Changes in right ventricular volume in early human neonates

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Abstract

To evaluate changes in the right ventricular volume in early human neonates, twenty fullterm infants were examined at 2, 24 and 120 h of age by two-dimensional echocardiography. End-diastolic and end-systolic right ventricular volumes (RVEDV and RVESV, respectively) were calculated with a computer system based on the bi-plane Simpson's rule using the apical four chamber and parasternal short axis views. Then right ventricular stroke volume (RVSV), ejection fraction (RVEF), and the mean normalized systolic ejection rate were obtained. The inner diameter of the ductus arteriosus was also measured simultaneously. RVEDV increased significantly by 24 h of age, but remained constant thereafter. RVESV remained virtually unchanged from 2 to 120 h, resulting in a significant increase (36%) of RVSV at 24 h compared with that at 2 h. The mean normalized systolic ejection rate remained unchanged. There was a good correlation between RVEDV and RVSV (r=0.83). All ductus arteriosus except three narrow ones was closed by 24 h of age. In conclusion, at 24 h of age, the significantly increased RVEDV was closely related to the increased RVSV, which might be induced by increased volume load to the right ventricle because of the closure of the ductus arteriosus.

Introduction

Cardiovascular changes occurring immediately after birth are dramatic and relate to the adaptation process from fetal to extrauterine life [3]. Several authors have investigated the early neonatal left ventricular performance 4, 13, 16, 19, and it has been recognized that these changes are greatly related with the serial changes in the ductus arteriosus shunting. Previously, we reported the influence of this shunting to the left ventricle in the early neonatal period, and demonstrated that it acts as a preload 7, 8. On the other hand, the influence to the right ventricular performance in the early neonate have not been fully elucidated 2, 5, 6, 18. Some investigators have shown that the right ventricular output increases after birth 3, 6, 17. In adult dogs, Rudolph studied the effect of the opening and closing of the aortopulmonary prosthetic shunt, and showed that right ventricular cardiac output (RVCO) decreased after the shunt was open [14]. It is natural to expect that the changes in right ventricular volume will be influenced by the ductus arteriosus shunting, but, to our knowledge, few studies have been focused on the right ventricular volume changes in early human neonates. Accordingly, the contribution of changes in the right ventricular volume to the right ventricular stroke volume (RVSV) and RVCO remains unclear. Recently, two-dimensional echocardiography have been validated as a noninvasive means of estimating the right ventricular volume 12, 15, 20. The purpose of this study was to demonstrate postnatal changes in the right ventricular volume in human neonates using two-dimensional echocardiography.

Section snippets

Study subjects

We studied 20 fullterm infants selected from the neonatal unit in our hospital, who had a history of normal pregnancy and delivery and had no congenital malformation. The mean gestational age was 39.5±1.1 weeks (mean±SD) and the mean birth weight was 3255±504 gm. Informed consent was obtained from the parents of each infant.

Examination technique

All infants were in a non-sedated resting state during the examinations, and complete two-dimensional and pulsed Doppler echocardiographic examinations were performed using

Results

The results of the measurements are summarized in Table 1 and illustrated in Fig. 2 and Fig. 3.

Discussion

We studied the serial changes in the right ventricular volume by two-dimensional echocardiography, which, to our knowledge, is the first non-invasive evaluations in early human neonates. Our results showed that the RVEDV significantly increased without change in the RVESV, causing a 36 and 27% increases of the RVSV and RVCO, respectively, at 24 h compared with those of 2 h, which were statistically significant. Concerning the RVSV, Takenaka et al. demonstrated a 25% increase in RVSV from 5 to

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