scholarly journals Successful Use of Pulmonary Vasodilators in Acute Chest Syndrome Complicated by Persistent Right Ventricular Failure

2019 ◽  
Vol 2019 ◽  
pp. 1-5
Author(s):  
Jacqueline T. DesJardin ◽  
Lucas S. Zier
Keyword(s):  
Cardiogenic Shock ◽  
Right Ventricular ◽  
Pain Control ◽  
Right Ventricular Failure ◽  
Acute Chest Syndrome ◽  
Cell Disease ◽  
Ventricular Failure ◽  
Pulmonary Vasodilators ◽  
Control And Prevention ◽  
History Of

Pulmonary hypertension (PH) is a known consequence of sickle cell disease (SCD) and is associated with increased mortality and more frequent episodes of acute chest syndrome (ACS). Pulmonary pressures are known to increase during ACS, and right ventricular (RV) failure has been described as a significant cause of mortality in this condition. Management of ACS includes exchange transfusion, pain control, and prevention of hypovolemia and hypoxemia. However, in patients with a history of precapillary PH in whom ACS is complicated by persistent RV failure and cardiogenic shock, RV afterload reduction with pulmonary vasodilators may be an effective treatment strategy. Here, we present a case of a young man with SCD-associated PH and ACS who was successfully managed with inhaled and oral pulmonary vasodilators in the setting of persistent elevations in pulmonary vascular resistance leading to acute RV failure and cardiogenic shock.

scholarly journals Inhaled Pulmonary Vasodilators and Thoracic Organ Transplantation: Does Evidence Support Its Use and Cost Benefit?

2019 ◽  
Vol 24 (1) ◽  
pp. 67-73 ◽  
Author(s):  
Ryan Krebs ◽  
Yoshihisa Morita
Keyword(s):  
Nitric Oxide ◽  
Pulmonary Hypertension ◽  
Heart Transplantation ◽  
Lung Transplantation ◽  
Right Ventricular ◽  
Right Ventricular Failure ◽  
Primary Graft Dysfunction ◽  
Graft Dysfunction ◽  
Ventricular Failure ◽  
Pulmonary Vasodilators

In heart transplantation, pulmonary hypertension and increased pulmonary vascular resistance followed by donor right ventricular dysfunction remain a major cause of perioperative morbidity and mortality. In lung transplantation, primary graft dysfunction remains a major obstacle because it can cause bronchiolitis obliterans and mortality. Pulmonary vasodilators have been used as an adjunct therapy for heart or lung transplantation, mainly to treat pulmonary hypertension, right ventricular failure, and associated refractory hypoxemia. Among pulmonary vasodilators, inhaled nitric oxide is unique in that it is selective in pulmonary circulation and causes fewer systemic complications such as hypotension, flushing, or coagulopathy. Nitric oxide is expected to prevent or attenuate primary graft dysfunction by decreasing ischemia-reperfusion injury in lung transplantation. However, when considering the long-term benefit of these medications, little evidence supports their use in heart or lung transplantation. Current guidelines endorse inhaled vasodilators for managing immediate postoperative right ventricular failure in lung or heart transplantation, but no guidance is offered regarding agent selection, dosing, or administration. This review presents the current evidence of inhaled nitric oxide in lung or heart transplantation as well as comparisons with other pulmonary vasodilators including cost differences in consideration of economic pressures to contain rising pharmacy costs.

scholarly journals Acute Right Ventricular Failure in a Patient with Non-ischemic Cardiogenic Shock on Left-Sided Mechanical Circulatory Support

2021 ◽  
Author(s):  
Shuvodra Routh ◽  
Carly Fabrizio ◽  
Christopher Sciortino ◽  
Arman Kilic ◽  
Catalin Toma ◽  
...  
Keyword(s):  
Cardiogenic Shock ◽  
Heart Transplantation ◽  
Right Ventricular ◽  
Mechanical Circulatory Support ◽  
Right Ventricular Failure ◽  
Circulatory Support ◽  
Mechanical Support ◽  
Ventricular Failure ◽  
Acute Right Ventricular Failure ◽  
Learning Points

We report a case of acute right ventricular failure in a patient with cardiogenic shock on left-sided mechanical circulatory support with Impella 5.0. The patient was successfully bridged to heart transplantation using additional right-sided support with ProtekDuo. Key learning points of the case include prompt recognition of right ventricular failure in patients on left-sided support, early consideration of right-ventricular mechanical support platforms, and timely deployment of right-sided mechanical support.

scholarly journals Surgical Treatment of Ebstein's Anomaly

2017 ◽  
Vol 65 (08) ◽  
pp. 639-648 ◽  
Author(s):  
Rüdiger Lange ◽  
Melchior Burri
Keyword(s):  
Surgical Treatment ◽  
Right Ventricular ◽  
Surgical Repair ◽  
Surgical Techniques ◽  
Right Ventricular Failure ◽  
Ebstein’S Anomaly ◽  
Ventricular Failure ◽  
Ebstein's Anomaly ◽  
History Of ◽  
Surgical Options

AbstractSurgical repair of the tricuspid valve is a milestone in the medical history of patients with Ebstein's anomaly. The timely alleviation of the insufficiency has an important impact on the prognosis. In this review, we describe features of the disease relevant to surgical correction and the evolution of surgical techniques over six decades. We compare the results of different repair and replacement techniques. Additionally, we discuss concomitant antiarrhythmic surgery and bailout strategies for postoperative right ventricular failure. Finally, we review the surgical options in symptomatic neonates with Ebstein's disease.

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