the specific amount of oxygen transported (limited oxygen supply by coronary artery stenosis or reduced oxygen transport due to hemodilution or perfusion with desaturated instead of arterial blood). Additionally the functional response of the myocardium to local impediment of the coronary blood flow might depend on the coronary artery architecture and on the absence or presence of collaterals—genetically preformed or acquired.
Thus, this chapter deals with regional differences in left ventricular performance, with species–related differences of myocardial functional response to coronary artery blood flow restriction, and with variations of oxygen delivery irrespective of blood volume-flow and their effects on myocardial function.
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