Acute pressure overload of the right ventricle. Comparison of two models of right-left shunt. Pulmonary artery to left atrium and right atrium to left atrium: experimental study

Argiriou, Mihalis; Mikroulis, Dimitrios; Sakellaridis, Timothy; Didilis, Vassilios; Papalois, Αpostolos; Bougioukas, Georgios

doi:10.1186/1749-8090-6-143

Cited by 3 publications

(3 citation statements)

References 23 publications

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“…This can be accomplished via pulmonary artery-left atrial graft and has been shown to improve RV function. 29,30 Intraoperative echocardiography is used to assess biventricular and valvular function, presence of shunts, and detection of cardiac thrombi. Adequate pump function should be confirmed at this time, and if cardiac index is < 2.0 and central venous pressure is > 20, a temporary RVAD should be considered.…”

Section: Surgical Managementmentioning

confidence: 99%

Predictors and Management of Right Heart Failure after Left Ventricular Assist Device Implantation

Fida¹,

Loebe²,

Estep³

et al. 2015

Methodist DeBakey Cardiovascular Journal

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Early recognition and improved outcomes of ischemic heart disease has resulted in an aging population and a global increase in the prevalence of heart failure (HF).1 Consequently, the burden of stage D heart failure (HF), which is unresponsive to conventional medical therapy, has surpassed the availability of the finite donor organ pool. 2 Significant advances in the field of mechanical circulatory support has made destination therapy (DT) with left ventricular assist devices (LVADs) a promising alternative to heart transplantation, with 1-year postimplant actuarial survival at about 80% with a continuous flow LVAD (CF-LVAD). 3However, despite newer technology and greater familiarity with patient management, physicians continue to be confronted by early and/or late right ventricular failure (RVF) that significantly impacts survival post-LVAD implantation. As none of the current mechanical circulatory support (MCS) devices are approved for DT for solitary right heart support or biventricular support, it is critical to identify preoperative predictors of right heart failure post-LVAD implant. Definition and Incidence of Right Ventricular Failure after LVAD PlacementIn the absence of a universally agreed-upon definition of RVF after LVAD placement, its reported incidence varies with the institutional practice, the United Network for Organ Sharing (UNOS) indication for MCS, the device type, and the criteria used to define failure. Additionally, it is now recognized that RVF is a progressive condition that can occur beyond the immediate postoperative period. However, this emerging concept of "late RVF" remains ill-defined and difficult to predict. The Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) defines RVF as persistent signs and symptoms of RV dysfunction evident by central venous pressure (CVP) > 18 mm Hg with a cardiac index (CI) < 2.0 L/min/m 2 in the absence of increased left atrial filling pressure/pulmonary capillary wedge pressure (PCWP) > 18 mm Hg, cardiac tamponade, ventricular arrhythmias, and/or pneumothorax requiring either right ventricular assist device (RVAD) implantation or inhaled nitric oxide or inotropic therapy for ≥ 14 days after LVAD implantation. 4 According to INTERMACS, RVF severity is described as follows:• Severe, when there is a need for RVAD; • Moderate, when inotropes or intravenous or inhaled pulmonary vasodilators are used; and • Mild, when a combination of ≥ 2 signs and symptoms are present but without the need for RVAD or inotropic and/ or vasodilator support. Signs and symptoms include CVP > 18 mm Hg, CI < 2.3 L/min/m 2 , ascites, moderate to severe peripheral edema, or evidence of high CVP on physical exam or transthoracic echocardiogram.The incidence of severe RVF necessitating RVAD placement after LVAD or preemptive BiVAD support is reported to be anywhere from 9.4% to 37.0%. [5][6][7][8][9] Most studies have reported the incidence encompassing the need for inotropic support with or without RVAD (≥ 14 days) after LVAD implant, with a range of b...

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Section: Surgical Managementmentioning

confidence: 99%

Predictors and Management of Right Heart Failure after Left Ventricular Assist Device Implantation

Fida¹,

Loebe²,

Estep³

et al. 2015

Methodist DeBakey Cardiovascular Journal

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“…A worsening TR, due to the shift of IVS with a dilated tricuspid annulus, may need correction, as this will help in maintaining venous flow and renal perfusion and significantly reduces post-operative morbidity. There are sporadic reports indicating that creation of a PA to LA shunt helps in reducing the RV after-load and improves function [48,49]. Intraoperatively, RV failure is recognized when the cardiac index (CI) remains than 2.0 L/min/m 2 and CVP is greater than 20 mmHg.…”

Section: Iv) Pulmonary Artery Pulsatility Index (Papi)mentioning

confidence: 99%

Perioperative right ventricular function and dysfunction in adult cardiac surgery—focused review (part 2—management of right ventricular failure)

Varma

Srimurugan

Jose

et al. 2021

Indian J Thorac Cardiovasc Surg

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“…Pulmonary artery-left atrium shunt has been proposed and preferred to an inter-atrial shunt to moderate or even partially reverse the adverse effects of acute right ventricle pressure overload [56]. Finally, atrial fibrillation is common after lung transplantation despite the absence of graft rejection and cardiac dysfunction [57].…”

Section: Pulmonary Hypertension Pulmonary Wedge Pressure and Right Vmentioning

confidence: 99%

Cardiopulmonary Consequences of Post Thoracic Surgery Pulmonary Hypertension: Cause or Consequence of Lung Edema?

Rivolta¹,

Beretta²,

Panariti

et al. 2013

J Clin Exp Cardiolog

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The major complication of post-thoracic surgery is a severe disturbance of lung extravascular water that is the main cause of morbidity and mortality and therefore still represents an unmet medical challenge. Accordingly, the need to devise novel therapies ought to go through a more thorough understanding of the pathophysiological mechanisms. This review presents an updated description of the time evolution of this process providing the pathophysiological reason for its explosive development. Despite various names ("idiopathic edema", acute lung injury-ALI, atelectasis, ARDS), a common patho-physiological pathway can be traced for respiratory dysfunction in post-operative thoracic surgery. We will present the evidence for the loss of control on the volume of extravascular lung water from the new perspective of the derangement and disorganization of interstitial proteoglycans, a family of link molecules controlling microvascular permeability and mechanical stability of the extravascular matrix. We analyze in detail specific conditions of lung water disturbance pertaining to cardiac surgery, lung transplant and lung resection surgery. In particular, we will discuss the functional link between lung edema formation and increase in pulmonary vascular resistances, and wish to develop the concept that pulmonary hypertension and right ventricle overload ought to be regarded as the consequence of a decrease in vascular bed reflecting microvessels compression in the edematous tissue both in the acute phase as well as in the fibro-proliferative repair process.

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Acute pressure overload of the right ventricle. Comparison of two models of right-left shunt. Pulmonary artery to left atrium and right atrium to left atrium: experimental study

Cited by 3 publications

References 23 publications

Predictors and Management of Right Heart Failure after Left Ventricular Assist Device Implantation

Predictors and Management of Right Heart Failure after Left Ventricular Assist Device Implantation

Perioperative right ventricular function and dysfunction in adult cardiac surgery—focused review (part 2—management of right ventricular failure)

Cardiopulmonary Consequences of Post Thoracic Surgery Pulmonary Hypertension: Cause or Consequence of Lung Edema?

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