Managing Harlequin Syndrome in VA-ECMO – do not forget the right ventricle

Perfusion ◽  
2021 ◽  
pp. 026765912110208
Author(s):  
James Wilson ◽  
Richard Fisher ◽  
Francisca Caetano ◽  
Hatem Soliman-Aboumarie ◽  
Brijesh Patel ◽  
...  
Keyword(s):  
Gas Exchange ◽  
Extracorporeal Membrane Oxygenation ◽  
Right Ventricle ◽  
Ventricular Dysfunction ◽  
Right Ventricular Dysfunction ◽  
Left Ventricular ◽  
Ecmo Circuit ◽  
Harlequin Syndrome ◽  
Va Ecmo ◽  
The Right

Harlequin Syndrome (also known as North-South Syndrome) is a complication of veno-arterial extracorporeal membrane oxygenation (V-A ECMO) that can occur when left ventricular function starts to recover. While most commonly due to continued impaired gas exchange in the lungs, we present a case caused by right ventricular dysfunction, successfully managed by conversion of the ECMO circuit to a veno-veno-arterial (VV-A) configuration.

Right Ventricular Failure

2020 ◽  
Vol 31 (1) ◽  
pp. 49-56
Author(s):  
Barbara Leeper
Keyword(s):  
Right Ventricle ◽  
Right Ventricular ◽  
Ventricular Dysfunction ◽  
Right Ventricular Dysfunction ◽  
Left Ventricular ◽  
Right Ventricular Failure ◽  
Ventricular Assist Devices ◽  
Ventricular Failure ◽  
Assist Devices ◽  
The Right

Interest in the right ventricle has increased because of advances in pulmonary hypertension treatment, improved diagnostic technology, and increased implantation of left ventricular assist devices and other mechanical circulatory assist devices. Right ventricular dysfunction is an independent predictor of mortality in patients with chronic heart failure. The purpose of this article is to describe the normal structure and function of the right ventricle, causes of right ventricular dysfunction leading to right ventricular failure, diagnostic hemodynamic assessments, and management of right ventricular failure in the critical care unit.

scholarly journals Carfilzomib-induced pulmonary hypertension with associated right ventricular dysfunction: A case report

2021 ◽  
Vol 9 ◽  
pp. 2050313X2199403
Author(s):  
Pei-Chun McGregor ◽  
Valia Boosalis ◽  
Jayashri Aragam
Keyword(s):  
Multiple Myeloma ◽  
Pulmonary Hypertension ◽  
Right Ventricular ◽  
Ventricular Dysfunction ◽  
Right Ventricular Dysfunction ◽  
Left Ventricular ◽  
Elderly Male ◽  
Acute Right Ventricular Failure ◽  
The Right ◽  
Male Veteran

Carfilzomib, a selective proteasome inhibitor, is approved for use in relapsed and refractory multiple myeloma. Its link to left ventricular dysfunction is well established but little is known about its effects on the right ventricle. One of its rare complications is pulmonary hypertension, which at its extreme may result in right ventricular dysfunction. Here, we present a case of an elderly male veteran with multiple myeloma status post various failed therapies who developed acute dyspnea after four cycles of carfilzomib and subsequently found to have severe pulmonary hypertension with resultant acute right ventricular failure, which recovered after cessation of carfilzomib. This case highlights the need for careful cardiovascular surveillance while on carfilzomib and the importance of knowing even its rarest complications as these cardiotoxicities are reversible with discontinuation of the drug.

scholarly journals Forgotten No More—The Role of Right Ventricular Dysfunction in Heart Failure with Reduced Ejection Fraction: An Echocardiographic Perspective

Diagnostics ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. 548
Author(s):  
Aura Vijiiac ◽  
Sebastian Onciul ◽  
Claudia Guzu ◽  
Alina Scarlatescu ◽  
Ioana Petre ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Right Ventricle ◽  
Right Ventricular ◽  
Functional Assessment ◽  
Ventricular Dysfunction ◽  
Right Ventricular Dysfunction ◽  
Reduced Ejection Fraction ◽  
The Right

During the last decade, studies have raised awareness of the crucial role that the right ventricle plays in various clinical settings, including diseases primarily linked to the left ventricle. The assessment of right ventricular performance with conventional echocardiography is challenging. Novel echocardiographic techniques improve the functional assessment of the right ventricle and they show good correlation with the gold standard represented by cardiac magnetic resonance. This review summarizes the traditional and innovative echocardiographic techniques used in the functional assessment of the right ventricle, focusing on the role of right ventricular dysfunction in heart failure with reduced ejection fraction and providing a perspective on recent evidence from literature.

scholarly journals Current outcomes and treatment of tetralogy of Fallot

F1000Research ◽  
2019 ◽  
Vol 8 ◽  
pp. 1530 ◽  
Author(s):  
Jelle P.G. van der Ven ◽  
Eva van den Bosch ◽  
Ad J.C.C. Bogers ◽  
Willem A. Helbing
Keyword(s):  
Right Ventricle ◽  
Right Ventricular ◽  
Ventricular Dysfunction ◽  
Pulmonary Regurgitation ◽  
Treatment Strategies ◽  
Right Ventricular Dysfunction ◽  
Pulmonary Valve Replacement ◽  
Term Survival ◽  
The Right

Tetralogy of Fallot (ToF) is the most common type of cyanotic congenital heart disease. Since the first surgical repair in 1954, treatment has continuously improved. The treatment strategies currently used in the treatment of ToF result in excellent long-term survival (30 year survival ranges from 68.5% to 90.5%). However, residual problems such as right ventricular outflow tract obstruction, pulmonary regurgitation, and (ventricular) arrhythmia are common and often require re-interventions. Right ventricular dysfunction can be seen following longstanding pulmonary regurgitation and/or stenosis. Performing pulmonary valve replacement or relief of pulmonary stenosis before irreversible right ventricular dysfunction occurs is important, but determining the optimal timing of pulmonary valve replacement is challenging for several reasons. The biological mechanisms underlying dysfunction of the right ventricle as seen in longstanding pulmonary regurgitation are poorly understood. Different methods of assessing the right ventricle are used to predict impending dysfunction. The atrioventricular, ventriculo-arterial and interventricular interactions of the right ventricle play an important role in right ventricle performance, but are not fully elucidated. In this review we present a brief overview of the history of ToF, describe the treatment strategies currently used, and outline the long-term survival, residual lesions, and re-interventions following repair. We discuss important remaining challenges and present the current state of the art regarding these challenges.

scholarly journals Interaction between veno-arterial extracorporeal membrane oxygenation and the right ventricle

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
EP Elena Puerto ◽  
GT Guido Tavazzi ◽  
AG Alessia Gambaro ◽  
CC Chiara Cirillo ◽  
AP Alessandro Pecoraro ◽  
...  
Keyword(s):  
Left Ventricle ◽  
Extracorporeal Membrane Oxygenation ◽  
Right Ventricle ◽  
Outflow Tract ◽  
Ecmo Support ◽  
Ventricular Failure ◽  
Membrane Oxygenation ◽  
Va Ecmo ◽  
The Right ◽  
Rv Function

Abstract Funding Acknowledgements Type of funding sources: Private company. Main funding source(s): Fundación Alfonso Martín Escudero The response of the right ventricle (RV) to the hemodynamic effects of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is unpredictable. We hypothesized if presence of uni- or bi-ventricular failure before implantation and cannulation strategy may influence. We assessed RV performance during VA-ECMO support and identify RV-related predictors of weaning.  Methods. Changes of RV size and function during VA-ECMO by echocardiography were retrospectively analyzed in 87 patients. Predictors of weaning were evaluated by logistic regression. Results. RV echocardiographic parameters did not vary significantly during VA-ECMO, neither after stratification by cannulation type or presence of isolated or biventriular failure. Succesful weaning was conditioned by absence of RV dysfunction before implantation (OR 14.7,95%CI 13.3-140.3;p = 0.025) or in the last day of support (OR 9.5; 95%CI 1.6-54;p = 0.011) and was favored by a total or partial recovery of RV function during the assistance (OR 6.2; 95%CI 1.7-22.4;p = 0.005). RV improvement was more often observed in patients with acute RV failure, while VA-ECMO configuration had no effect. Conclusions. Preservation or improvement of RV function during VA-ECMO support is essential for weaning. RV echocardiographic performance does not change significantly during VA-ECMO  and is not influenced by cannulation type or presence of uni- or bi-ventricular failure before implantation. Echo parameters evolution during VA-ECMOPre-ECMO< 24h on ECMO> 24h on ECMOpNn = 68n = 68n = 63LV diastolic diameter, mm (mean ± SD)53.34 ± 15.5954.86 ± 13.8956.18 ± 14.620.317LV systolic diameter, mm45.28 ± 11.6745.17 ± 14.5846.07 ± 15.590.963LVEF, n (%)20 (10-38.75)17.5 (10-30)25 (10-40)0.102RV basal diameter, mm (mean ± SD)41.05 ± 9.7938.92± 9.1740.05 ± 9.560.484RV systolic disfunction, n (%)65 (95.6)65 (95.5)43 (68.2)0.073Tricuspid regurgitation, n (%)50 (73.4)37 (54.3)49 (77.8)0.146Pulmonary systolic pressure, mmHg (mean ± SD)41.54 ± 24.1339.09 ± 20.2445.29 ± 25.730.783Aortic regurgitation, n (%)47 (69.1)39 (57.4)35 (55.5)0.775Mitral regurgitation, n (%)64 (94.1)48 (70.5)44 (69.8)0.591Dd diastolic diameter; EF: ejection fraction; LV: left ventricle; LVOT: left ventricle outflow tract; RV: right ventricle; RVOT: right ventricle outflow tract; VTI: velocity time integralAbstract Figure. Right ventricular function predictors

scholarly journals Right Ventricular Function in Chronic Heart Failure: From the Diagnosis to the Therapeutic Approach

2020 ◽  
Vol 7 (2) ◽  
pp. 12 ◽  
Author(s):  
Francesco Monitillo ◽  
Vito Di Terlizzi ◽  
Margherita Ilaria Gioia ◽  
Roberta Barone ◽  
Dario Grande ◽  
...  
Keyword(s):  
Heart Failure ◽  
Right Ventricle ◽  
Ventricular Dysfunction ◽  
Diagnostic Techniques ◽  
Left Ventricular ◽  
Complete Evaluation ◽  
Right Ventricle Dysfunction ◽  
Important Challenge ◽  
The Right ◽  
And Function

There is growing attention for the study of the right ventricle in cardiovascular disease and in particular in heart failure. In this clinical setting, right ventricle dysfunction is a significant marker of poor prognosis, regardless of the degree of left ventricular dysfunction. Novel echocardiographic methods allow for obtaining a more complete evaluation of the right ventricle anatomy and function as well as of the related abnormalities in filling pressures. Specific and effective therapies for the right ventricle dysfunction are still not well defined and this represents the most difficult and important challenge. This article focuses on available diagnostic techniques for studying right ventricle dysfunction as well as on the therapies for right ventricle dysfunction.

P1833The c-fos mRNA expression reveals persistent myocardial stretch in the right ventricle during asphyxiated cardiac arrest

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Kadowaki ◽  
S Yamazaki ◽  
Y Kotani ◽  
T Tsuji ◽  
N Sakoda ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Left Ventricle ◽  
Right Ventricle ◽  
Heart Transplantation ◽  
Right Ventricular ◽  
Ventricular Dysfunction ◽  
Volume Overload ◽  
Right Ventricular Dysfunction ◽  
Dunnett's Test ◽  
The Right

Abstract Background Donation after circulatory death (DCD) heart transplantation has been debated over the past decades because of the shortage of donor. The right ventricular dysfunction is one of the remaining problems for clinical implication of DCD heart transplantation. DCD hearts suffering from the volume overload have a potential to aggravate the right ventricular dysfunction after heart transplantation. The c-fos mRNA is one of the “immediate” response genes to mechanical stresses, such as myocardial cell stretch, without neural and humoral factors. In this study, we assessed myocardial stretch during asphyxiated cardiac arrest using c-fos mRNA expression. Purpose The purpose of this study is to reveal the impact of right ventricular volume overload during asphyxiated cardiac arrest. Methods Male Wistar rats (8 weeks of age, n=18) were anesthetized with paralyzed ventilation. The trachea was dissected and ligated to initiate asphyxiation. Hearts were harvested at 3 time points: 0, 15 and 30 minutes after termination of the ventilation. Free walls of right and left ventricle were sectioned and immersed in RNA stabilization solution as soon as possible. Total RNA was extracted from these tissues using a guanidine thiocyanate-phenol-chloroform method and cDNA was synthesized using a reverse transcriptase. Next, we measured the quantified expression level by using the droplet digital PCR method with a probe and primers for c-fos gene. Expression of c-fos level was divided by extracted TATA binding protein (TBP) level as a control marker, the ratio of c-fos and TBP was used in analysis. Results In the left ventricle, the expression of c-fos rapidly increased by 15 minutes (0.81±0.24 (c-fos/TBP), p<0.05 by one-way ANOVA followed by the Dunnett's test) compared to at 0 minutes (0.21±0.06), but the expression level recovered to the baseline level at 30 minutes after termination of the ventilation (0.19±0.03). On the other hand, in the right ventricle, the c-fos expression was gradually elevated and peaked at 30 minutes (0.88±0.20, p<0.05 by the Dunnett's test) compared to at 0 minutes (0.22±0.05). Conclusion These results suggest that the volume overload to the right ventricle during asphyxiated cardiac arrest prolongs compared to that to the left ventricle, which may cause the right ventricular dysfunction after DCD heart transplantation.

scholarly journals Determination of the most informative indicators of right-ventricular dysfunction in patients with chronic obstructive pulmonary disease

2020 ◽  
Vol 15 (2) ◽  
pp. 115-123
Author(s):  
Mikhail Kharitonov ◽  
◽  
Victor Tarasov ◽  
Sergei Grishaev ◽  
Alexander Filippov ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Right Ventricle ◽  
Right Ventricular ◽  
Ventricular Dysfunction ◽  
Right Ventricular Dysfunction ◽  
Control Group ◽  
Chronic Obstructive ◽  
Study Group ◽  
Obstructive Pulmonary Disease ◽  
The Right

The aim of the article was the evaluation of structural and functional indicators that reflect the nature of right heart remodeling in patients with chronic obstructive pulmonary disease (COPD) in order to identify the most informative indicators of right ventricular heart dysfunction. The study included 60 patients, who were on inpatient treatment. Patients were divided into two groups: I — study group with COPD (n = 30), and II control group — patients of comparable age without COPD (n = 30). During hospitalization, all patients underwent ECHO-KG with an emphasis on evaluating the systolic-diastolic parameters of the right ventricle. Criteria for inclusion in the study: age over 50 years, presence of COPD, signed informed consent when reading the terms of the study. Exclusion criteria: history/course of neoplastic or hematological disease, systemic connective tissue diseases, documented ischemic disease, valvular heart disease, interstitial lung disease, bronchial asthma. When comparing echocardiographic indicators of right ventricular (RV) function detected significant decrease of systolic function the RV — TAPSE (16.64 ± 4.0 vs 23.21 ± 2.31; p = 0.043), S’(12.57 ± 1.87 vs. 14.96 ± 1.09; p = 0.026), estimated RV EF (49.27 ± 9.23 vs 66.12 ± 7.42; p = 0.021), EFSRV (55.58 ± 7.16 vs 72.4 ± 13.06; p = 0.01) and higher rates SDLA (49.55 ± 6.0 vs 27.1 ± 5.29; p = 0.023) in the study group 1. Measure of right ventricular arterial pairing TAPSE/SDLA was significantly reduced compared with the control group (0.36 ± 0.05 vs 0.86 ± 0.14; p = 0.01). In the main 1 group of patients with COPD, there was a tendency increase of the myocardial performance index (TEI index) (0.76 ± 0.42 vs 0.59 ± 0.22; p = 0.43), which is probably associated with a violation of the relaxation of the right ventricle. To confirm the presence of diastolic RV dysfunction in patients with COPD (in comparison with the control group) revealed significant changes in the indicators obtained from transtricuspid flow — E/Atk (0.67 ± 0.02 vs 1.5 ± 0.38; p = 0.016). The dynamics of the degree of severity of right ventricular dysfunction, estimated using the proposed indicators, may be another additional characteristic of the success of therapy to achieve disease control in patients with COPD.

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