Epicardial Echocardiography as Rescue Modality for Detection of Dynamic Right Ventricular Outflow Tract Obstruction in Post Pulmonary Valve Stenosis Repair

Right Ventricular Outflow Tract Obstruction in Adults: A Systematic Review and Meta-analysis

“… 223 Most of the other reported cases were observed after lung transplantation (n = 9). 55 , 61 , 65 , 67 , 70 , 108 , 142 , 231 Two cases occurred as a result of cardiac surgery complications, 134 , 242 and one case resulted from a postoperative mediastinal hematoma. 66 A single case could be attributed to cardiac catheterization, which iatrogenically precipitated infundibular muscular spasm in a patient with pulmonic stenosis and thus dynamic RVOTO.…”

Right Ventricular Outflow Tract Obstruction in the Intensive Care Unit: A Case Report of 2 Patients

“… 13 Dynamic RVOTO may also occur after lung transplantation 3 and pulmonic stenosis correction. 8 The term “suicide” RV has been used to describe dynamic RVOTO occurring after acute reduction of RV afterload, such as after lung transplantation or due to RVOT spasm during catheterization. 1 , 3 , 7 Figure 4 summarizes the various etiologies and mechanisms of RVOTO.…”

“… 4 , 6 , 7 RVOTO may be identified on transthoracic (TTE), transesophageal (TEE), 4 or epicardial echocardiography. 8 Diagnosis can also be made with right ventricle (RV) cardiac catheterization 6 with Prv waveform display 9 using an opening at 19 cm from the distal tip (Thermodilution pace port catheter, Swan-Ganz P. ref 931F75; Edwards Lifesciences). This allows dual pressure monitoring of the Prv and Ppa.…”

“…Severe RVOTO has been reported after lung transplantation, cardiac surgery, and cardiac catheterization, and has been called “suicide” RVOTO 1 , 3 , 7 as a result of acute reduction in RV afterload. 4 , 8 We describe the first cases of RVOTO diagnosed postoperatively in the ICU using continuous Prv waveform monitoring. Family of patient 1 gave written consent, and patient 2 gave written consent to report these cases.…”