title: Impact of pericardial adhesions on diastolic function as assessed by vortex formation time, a parameter of transmitral flow efficiency.
abstract: BACKGROUND
  Pericardial adhesions are a pathophysiological marker of constrictive pericarditis (CP), which impairs cardiac filling by limiting the total cardiac volume compliance and diastolic filling function. We studied diastolic transmitral flow efficiency as a new parameter of filling function in a pericardial adhesion animal model. We hypothesized that vortex formation time (VFT), an index of optimal efficient diastolic transmitral flow, is altered by patchy pericardial-epicardial adhesions.
  
  
  METHODS
  In 8 open-chest pigs, the heart was exposed while preserving the pericardium. We experimentally simulated early pericardial constriction and patchy adhesions by instilling instant glue into the pericardial space and using pericardial-epicardial stitches. We studied left ventricular (LV) function and characterized intraventricular blood flow with conventional and Doppler echocardiography at baseline and following the experimental intervention.
  
  
  RESULTS
  Significant decreases in end-diastolic volume, ejection fraction, stroke volume, and late diastolic filling velocity reflected the effects of the pericardial adhesions. The mean VFT value decreased from 3.61 ± 0.47 to 2.26 ± 0.45 (P = 0.0002). Hemodynamic variables indicated the inhibiting effect of pericardial adhesion on both contraction (decrease in systolic blood pressure and +dP/dt decreased) and relaxation (decrease in the magnitude of -dP/dt and prolongation of Tau) function.
  
  
  CONCLUSIONS
  Patchy pericardial adhesions not only negatively impact LV mechanical functioning but the decrease of VFT from normal to suboptimal value suggests impairment of transmitral flow efficiency.
authors.affiliation: Translational Ultrasound Research Laboratory, Division of Cardiovascular Diseases, Mayo Clinic, Scottsdale, Arizona, USA.
authors.forename: Panupong
authors.initials: P
authors.lastname: Jiamsripong
authors.forename: Mohsen S
authors.initials: MS
authors.lastname: Alharthi
authors.forename: Anna M
authors.initials: AM
authors.lastname: Calleja
authors.forename: Eileen M
authors.initials: EM
authors.lastname: McMahon
authors.forename: Minako
authors.initials: M
authors.lastname: Katayama
authors.forename: John
authors.initials: J
authors.lastname: Westerdale
authors.forename: Michele
authors.initials: M
authors.lastname: Milano
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Heys
authors.forename: Farouk
authors.initials: F
authors.lastname: Mookadam
authors.forename: Marek
authors.initials: M
authors.lastname: Belohlavek
mesh_terms: D000818:Animals; D001783:Blood Flow Velocity / Q000502:physiology*; D003971:Diastole; D004195:Disease Models, Animal; D015150:Echocardiography, Doppler / Q000379:methods*; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000503:physiopathology*; D010493:Pericarditis / Q000150:complications / Q000000981:diagnostic imaging*; D010496:Pericardium / Q000000981:diagnostic imaging*; D013552:Swine; D000267:Tissue Adhesions / Q000000981:diagnostic imaging; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology*; D016277:Ventricular Function, Left / Q000502:physiology*