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Septal myocardial protection during cardiac surgery for prevention of right ventricular dysfunction [Anatol J Cardiol]
Anatol J Cardiol. 2008; 8(Suppl. 2): 108-116

Septal myocardial protection during cardiac surgery for prevention of right ventricular dysfunction

Gerald Buckberg1, Constantine Athanasuleas2, Saleh Saleh1
1Division of Cardiothoracic Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
2Department of Cardiothoracic Surgery, School of Medicine, University of Alabama, Birmingham, Alabama, USA

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 ~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.

Keywords: septum, right ventricle, helical ventricular myocardial band, myocardial protection


Gerald Buckberg, Constantine Athanasuleas, Saleh Saleh. Septal myocardial protection during cardiac surgery for prevention of right ventricular dysfunction. Anatol J Cardiol. 2008; 8(Suppl. 2): 108-116

Corresponding Author: Gerald Buckberg, United States


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