AN AUTOPSY CASE OF IDIOPATHIC ENLARGEMENT OF THE RIGHT ATRIUM, AND A REVIEW OF THE LITERATURE

A 69-year-old man in whom idiopathic enlargement of the right atrium was revealed at autopsy is described. The patient had had cardiomegaly of at least 19 years'duration prior to his death, even though cardiac symptoms were absent. Cause of death was pancreatic carcinoma. Postmortem examination revealed marked and diffuse dilatation of the right atrium and moderate dilatation of the left atrium. Measurement of the cardiac chambers showed that the right and left atria were 7.6 and 4.7 times as large as those of normal hearts, respectively. The volume of either ventricle was about twice the normal value. Histologically, widespread cardiac muscular degeneration and necrosis, diffuse fibrosis, and focal lymphocytic infiltration were found in the right atrium and also, to a lesser degree, in the left atrium. Such pathologic changes were not found in either of the ventricles. The etiology of these muscular changes, which might have been related to atrial enlargement, was unclear. The present case was thought to be consistent with idiopathic enlargement of the right atrium, and a brief review of the literature is given.     

Morphometric studies of the vegetative nervous system in sudden cardiac death

Histochemical investigation of the adrenergic cardiac nerves was undertaken for 101 victims of sudden cardiac death. In addition, the cervicothoracic ganglia of 12 persons between ages 40 and 60 who had died a sudden death were studied electron microscopically. Use of morphometric methods demonstrated that there was a significant reduction in the volume density of adrenergic nerve plexuses with focal depletion in the right and left ventricular walls and degenerative changes in the autonomic ganglia. In the sympathetic neurons, along with dilatation of the endoplasmic reticulum, damage to the mitochondrial inner membranes and the emergence of osmiophilic, dense bodies in the mitochondria were recorded. Morphometric analysis revealed a significant increase of the volume density of the mitochondria, which reflected predominantly the enlargement of these cell organelles. It is concluded that these degenerative changes in the vegetative nervous system have a possibly causal relevance to the occurrence of sudden cardiac death.     

致心律失常性右室心肌病心力衰竭期的病理特点分析

目的 通过分析致心律失常性右室心肌病(ARVC)心力衰竭期的病理改变,以进一步了解其临床分期与病理表型的关系.方法 从2004-2007 年在阜外心血管病医院接受心脏移植的心力衰竭病例中,收集病理诊断为ARVC的受体心脏8例,测量心脏重量,评价左右心室心腔扩张、心肌细胞肥大、脂肪浸润、纤维化、附壁血栓和伴发心肌炎等指标,注意左心室受累情况,并进行病理分型.结果 8例中的7例为经典型(即右心室改变为主),1例为左优势型(左心室改变为主),未见双室型病例.组织学均为纤维脂肪型,未见单纯脂肪型病例.经典型病例的右心室中、重度扩张,少数有室壁瘤形成,其中6例伴左心室受累,受累左心室轻、中度扩张,心肌广泛间质纤维化,部分病例伴替代性疤痕,而脂肪浸润量小,多局限于心外膜下.左心室心肌细胞肥大普遍.而左优势型的左心室重度扩张,弥漫间质纤维化和局部透壁性脂肪浸润.8例中3例左心室明显肥厚,3例查见双室附壁血栓,1例伴局灶性心肌炎.结论 ARVC心力衰竭期的左心室受累多见而严重,左心室间质纤维化突出,心肌细胞肥大明显,但脂肪替代少见和局限.左、右心室多扩张,可见附壁血栓,应注意与扩张型心肌病等鉴别.     

Right ventricular dilatation after left ventricular acute myocardial infarction is predictive of extremely high peri-infarctual apoptosis at postmortem examination in humans

BACKGROUND: Cardiac remodelling after acute myocardial infarction (AMI) is characterised by molecular and cellular mechanisms involving both left and right ventricles, and biventricular failure identifies patients with an extremely unfavourable prognosis. AIMS: To assess whether a link exists between increased myocardial apoptotic rates (AR) at sites of recent infarction and patterns of unfavourable cardiac remodelling, such as biventricular enlargement after left ventricular (LV) infarction. METHODS: Twelve patients with recent AMI involving the LV and not the right ventricle (RV) and with permanent infarct related artery occlusion were selected at necropsy. Gross pathological characteristics, such as LV and RV dilatation, and AR at site of infarction were assessed. Potential false positive results (DNA synthesis and RNA splicing) were excluded from the cell count. RESULTS: RV enlargement, defined as a tricuspidal ring greater than 120 mm, was found in five cases and was associated with LV dilatation. These patients showed significantly higher AR than the others. When the subjects were divided into three groups according to progressive cardiac remodelling (absence of cardiac dilatation, isolated LV dilatation, and biventricular enlargement), the last group had significantly higher ARs than the other two groups, showing that myocardiocyte apoptosis is increased in more unfavourable forms of cardiac remodelling. CONCLUSION: Patients with severely unfavourable cardiac remodelling, such as biventricular enlargement, have extremely high myocardiocyte apoptosis at necropsy, even late after LV myocardial infarction, supporting the role of myocardiocyte loss in determining post-infarction adverse remodelling.     

The importance of atrial structure and fibers

Atrial structures are important in the current era of cardiac interventions using percutaneous transcatheter procedures. Understanding their locations and component parts helps to reduce risks of procedural-related damage. The general arrangement of the myofibers that make up the atrial walls is reviewed to provide a morphologic basis for atrial conduction and potential substrates of arrhythmias. The right atrium, dominated by its appendage, is characterized by having an extensive array of pectinate muscles. These extend almost perpendicularly from the terminal crest. The left atrium has relatively smooth walls and a small tubular-shaped appendage. The myofibers show changes in orientations when traced through the thickness of the walls. Extensions of atrial myocardium onto the pulmonary veins and the superior caval vein are common. Apart from Bachmann's bundle, there are other muscular bridges of variable numbers and sizes that provide interatrial connections, connections between the left atrium and the coronary sinus, and connections between the muscular sleeves of the right pulmonary veins and the right atrium. The purpose of this review is to summarize the three-dimensional arrangement of gross atrial structures, the myoarchitecture and variations in muscular interatrial connections. These are important features in intra- and interatrial conduction.     

Left atrio-ventricular valve degeneration, left ventricular dilation and right ventricular failure: A possible association with pulmonary hypertension and aetiology of ascites in broiler chickens.

The results presented here are based on a collection of heart necropsy data obtained from a large population of ascitic and normal broiler chickens raised at low altitude. The hearts were subjected to gross postmortem evaluation. Generally, gross changes in the cardiac muscle predominantly consisted of various degrees of right and left ventricular enlargement and atrial enlargement, and were observed in all hearts from birds that developed ascites and in some apparently normal chickens. These hearts appeared flaccid, had a thin ventricular muscle wall, and lacked the normal tone of healthy heart muscle. Ventricular enlargement (mostly dilation) and AV valve degeneration (endocardiosis) were observed as early as 7 to 10 days of age and throughout the remaining growth period in broilers with or without ascites. The hearts from 264 ascitic and 255 apparently normal commercial broilers were used for quantitative analysis, with emphasis on dilatory changes of the ventriculi and detailed evaluation of the atrio-ventricular (AV) valves. The lesions of the AV apparatus and the degree of dilation of the ventriculi were graded according to a priori established standards, and categorized as mild, moderate or severe. Severe or moderate dilation of both the right and left ventricle were observed more frequently (P < 0.001) in ascitic birds than in normal birds. Of hearts from apparently normal birds, 34 and 61% had grossly normal right and left ventricle, respectively. Overall, 30% of ascitic birds had a grossly normal left ventricle, but some degree of right ventricular dilation was found in all ascitic birds. Prominent endocardiosis was a common feature in a majority of hearts from ascitic birds and in some apparently normal birds. Endocardiosis of the left AV valves was observed considerably more frequently (P < 0.001) than of right AV valves. Most severe lesions were found on left AV valves, and consisted of nodules or coalescing formations associated with annulus, valve cusps, chordae tendineae, and sometimes spread to the mural endocardium in the vicinity of the valve apparatus. Frequently the cusps appeared thickened and rigid, and had rolled edges. Chordae tendineae were frequently thickened, and sometimes ruptured. These severe left AV valve lesions were found most frequently (P < 0.001) in the hearts from ascitic birds (52%) in comparison to apparently normal birds (18%). The right AV valve lesions were mainly in the form of small nodules found around the orifice, and less frequently seen on the muscular leaflets of the right valve. Only in a few instances the nodules were larger, ranging from 1 to 3 mm in diameter. The severity of gross lesions on the left AV valve were indicative of stenosis and/or insufficiency of the valve apparatus. A hypothesis that left atrio-ventricular valve degeneration and left ventricular dilation should be considered as a possible aetiologic association with pulmonary hypertension, right ventricular failure, and ascites in broiler chickens is presented and discussed.     

Remodeling of chick embryonic ventricular myoarchitecture under experimentally changed loading conditions

Adult myocardium adapts to changing functional demands by hyper‐ or hypotrophy while the developing heart reacts by hyper‐ or hypoplasia. How embryonic myocardial architecture adjusts to experimentally altered loading is not known. We subjected the chick embryonic hearts to mechanically altered loading to study its influence upon ventricular myoarchitecture. Chick embryonic hearts were subjected to conotruncal banding (increased afterload model), or left atrial ligation or clipping, creating a combined model of increased preload in right ventricle and decreased preload in left ventricle. Modifications of myocardial architecture were studied by scanning electron microscopy and histology with morphometry. In the conotruncal banded group, there was a mild to moderate ventricular dilatation, thickening of the compact myocardium and trabeculae, and spiraling of trabecular course in the left ventricle. Right atrioventricular valve morphology was altered from normal muscular flap towards a bicuspid structure. Left atrial ligation or clipping resulted in hypoplasia of the left heart structures with compensatory overdevelopment on the right side. Hypoplastic left ventricle had decreased myocardial volume and showed accelerated trabecular compaction. Increased volume load in the right ventricle was compensated primarily by chamber dilatation with altered trabecular pattern, and by trabecular proliferation and thickening of the compact myocardium at the later stages. A ventricular septal defect was noted in all conotruncal banded, and 25% of left atrial ligated hearts. Increasing pressure load is a main stimulus for embryonic myocardial growth, while increased volume load is compensated primarily by dilatation. Adequate loading is important for normal cardiac morphogenesis and the development of typical myocardial patterns. Anat Rec 254:238–252, 1999. © 1999 Wiley‐Liss, Inc.     

云南不明原因聚集性猝死中心肌炎病例的病理特点分析

目的观察分析云南不明原因聚集性猝死病例心肌炎的病理改变特点,探讨心肌炎在这类猝死中的作用。方法心肌炎的病理诊断参照Dallas和世界心脏联合会的标准。分析云南省1991—2006年进行猝死监测期间收集的尸检病例29例,其中14例为心肌炎病例。心肌炎患者年龄8～68岁,平均30岁。男9例、女5例。回顾流行病学资料,核查心脏标本,观察心脏等器官的组织切片,其中3例做了心脏传导系统检查。结果心肌炎共14例,占尸检病例的48％。其中淋巴细胞性心肌炎11例,中性粒细胞性心肌炎3例。心肌炎均表现为局灶性,未见弥漫性心肌炎。仅20％（8％～42％）的心肌组织切片可检出炎性病灶,病灶多分布在左心室侧壁,少数在室间隔和右心室部心肌。病灶区心肌细胞形态损伤多数较轻微,个别病例出现片状心肌溶解或凝固性坏死。多数病变为急性炎,也可见机化和急性损伤共存。4例还伴有心包炎,1例伴亚急性心内膜炎,3例行传导系统检查者中1例炎症波及房室结。心脏外观多无异常,仅2例左室或全心扩大。5例伴有呼吸道和肺部感染。结论心肌炎是云南不明原因聚集性猝死的主要病变之一,病理表现以局灶性为主,病变形态提示病毒和细菌性感染均有可能,但是,尚不能确定心肌炎症与中毒的关系。心肌炎的病因及其与猝死聚集性的关系值得进一步研究。     

Fusiform enlargement of the nasolacrimal canal: a rare anatomic variation

To determine the standard width and shape of the nasolacrimal canal (NLC) in the coronal plane, a retrospective review of 950 coronal paranasal CT sections was undertaken. The coronal diameter of NLC was measured at its upper and lower ends and anomalies in its configuration noted. The mean diameters of the NLC were 4.8 ± 1.2 mm and 4.7 ± 1.1 mm on the right and left sides, respectively. There was no difference in the mean NLC diameter between the right and left sides, upper and lower portions or males and females. In two cases, an abnormal dilation of the NLC at its inferior portion was encountered. A marked enlargement of the NLC can occur in the absence of a neoplastic or obstructive process and may be detected as an isolated finding representing idiopathic or congenital enlargement. Segmental NLC dilatation is not always an indicator of pathology, particularly in asymptomatic cases, and should be considered a rare anatomic variation.     

Anomalous venous system in the human heart

In a 2002 cadaveric dissection course, a complex manner of rare variation was found in the abnormal venous system of the heart of an 88-year-old Japanese man who died of acute pneumonia. The superior vena cava and the left and right brachiocephalic veins were normal. In this case, a complex venous system existed as follows. (1) A left superior vena cava was persistent. (2) The innominate vein was present. It went upward between the ascending aorta and the pulmonary trunk, passed through the ventral side of the bifurcation of the pulmonary trunk, and then anastomosed with the left superior vena cava. The oblique vein of the left atrium, as a fibrous bundle, was connected to the junction of the left superior vena cava and the innominate vein in the pericardium. (3) The great cardiac vein was divided into two branches. One was located at the right side of the left coronary artery, forming the origin of the innominate vein. The other extended to the coronary sinus as a normal great cardiac vein. (4) The orifice of the coronary sinus on the right atrium was obliterated. (5) The abnormal orifice existed between the left atrium and the coronary sinus. The formation process and functional significance of such venous variations are discussed.     

正常引流肺静脉解剖变异的多层螺旋CT血管成像研究

目的 探讨正常引流肺静脉的解剖变异率及其变异形式。方法 回顾性分析2013年5月—2014年7月中山大学附属孙逸仙纪念医院220例两侧肺静脉均引流至左心房患者的胸部64层螺旋CT血管成像(MSCTA)资料,对肺静脉进行多平面重建(MPR)、最大强度投影(MIP)及VR重建,观察段以上肺静脉引流区域,以及双侧肺静脉与左心房连接模式。两侧肺静脉分别以上、下肺静脉独立开口于左房,右中叶肺静脉回流至上肺静脉者为正常肺静脉引流模式;一侧单支或多于两支肺静脉引流、跨叶引流者为肺静脉解剖变异。结果 220例正常引流肺静脉中,左右肺静脉总变异发生率22.7%(50/220)。右肺静脉解剖变异38例(17.3%,38/220),共见8种变异模式,分别为:(1)上、下叶肺静脉分别汇入左心房,中叶静脉汇入下叶肺静脉 4例(1.8%,4/220);(2)上、下叶肺静脉分别汇入左心房,上叶后段汇入下叶肺静脉2例(0.9%,2/220);(3)上、中、下叶静脉分别汇入左心房16例(7.3%,16/220);(4)上叶后段、尖前段、下叶肺静脉分别汇入左心房,中叶静脉汇入尖前段肺静脉4例(1.8%,4/220);(5)上叶、下叶背段、下叶基底段肺静脉分别汇入左心房,中叶静脉汇入上叶肺静脉2例(0.9%,2/220);(6)上叶、 中叶内段、中叶外段、下叶肺分别静脉汇入左心房6例(2.7%,6/220);(7)上叶后段、上叶尖前段、中叶、下叶肺静脉分别汇入左心房2例(0.9%,2/220);(8)上叶、中叶、下叶背段、下叶基底段肺静脉分别汇入左心房2例(0.9%,2/220)。左肺静脉变异12例(5.5%,12/220),共见2种变异模式,即上、下叶肺静脉组成共干汇入左心房8例(3.6%,8/220),上叶、舌叶、下叶肺静脉分别汇入左心房4例(1.8%,4/220)。220例患者中,左右肺静脉解剖变异率的差异有统计学意义(χ²＝13.533, P<0.01)。结论 MSCTA上正常引流肺静脉解剖变异常见,右肺静脉解剖变异发生率显著高于左肺静脉,且变异模式多样。     

Anatomy of the pig heart: comparisons with normal human cardiac structure

Transgenic technology has potentially solved many of the immunological difficulties of using pig organs to support life in the human recipient. Nevertheless, other problems still remain. Knowledge of cardiac anatomy of the pig (Sus scrofa) is limited despite the general acceptance in the literature that it is similar to that of man. A qualitative analysis of porcine and human cardiac anatomy was achieved by gross examination and dissection of hearts with macrophotography. The porcine organ had a classic ‘Valentine heart’ shape, reflecting its location within the thorax and to the orientation of the pig's body (unguligrade stance). The human heart, in contrast, was trapezoidal in silhouette, reflecting man's orthograde posture. The morphologically right atrium of the pig was characterised by the tubular shape of its appendage (a feature observed on the left in the human heart). The porcine superior and inferior caval veins opened into the atrium at right angles to one another, whereas in man the orifices were directly in line. A prominent left azygous vein (comparable to the much reduced left superior caval or oblique vein in man) entered on the left side of the pig heart and drained via the coronary sinus. The porcine left atrium received only 2 pulmonary veins, whereas 4 orifices were generally observed in man. The sweep between the inlet and outlet components of the porcine right ventricle was less marked than in man, and a prominent muscular moderator band was situated in a much higher position within the porcine right ventricle compared with that of man. The apical components of both porcine ventricles possessed very coarse trabeculations, much broader than those observed in the human ventricles. In general, aortic-mitral fibrous continuity was reduced in the outlet component of the porcine left ventricle, with approximately two-thirds of the aortic valve being supported by left ventricular musculature. Several potentially significant differences exist between porcine and human hearts. It is important that these differences are considered as the arguments continue concerning the use of transgenic pig hearts for xenotransplantation.     

Effects of 2-(2-Pyridyl)ethylamine (PEA) on the isolated guinea-pig heart

The effect of 2-(2-pyridyl)ethylamine (PEA) on the rate and force of contraction of cardiac tissues from untreated and reserpine-pretreated guinea-pigs was examined. PEA produced changes in rate of spontaneously beating right atria without activation of H₁ or H₂-receptors. The positive chronotropic effect of PEA was eliminated when atria from reserpine-pretreated animals were used, indicating an entirely indirect mode of action of PEA in the right atrium.The positive inotropic effect of low doses of PEA in left atria was antagonized by promethazine, whereas the inotropic effect of higher doses of PEA was reduced either by propranolol or following reserpine pretreatment. In the right ventricle strip, the inotropic effect of high doses of PEA was blocked equally by propranolol and promethazine.The results obtained indicate that in the guinea-pig heart, PEA either produces its effects through catecholamine release (right atrium) or through a combination of both H₁-receptor stimulation and catecholamine release (left atrium and right ventricle strip). The direct inotropic effects of PEA produced only small increases in force of contraction. The study indicates that caution should be used in ascribing all of the effects of PEA to histamine receptor stimulation.Supported by a grant from the Canadian Heart Foundation.Predoctoral Research Trainee of the Canadian Heart Foundation.     

Primary lymphoma of the heart: case report and literature review

Primary cardiac lymphoma (PCL) is a rare and usually fatal neoplasma. A case of PCL in a 78-year-old man who complained of exertional dyspnea and peripheral edema is presented. Echocardiography revealed a mass in the right atrium and a diagnosis of low-grade B-cell lymphoma was obtained with the surgically resected tumor. The lesion appeared to have originated in the right atrium and involved the right ventricle. The patient died of bronchopneumonia 8 months after the initial consultation. The present case and 39 patients with PCL reported between 1995 and 2002 were reviewed. Forty patients showed various and non-specific symptoms such as dyspnea, edema, arrhythmia and pericardial effusion. Primary cardiac lymphoma occurred slightly more often in male patients (M : F = 23:17) and in the elderly in general (mean age, 67 years), with lesions found in the following locations, listed in order of frequency: right atrium, pericardium, right ventricle, left atrium, left ventricle, and other sites. Antemortem diagnosis was obtained in 37 of the 40 patients. Thirty-seven cases were of B-cell lineage and two cases were of T-cell lineage. Complete remission was obtained in only 15 of the 40 patients. Although PCL antemortem diagnoses have been made in the majority of recent cases, the prognosis still remains poor.     

Ultrastructural analysis of viral and bacterial lesions in human sudden cardiac death

Sinoatrial node, perinodular working myocardium of the right atrium and subendocardial muscle fibers of the left ventricle of 8 persons who died suddenly at the age of 23-69 years were studied ultrastructurally. In 1% of working cardiomyocytes, in 2 out of 5 cases of sudden cardiac death, viruses were detected. Myofibrils were destroyed in the damaged myocytes but the contact zones with undamaged myocytes remained intact. Rod-like bacteria were observed in the interstitium of the subendocardial myocardium of the left ventricle in one case. Destructive changes of the mitochondria, myofibrils and intercalated discs were found in the myocytes adjacent to bacteria. Viruses and bacteria were absent in 3 control cases. The possible role of viruses and bacteria in the development of sudden cardiac death is discussed.     

A case of persistent left and absent right superior caval vein: An anatomical and embryological perspective

The relatively common persistent left superior caval vein (LSCV) is in most cases associated with doubling of the superior caval vein. A persistent LSCV with absent right superior caval vein (RSCV)—a rather rare event—was found during our course of gross anatomy. The LSCV drained into an enlarged coronary sinus, which was partly accompanied by an apparent “double” sinus of normal size draining into this enlarged coronary sinus. Histological and immunofluorescence studies using antibodies against smooth and cardiac muscle actins were performed. The terminal part of the LSCV near the opening into the right atrium contained cardiac actin as expected for a normal derivative of the left sinus horn. Previously only one case of doubled coronary sinus with LSCV has been reported and this abnormality was explained by splitting of the sinus. In our case, the partly doubled coronary sinus had the structure of coronary veins. Mechanical forces have been invoked for the obliteration of the LSCV. Therefore, we examined thirteen human embryos from 15 mm to 32 mm crown‐rump length. In one embryo, we found a persistent LSCV together with an enormously enlarged left atrium. Contrary to previous suggestions our data indicate that during normal development a compression of the left anterior cardinal vein does not sufficiently explain the obliteration of the left and the persistence of the right vein. We therefore believe that beside a left dominated blood flow of head and arm, genes for left‐right signaling may have to be taken into consideration. Clin. Anat. 23:277–286, 2010. © 2010 Wiley‐Liss, Inc.     

山羊和家猪冠状窦和Marshall静脉肌桥的解剖学特征

目的：报道山羊和家猪心脏冠状窦和Marshall静脉肌桥的形态特征。方法：用大体解剖方法，观测山羊和家猪冠状窦和Marshall静脉肌桥的形态，起止点、走行及出现率，结果：两种动物冠状窦和Marshall静脉肌桥的出现率大于90%，其形态可分环形、纵形和斜形3种，它们均来源于右心房后壁，止于左心房。结论：山羊和家猪冠状窦和Marshall静脉表面覆盖有心肌纤维，是左右心房的异常通道之一这两种动物具备制作局灶性心房颤动物模型的解剖学基础。     

MORPHOLOGICAL OBSERVATION OF IDIOPATHIC CARDIOMYOPATHY CONSISTING OF 9 CASES ENCOUNTERED IN SUDDEN AND UNEXPECTED DEATH

The present study consists of 9 cases of idiopathic cardiomyopathy which were divided into two types, i.e. 6 cases of the hypertrophic type and 3 cases of the dilated type. The former type was found in school-children and relatively younger adults, and the latter in various ages. In both types the hearts showed marked enlargement. The characteristic gross changes of the hypertrophic type were hypertrophy of the anterior wall of left ventricle and of the ventricular septum. Microscopically, the hypertrophied myocardium demonstrated a bizarre arrangement showing different size and shape of muscle fibers. In addition, the walls of small arteries and arterioles revealed circumscribed elastosls here and there. In the dilated type, the hearts showed marked dilatation of both ventricles, and microscopy revealed coagulation necrosis of the myocardial fibers and marked scar formation with slight inflammatory cell Infiltration. The gross and microscopic changes in both types of idiopathic cardiomyopathy differed from one another in several respects, and the authors assumed that the differences indicate an independent etiology of both types in man.     

The effect of left ventricular assist device (LVAD) on cardiac reserve in dogs

The effect of LVAD on the preservation of cardiac reserve against ischemic damage was studied using Sarnoff's ventricular function curve. An LVAD was implanted between the canine left atrium and the aorta. Left ventricular function was measured by changing the height of the reservoir connected to the left atrium. The left ventricular function curve (LVFC) was drawn by plotting left ventricular stroke work (LVSW) against left atrial pressure (LAP). The coronary artery was occluded under a pump-on (ON group) or pump-off (OFF group). After reperfusion, measurements were repeated and changes in the LVFC caused by ischemia were compared in both groups. The gradient of the LVFC was significantly reduced by ischemia (107 +/- 15 ml/beat----80 +/- 14, n = 13) but not in the ON group. LVSW under normal preload did not significantly change in either group. This suggests that the LVAD preserved cardiac reserve against ischemic damage.