Determinants of maximal right ventricular function: Role of septal shift

Klima, Uwe; Lee, Myung-Yong; Guerrero, J. Luis; LaRaia, Paul J.; Levine, Robert A.; Vlahakes, Gus J.

doi:10.1067/mtc.2002.118683

Cited by 80 publications

(67 citation statements)

References 29 publications

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“…9,19,20 This benefit was independent of LV cardiac output. 9 Although the use of vasopressors can be beneficial, its prolonged administration can also contribute to systemic organ failure. 22 Specifically, prolonged administration (more than 48 h) of vasopressin has been linked to hepatic failure, renal failure, and thrombocytopenia.…”

Section: Managing Rv Failurementioning

confidence: 82%

“…23 However, the importance of maintaining systemic blood pressure and, subsequently, right coronary pressure and flow in the face of RV dysfunction may not be as well appreciated. 9 This has been demonstrated in experimental models of RV failure, where an increase in right coronary flow resulted in improved RV function. 9,19,20 This benefit was independent of LV cardiac output.…”

Section: Managing Rv Failurementioning

confidence: 90%

“…9 This has been demonstrated in experimental models of RV failure, where an increase in right coronary flow resulted in improved RV function. 9,19,20 This benefit was independent of LV cardiac output. 9 Although the use of vasopressors can be beneficial, its prolonged administration can also contribute to systemic organ failure.…”

Section: Managing Rv Failurementioning

confidence: 90%

“…[4][5][6][8][9][10][11] A number of investigations describe this interventricular interaction in terms of the IVS position, highlighting its impact on both LV and RV functions. [4][5][6][8][9][10][11] With the patient's informed consent, we present a case of severe primary RV failure that was successfully resuscitated with no significant improvement in the systolic function of the primary RV myocardial tissues. Of note, was the occurrence of paradoxical ventricular systolic septal motion (PVSM), during which the IVS moved toward the RV free wall during systole and appeared to contribute substantially to RV ejection.…”

Section: Résumémentioning

confidence: 99%

“…17 Based on these data, management of RV failure should consider early administration of vasoactive therapy with less aggressive fluid therapy. 4,9,17,[19][20][21] However, the selection of vasoactive medications needs to be tailored toward each specific situation.…”

Section: Managing Rv Failurementioning

confidence: 99%

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Case report: paradoxical ventricular septal motion in the setting of primary right ventricular myocardial failure

Maslow

Schwartz

Mahmood

et al. 2009

Can J Anesth/J Can Anesth

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Purpose In this report, a case of right ventricular (RV) failure, hemodynamic instability, and systemic organ failure is described to highlight how paradoxical ventricular systolic septal motion (PVSM), or a rightward systolic displacement of the interventricular septum, may contribute to RV ejection. Clinical features Multiple inotropic medications and vasopressors were administered to treat right heart failure and systemic hypotension in a patient following combined aortic and mitral valve replacement. In the early postoperative period, echocardiographic evaluation revealed adequate left ventricular systolic function, akinesis of the RV myocardial tissues, and PVSM. In the presence of PVSM, RV fractional area of contraction was C35% despite akinesis of the primary RV myocardial walls. The PVSM appeared to contribute toward RV ejection. As a result, the need for multiple inotropes was re-evaluated, in considering that end-organ dysfunction was the result of systemic hypotension and prolonged vasopressor administration. After discontinuation of phosphodiesterase inhibitors, native vascular tone returned and the need for vasopressors declined. This was followed by recovery of systemic organ function. Echocardiographic re-evaluation two years later, revealed persistent akinesis of the RV myocardial tissues and PVSM, the latter appearing to contribute toward RV ejection. Conclusions This case highlights the importance of left to RV interactions, and how PVSM may mediate these hemodynamic interactions. RésuméObjectif Dans ce compte-rendu, un cas de de´faillance ventriculaire droite (VD), d'instabilite´he´modynamique et de de´faillance organique syste´mique est de´crit afin de souligner la manie`re dont le mouvement systolique paradoxal du septum interventriculaire (PVSM), ou un de´placement systolique de la cloison interventriculaire vers la droite, peut jouer un rôle dans l'e´jection du VD. É léments cliniques De nombreux me´dicaments inotropes et vasopresseurs ont e´te´administre´s pour traiter une de´faillance cardiaque droite ainsi qu'une hypotension syste´mique chez un patient a`la suite d'une chirurgie valvulaire aortique et mitrale combine´e. Au de´but de la pe´riode postope´ratoire, l'e´valuation e´chocardiographique a re´ve´le´une fonction systolique ade´quate du ventricule Electronic supplementary material The online version of this article

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Section: Managing Rv Failurementioning

confidence: 82%

Section: Managing Rv Failurementioning

confidence: 90%

Section: Managing Rv Failurementioning

confidence: 90%

Section: Résumémentioning

confidence: 99%

Section: Managing Rv Failurementioning

confidence: 99%

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Case report: paradoxical ventricular septal motion in the setting of primary right ventricular myocardial failure

Maslow

Schwartz

Mahmood

et al. 2009

Can J Anesth/J Can Anesth

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Durable BiVADSupport: Configurations, Techniques, and Outcomes

Kearns,

Barac,

Daneshmand

et al. 2023

Textbook of Transplantation and Mechanical Support for End‐Stage Heart and Lung Disease

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Right heart failure with left ventricular assist devices: Preoperative, perioperative and postoperative management strategies. A clinical consensus statement of the Heart Failure Association (HFA) of the ESC

Adamopoulos,

Bonios,

Ben Gal

et al. 2024

European J of Heart Fail

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Right heart failure (RHF) following implantation of a left ventricular assist device (LVAD) is a common and potentially serious condition with a wide spectrum of clinical presentations with an unfavourable effect on patient outcomes. Clinical scores that predict the occurrence of right ventricular (RV) failure have included multiple clinical, biochemical, imaging and haemodynamic parameters. However, unless the right ventricle is overtly dysfunctional with end‐organ involvement, prediction of RHF post‐LVAD implantation is, in most cases, difficult and inaccurate. For these reasons optimization of RV function in every patient is a reasonable practice aiming at preparing the right ventricle for a new and challenging haemodynamic environment after LVAD implantation. To this end, the institution of diuretics, inotropes and even temporary mechanical circulatory support may improve RV function, thereby preparing it for a better adaptation post‐LVAD implantation. Furthermore, meticulous management of patients during the perioperative and immediate postoperative period should facilitate identification of RV failure refractory to medication. When RHF occurs late during chronic LVAD support, this is associated with worse long‐term outcomes. Careful monitoring of RV function and characterization of the origination deficit should therefore continue throughout the patient's entire follow‐up. Despite the useful information provided by the echocardiogram with respect to RV function, right heart catheterization frequently offers additional support for the assessment and optimization of RV function in LVAD‐supported patients. In any patient candidate for LVAD therapy, evaluation and treatment of RV function and failure should be assessed in a multidimensional and multidisciplinary manner.

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Determinants of maximal right ventricular function: Role of septal shift

Cited by 80 publications

References 29 publications

Case report: paradoxical ventricular septal motion in the setting of primary right ventricular myocardial failure

Case report: paradoxical ventricular septal motion in the setting of primary right ventricular myocardial failure

Durable BiVADSupport: Configurations, Techniques, and Outcomes

Right heart failure with left ventricular assist devices: Preoperative, perioperative and postoperative management strategies. A clinical consensus statement of the Heart Failure Association (HFA) of the ESC

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