Abstract
A two-dimensional echocardiographic study using short axis, long axis and four chamber views was performed to evaluate right ventricular (RV) and left ventricular (LV) geometry and interrelationships in 10 CF patients with severe obstructive lung disease and secondary cor pulmonale. All patients had clinical scores less than 50, vital capacity less than 55% of predicted, evidence of RV failure, hypoxia, and were receiving diuretics. Six patients were receiving digoxin. RV enddiastolic dimension (RVED), RV outflow tract (RVOT), ratio of RVOT to aortic root (AO) and ratio of RVED to LV end-diastolic dimension (LVED) were significantly (p< 0.005) larger than predicted normal values derived from M-mode studies. LVED was smaller than predicted. The massively enlarged RV encroached on the LV in all patients. This resulted in persistently abnormal interventricular septal configuration with bulging of the septum into the LV, an eccentric oval shaped LV chamber, and flat or paradoxic septal motion. This was associated with dyskinetic contraction and relaxation of the LV chamber, which could contribute to diminished performance. Thus massive RV enlargement may be a major factor in producing LV dysfunction in chronic cor pulmonale.
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