Theoretical model of ventricular interdependence: pericardial effects

Abstract

One ventricle can influence the filling characteristics of the opposite ventricle directly through the myocardium and indirectly through the pericardium. Based on definitions of compliances and volumes, we developed a theoretical analysis that indicated that the magnitude of interdependence was related to the relative compliances of the left and right ventricular free walls, septum, and pericardium. This analysis was verified in postmortem canine hearts. Balloons were inserted into each ventricle, and left ventricle pressure (delta Pl) and volume (delta Vl) changes caused by increasing right ventricular pressure (delta Pr) and volume (delta Vr) or pericardial pressure (delta Pp) were recorded. For delta Pl/delta Pr, delta Pl/delta Pp, delta Pl/delta Vr, delta Vl/delta Pr, delta Vl/delta Pp, and delta Vl/delta Vr measurements, the standard error of estimates was small and the predicted and measured values were significantly related (P less than 0.05); the values were 0.88 +/- 0.16, 0.87 +/- 0.17, 0.93 +/- 0.05, 0.95 +/- 0.09, 0.96 +/- 0.05, and 0.96 +/- 0.04, respectively. These coupling coefficients (delta Pl/delta Pr, delta Pl/delta Pp, etc.) a direct measurement of interdependence, indicated that pericardial-to-ventricular coupling is greater than ventricular-ventricular coupling (delta Pl/delta Pp greater than delta Pl/delta Pr, 0.91 +/- 0.09 vs. 0.23 +/- 0.09, P less than 0.01; delta Vl/delta Pp greater than delta Vl/delta Pr, -1.04 +/- 0.35 vs. -0.19 +/- 0.05, P less than 0.05). This study, by developing a theoretical analysis and by direct measurements, provides a better understanding of ventricular interdependence and may help to predict effects of cardiac tamponade and constrictive pericarditis on ventricular interdependence.