Characterization of the right ventricle : embryonic development, noninvasive imaging and electrocardiography

Abstract

The aim of this thesis was to further characterize the right ventricle within three different fields of cardiovascular research: 1. Embryonic development, 2: Non-invasive right ventricular imaging, 3: Right ventricular electrocardiography. In part I, several aspects of embryonic development, relevant for normal right ventricular morphology and function are investigated. In chapter 2, a novel concept for normal development of the right ventricular outflow tract is introduced. In chapter 3, the potential relevance of epicardium-derived cells for the difference between left and right ventricular morphology is discussed. Non-invasive imaging techniques are evaluated in part II. In chapter 4, the use of conventional semi-quantitative measurement of right ventricular function in patients with transposition of the great arteries is analyzed. The relevance of abnormal response to stress, measured with cardiovascular magnetic resonance imaging, is investigated in chapter 5. Chapters 6-8 demonstrate how strain measurement can be used in various types of (suspected) right ventricular disease. In part III, both conventional electrocardiography as well as computerized vectorcardiography is described in patients with right v entricular disease. A case-study of conventional electrocardiographic assessment of right ventricular pressure overload is provided in chapter 9. The prognostic value of QRS duration in patients with tetralogy of Fallot who undergo pulmonary valve replacement, is demonstrated in chapter 10. Chapter 11 and 12 discuss the application of ECG-derived vectorcardiography in normal subjects and suspected pulmonary arterial hypertension patients