Point-of-Care Ultrasonography to Assess Portal Vein Pulsatility and the Effect of Inhaled Milrinone and Epoprostenol in Severe Right Ventricular Failure

Abstract

This article describes 2 patients with severe acute right ventricular failure causing circulatory shock. Portal vein pulsatility assessed by bedside ultrasonography suggested clinically relevant venous congestion. Management included cardiac preload reduction and combined inhalation of milrinone and epoprostenol to reduce right ventricular afterload. Portal vein ultrasonography may be useful in assessing right ventricular function in the acutely ill patient.

The Role of Point-of-Care Ultrasound Monitoring in Cardiac Surgical Patients With Acute Kidney Injury

“…96 In patients presenting a distended IVC and abnormalities of intrarenal venous flow or pulsatile portal flow, a management aimed at reducing venous pressure by treating right ventricular dysfunction or inducing a negative fluid balance may improve kidney function. For example, cases where the administration of pulmonary vasodilators resulted in a reduction in portal flow pulsatility 97 or a normalization of intrarenal venous flow have been published previously. 22 However, this strategy has not been investigated in an interventional trial so far.…”

Critical Care of Patients After Pulmonary Thromboendarterectomy

“…Analysis of RV pressure waveforms, calculation of pulmonary artery pulsatility index (PAPi), ultrasound assessment of portal vein flow, and echocardiography in the absence of PAC monitoring all can provide pertinent information on RV function. [38][39][40][41] In particular, echocardiography has high value in the assessment of acute hemodynamic deterioration in the ICU because it is readily available and often provides information pertinent to differentiate etiology of shock and instability. Aside from anatomical findings, subjective judgment of ventricular systolic function, and incorporation of tricuspid regurgitation and hepatic vein flow, specific parameters commonly used to assess the RV are 2-dimensional fractional area change, tricuspid annulus plane excursion, and spectral-Doppler derived parameters of myocardial performance index (TEI index) and myocardial systolic excursion (S').…”

Doppler Interrogation of the Femoral Vein in the Critically Ill Patient: The Fastest Potential Acoustic Window to Diagnose Right Ventricular Dysfunction?

“…This is particularly useful when these findings are combined with other clinical, hemodynamic, and echocardiographic variables associated with RV dysfunction and venous congestion. Similarly to the changes observed in hepatic or portal venous Doppler following fluid resuscitation and vasoactive treatment ( 19 , 21 , 60 ), changes in CFV Doppler signals could be also be used for that purpose. The technique is currently used by the ICU nursing personnel and medical students on ICU rotation.…”

“…At this point, diuretics and inhaled vasodilators (prostacyclin and milrinone) were initiated to reduce organ congestion ( 19 , 21 , 36 ). By postoperative day 3, the patient’s cumulative fluid balance was 200 mL positive, he no longer required vasopressor support, and he could be discharged to the ward.…”