Medical and Surgical Treatment of Acute Right Ventricular Failure

Lahm, Tim; McCaslin, Charles A.; Wozniak, Thomas; Ghumman, Waqas; Fadl, Yazid Y.; Obeidat, Omar; Schwab, Katie; Meldrum, Daniel R.

doi:10.1016/j.jacc.2010.05.046

Cited by 167 publications

(162 citation statements)

References 135 publications

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“…Treatment strategies for RV failure rely on the patophysiological grounds of RV function and dysfunction and include volume and preload optimization, afterload reduction and improvement of contractility and perfusion (12). These goals are achieved by careful volume management, vasopressor and inotrope support and use of selective pulmonary vasodilators.…”

Section: Treatment Of Right Ventricular Failurementioning

confidence: 99%

Right ventricular function in critically ill patients

2017

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The right ventricular function is crucial for maintaining hemodynamic stability in critically ill patients who suffer from sudden increases of right ventricular pressure overload and/or severely decreased right ventricular contractility. The morphological and functional assessment of the right ventricle is usually performed by bedside echocardiography and hemodynamic measurements with a pulmonary artery catheter. The therapeutic approach to patients with right ventricular failure includes measures to decrease right ventricular afterload and to improve its coronary perfusion and contractility.Key words: right ventricle, failure, systolic function BASIC ANATOMIC, PHYSIOLOGIC AND PATHOPHYSIOLOGIC DATA Sixty years ago, the right ventricle (RV) was considered a passive conduit for blood flow and only a "weak sister" of the strong and powerful left ventricle (1). More than thirty years later, the RV function was revisited and it became clear, that RV failure is responsible for shock in patients with massive pulmonary embolism and RV myocardial infarction (2-4). The thin free wall of the RV forms the anterior and inferior part of the RV and the posterolateral wall represents the intraventricular septum, which normally bulges into the RV. The RV blood supply occurs during systole and diastole; the oxygen extraction is very high, and ATP amount is lower than in the LV. The free wall is very compliant and is capable of maintaining low systemic pressure and preventing pulmonary edema in the case of LV failure. These characteristics make the RV very sensitive to hypoxia. The geometry of the RV is quite complex with clearly separated inflow and outflow tracts. Because of the complex geometry, the LV models are not valid for the RV. The contraction of the RV is less synchronous than that of the LV and occurs as a peristaltic wave starting in the inflow tract and propagating through the apex to the outflow tract. In physiologic conditions, when the pulmonary vascular resistance is low, RV function is indeed of secondary importance. On the other hand, in pathologic conditions with increased pulmonary vascular resistance and/or severely impaired RV contractility, RV function becomes essential for maintaining adequate pulmonary blood flow. The basic consequence of the sudden increase of RV afterload and/ or decreased contractility is RV dilation. Since a dilated RV reduces the LV volume in the rigid pericardial sac, the LV filling is reduced with consequently decreased LV stroke volume and mean arterial pressure. Arterial hypotension provokes RV ischemia that further reduces RV systolic function (5). The RV function is therefore relevant in patients with chronic lung diseases, primary pulmonary vascular disease, pulmonary thrombembolic disorders, sepsis related acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) and after cardiac surgery. Patients with chronic lung diseases frequently present with chronic cor pulmonale, which is characterized by RV free wall hypertrophy and various degrees of dilation w...

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Section: Treatment Of Right Ventricular Failurementioning

confidence: 99%

Right ventricular function in critically ill patients

2017

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“…Post-transplant RV failure Acute RV failure has several potential causes, including recipient pulmonary hypertension, intraoperative injury/ischemia, and excess volume/blood product resuscitation. MCS support provides time for the donor right ventricle to recover function, often with the assistance of inotropic and pulmonary vasodilator therapy [109]. Patients slow to wean from cardiopulmonary bypass following heart surgery Although selected patients may be transitioned to a percutaneous system for additional weaning, this is rarely done.…”

Section: Indication Commentsmentioning

confidence: 99%

2015 SCAI/ACC/HFSA/STS clinical expert consensus statement on the use of percutaneous mechanical circulatory support devices in cardiovascular care (Endorsed by the American heart assocation, the cardiological society of India, and sociedad latino Americana de cardiologia intervencion; Affirmation of value by the canadian association of interventional cardiology–association canadienne de cardiologie d'intervention)

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Cathet Cardio Intervent

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Although historically the intra-aortic balloon pump has been the only mechanical circulatory support device available to clinicians, a number of new devices have become commercially available and have entered clinical practice. These include axial flow pumps, such as Impella V R ; left atrial to femoral artery bypass pumps, specifically the is approached by other guideline developers and asked to review and consider guidelines for endorsement. Guidelines developed by external organizations will be considered for affirmation of value. The CAIC may not agree with every recommendation in such a document, but overall considers the document to be of educational value to its members. Catheterization and Cardiovascular Interventions 85:E175-E196 (2015)TandemHeart; and new devices for institution of extracorporeal membrane oxygenation. These devices differ significantly in their hemodynamic effects, insertion, monitoring, and clinical applicability. This document reviews the physiologic impact on the circulation of these devices and their use in specific clinical situations. These situations include patients undergoing high-risk percutaneous coronary intervention, those presenting with cardiogenic shock, and acute decompensated heart failure. Specialized uses for rightsided support and in pediatric populations are discussed and the clinical utility of mechanical circulatory support devices is reviewed, as are the American College of Cardiology/American Heart Association clinical practice guidelines.

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“…å øke oksygenering, redusere respiratorisk eller metabolsk acidose eller å dilatere lungekarsengen, f.eks. ved bruk av inhalert NO (4). NO het opprinnelig endotelderivert relakserende faktor og er en naturlig vasodilator som bidrar til å regulere vaskulaer motstand (5,6).…”

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Medical and Surgical Treatment of Acute Right Ventricular Failure

Cited by 167 publications

References 135 publications

Right ventricular function in critically ill patients

Right ventricular function in critically ill patients

En kvinne i 70-årene med dekompensert hjertesvikt under operasjon

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