scholarly journals Review Article: Management of Perioperative Anesthesia in Right Heart Failure

2018 ◽  
Vol 54 (1) ◽  
pp. 75
Author(s):  
Fajar Perdhana ◽  
Herdono Purnomo
Keyword(s):  
Heart Failure ◽  
Cardiac Surgery ◽  
Right Ventricular ◽  
Ventricular Dysfunction ◽  
Right Ventricular Dysfunction ◽  
Right Heart Failure ◽  
Left Ventricular ◽  
Right Ventricular Failure ◽  
Ventricular Failure ◽  
Right Heart

Right ventricular dysfunction and failure receive much less attention than the left ventricular failure. Right ventricular dysfunction or failure is associated with increased mortality rates in cardiac surgery, surgical cases other than cardiac surgery and also in patients treated in the ICU. The purpose of this article review was to describe the anatomy, physiology and pathophysiology of right ventricular failure, its detection and diagnosis, and management considerations from anesthetic point of view, including preoperative, intraoperative and postoperative stages. Cardiac surgery may result in right ventricular failure. For example, 0.1% post cardiotomy patients experience severe right heart failure and require long-term inotropic support, and so do 2-3% of post-transplant patients, and 20-30% of patients installed with instrument in his left heart. Therefore, anesthesiologists play a major role in perioperative and postoperative intensive care and are obliged to comprehend the nature of right ventricular dysfunction and failure so as to carry out early detection, prevent and manage patients with right ventricular dysfunction.

scholarly journals Right ventricular dysfunction and pulmonary hypertension: a neglected presentation of thyrotoxicosis

2018 ◽  
Vol 2018 ◽  
Author(s):  
Carolina Shalini Singarayar ◽  
Foo Siew Hui ◽  
Nicholas Cheong ◽  
Goay Swee En
Keyword(s):  
Heart Failure ◽  
Pulmonary Hypertension ◽  
Right Ventricular ◽  
Left Ventricular Dysfunction ◽  
Ventricular Dysfunction ◽  
Right Ventricular Dysfunction ◽  
Right Heart Failure ◽  
Left Ventricular ◽  
Newly Diagnosed ◽  
Right Heart

Summary Thyrotoxicosis is associated with cardiac dysfunction; more commonly, left ventricular dysfunction. However, in recent years, there have been more cases reported on right ventricular dysfunction, often associated with pulmonary hypertension in patients with thyrotoxicosis. Three cases of thyrotoxicosis associated with right ventricular dysfunction were presented. A total of 25 other cases of thyrotoxicosis associated with right ventricular dysfunction published from 1994 to 2017 were reviewed along with the present 3 cases. The mean age was 45 years. Most (82%) of the cases were newly diagnosed thyrotoxicosis. There was a preponderance of female gender (71%) and Graves’ disease (86%) as the underlying aetiology. Common presenting features included dyspnoea, fatigue and ankle oedema. Atrial fibrillation was reported in 50% of the cases. The echocardiography for almost all cases revealed dilated right atrial and or ventricular chambers with elevated pulmonary artery pressure. The abnormal echocardiographic parameters were resolved in most cases after rendering the patients euthyroid. Right ventricular dysfunction and pulmonary hypertension are not well-recognized complications of thyrotoxicosis. They are life-threatening conditions that can be reversed with early recognition and treatment of thyrotoxicosis. Signs and symptoms of right ventricular dysfunction should be sought in all patients with newly diagnosed thyrotoxicosis, and prompt restoration of euthyroidism is warranted in affected patients before the development of overt right heart failure. Learning points: Thyrotoxicosis is associated with right ventricular dysfunction and pulmonary hypertension apart from left ventricular dysfunction described in typical thyrotoxic cardiomyopathy. Symptoms and signs of right ventricular dysfunction and pulmonary hypertension should be sought in all patients with newly diagnosed thyrotoxicosis. Thyrotoxicosis should be considered in all cases of right ventricular dysfunction or pulmonary hypertension not readily explained by other causes. Prompt restoration of euthyroidism is warranted in patients with thyrotoxicosis complicated by right ventricular dysfunction with or without pulmonary hypertension to allow timely resolution of the abnormal cardiac parameters before development of overt right heart failure.

Mechanisms of hypotension produced by platelet-activating factor

1989 ◽  
Vol 66 (6) ◽  
pp. 2681-2690 ◽  
Author(s):  
F. R. Laurindo ◽  
R. E. Goldstein ◽  
N. J. Davenport ◽  
D. Ezra ◽  
G. Z. Feuerstein
Keyword(s):  
Right Ventricular ◽  
Pulmonary Vascular Resistance ◽  
Vascular Resistance ◽  
Ventricular Dysfunction ◽  
Platelet Activating Factor ◽  
Right Ventricular Dysfunction ◽  
Left Ventricular ◽  
Right Ventricular Failure ◽  
Right Atrial ◽  
Ventricular Failure

Platelet-activating factor (PAF) is a phospholipid mediator that induces cardiovascular collapse and release of the secondary mediator thromboxane A2 (TxA2). To clarify mechanisms involved in this collapse and, specifically, the relative contribution of left ventricular and right ventricular dysfunction, we studied 12 open-chest pigs. PAF infusion (0.04–0.28 nmol.kg-1.min-1) induced a 5- to 120-fold increase in pulmonary vascular resistance, a 75–98% fall in cardiac output, and systemic arterial hypotension. Right ventricular failure was indicated by chamber enlargement, decreased shortening, and increased right atrial pressures. In contrast, left ventricular dysfunction was accompanied by decreases in chamber dimensions and filling pressures that were unresponsive to volume expansion. U 46619 (a stable TxA2 analogue) and mechanical pulmonary artery constriction induced changes similar to PAF. In 11 additional closed-chest pigs, TxA2 blockade with indomethacin attenuated the PAF-induced rise in pulmonary vascular resistance, right ventricular dysfunction, and systemic hypotension. A specific TxA2 synthase inhibitor, OKY-046, also diminished hemodynamic effects of PAF in six other pigs. Tachyphylaxis was not observed in five pigs repeatedly given PAF. We conclude that acute right ventricular failure as the result of severe increase in pulmonary vascular resistance is the primary mechanism early in the course of PAF-induced shock in the pig. PAF-induced release of TxA2 may contribute significantly to these events.

Case Report: Nonarrhythmogenic Right Ventricular Dysplasia Presenting with Severe Right Ventricular Failure in an Adolescent

2010 ◽  
Vol 13 (1) ◽  
pp. 21
Author(s):  
Mustafa Pac ◽  
Aysenur Pac ◽  
Tugcin Bora Polat ◽  
Sevket Balli ◽  
Nesrin Turhan ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ventricular Arrhythmia ◽  
Right Ventricular ◽  
Right Heart Failure ◽  
Right Ventricular Failure ◽  
Orthotopic Heart Transplantation ◽  
Ventricular Failure ◽  
Right Heart ◽  
Right Ventricular Dysplasia ◽  
The Right

Right ventricular dysplasia is usually discovered by the presence of ventricular arrhythmia. As arrhythmia is an epiphenomenon, the first presentation of some cases can be primarily heart failure. We describe an adolescent girl who presented with progressive right heart failure and whose hallmark was fibrofatty replacement of ventricular muscle, especially of the right side, without ventricular arrhythmia. The patient was successfully treated by orthotopic heart transplantation.

scholarly journals Complicated postoperative course in isolated tricuspid valve surgery: looking for predictors

2021 ◽  
Author(s):  
Alessandra Sala ◽  
Roberto Lorusso ◽  
Marta Bargagna ◽  
Stefania Ruggeri ◽  
Nicola Buzzatti ◽  
...  
Keyword(s):  
Heart Failure ◽  
Length Of Stay ◽  
Right Ventricular ◽  
Tricuspid Valve ◽  
Ventricular Dysfunction ◽  
Univariate Analysis ◽  
Right Ventricular Dysfunction ◽  
Right Heart Failure ◽  
Right Heart ◽  
Postoperative Course

Background: This study aims at better defining the profile of patients with a complicated versus non-complicated postoperative course following isolated tricuspid valve (TV) surgery to identify predictors of a favourable/unfavourable hospital outcome. Methods: All patients treated with isolated tricuspid surgery from March 1997-January 2020 at our institution were retrospectively reviewed. Considering the complexity of most of these patients, a regular postoperative course was arbitrarily defined as a length-of-stay in intensive care unit <4 days and/or postoperative length-of-stay <10days. Patients were therefore divided accordingly in two groups. Results: 172 patients were considered, among whom 97 (56.3%) had a regular (REG) and 75 (43.6%) a non-regular (NEG) postoperative course. The latter had worse baseline clinical and echocardiographic characteristics, with higher rate of renal insufficiency, previous heart failure hospitalizations, cardiac operations, and right ventricular dysfunction. NEG patients more frequently needed tricuspid replacement and experienced a greater number of complications (p<0.001) and higher in-hospital mortality (13% vs 0%, p<0.001). The majority of these complications were related to more advanced stage of the tricuspid disease. Among most important predictors of a negative outcome univariate analysis identified chronic kidney disease, ascites, previous right heart failure hospitalizations, right ventricular dysfunction, previous cardiac surgeries, TV replacement and higher MELD scores. At multivariate analysis, liver enzymes and diuretics’ dose were predictors of complicated postoperative course. Conclusions: In isolated TV surgery a complicated postoperative course is observed in patients with more advanced right heart failure and organ damage. Earlier surgical referral is associated to excellent outcomes and should be recommended.

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.

Right ventricular failure with high echoic ventricular wall change after foetoscopic laser photocoagulation: a case report of a donor in twin-to-twin transfusion syndrome

2014 ◽  
Vol 26 (1) ◽  
pp. 155-157
Author(s):  
Eri Mineo ◽  
Takashi Honda ◽  
Masahiro Ishii
Keyword(s):  
Heart Failure ◽  
Right Ventricular ◽  
Laser Photocoagulation ◽  
Right Heart Failure ◽  
Right Ventricular Failure ◽  
Ventricular Wall ◽  
Ventricular Failure ◽  
Right Heart ◽  
The Right

AbstractThe introduction of foetoscopic laser photocoagulation has dramatically improved the prognosis of patients with severe twin-to-twin transfusion syndrome. We present the case of a donor who exhibited right-heart failure with a high echoic wall change of the right ventricle after the foetoscopic laser photocoagulation procedure. The prenatal and 1-year postnatal follow-up revealed the gradual recovery of the right ventricular function.

Pulmonary hypertension and right heart failure due to severe hypernatremic dehydration

Perfusion ◽  
2017 ◽  
Vol 32 (5) ◽  
pp. 413-415 ◽  
Author(s):  
Saurabh Chiwane ◽  
Tageldin M. Ahmed ◽  
Christian P. Bauerfeld ◽  
Monika Chauhan
Keyword(s):  
Heart Failure ◽  
Pulmonary Hypertension ◽  
Right Ventricular ◽  
Sinus Thrombosis ◽  
Right Heart Failure ◽  
Right Ventricular Failure ◽  
Dural Sinus ◽  
Ventricular Failure ◽  
Right Heart ◽  
Hypernatremic Dehydration

Introduction: Neonates are at risk of developing hypernatremic dehydration and its associated complications, such as stroke, dural sinus thrombosis and renal vein thrombosis. Pulmonary hypertension has not been described as a complication of hypernatremia. Case report: We report a case of a seven-day-old neonate with severe hypernatremic dehydration who went on to develop pulmonary hypertension and right heart failure needing extracorporeal membrane oxygenation (ECMO). Discussion: Normal or high anion gap metabolic acidosis commonly accompanies hypernatremic dehydration. The presence of acidosis and/or hypoxia can delay the normal drop in pulmonary vascular resistance (PVR) after birth, causing pulmonary hypertension and right ventricular failure. Conclusion: A high index of suspicion is paramount to diagnose pulmonary hypertension and aggressive correction of the acidosis and hypoxia is needed. In the presence of severe right ventricular failure, ECMO can be used as a bridge to recovery while underlying metabolic derangements are being corrected.

scholarly journals Usefulness of right ventricular contraction pressure index to predict short-term mortality and right heart failure in patients who underwent continuous-flow left ventricular assist device implantation

2019 ◽  
Vol 43 (1) ◽  
pp. 25-36 ◽  
Author(s):  
Koray Kalenderoğlu ◽  
Tolga Sinan Güvenç ◽  
Müge Taşdemir Mete ◽  
Hüseyin Kuplay ◽  
Semra Ağustos ◽  
...  
Keyword(s):  
Heart Failure ◽  
Right Ventricular ◽  
Right Heart Failure ◽  
Left Ventricular ◽  
Ventricular Contraction ◽  
Short Term ◽  
Right Heart ◽  
Ventricular Assist ◽  
Pressure Index ◽  
Short Term Mortality

Background: Right ventricular stroke work index is a useful but invasively measured parameter that can be used to predict right heart failure following continuous-flow left ventricular assist device implantation. Right ventricular contraction pressure index is a novel parameter that was developed to measure right ventricular stroke work index with echocardiography. We aimed to investigate the clinical usefulness of right ventricular contraction pressure index to predict short-term mortality and right heart failure in patients who underwent continuous-flow left ventricular assist device implantation. Methods: A total of 49 patients who participated in institutional advanced heart failure registry and underwent continuous-flow left ventricular assist device implantation with a bridge-to-candidacy indication were analyzed retrospectively. Right ventricular contraction pressure index was calculated using offline measurements. Demographic, clinical and outcome data were obtained from the registry data. Patients were grouped according to right ventricular contraction pressure index quartiles. Results: Patients within the lowest right ventricular contraction pressure index quartile had a trend toward higher short-term mortality (46.2%, p = 0.056) and combined short-term mortality and definitive right heart failure (53.8%, p = 0.054) at 15th day postoperatively. Similarly, short-term survival or survival free of definite right heart failure were significantly lower in the lowest right ventricular contraction pressure index quartile (log-rank p = 0.045 and log-rank p = 0.03, respectively). In a proportional hazards model that included echocardiographic parameters, right ventricular contraction pressure index was an independent predictor for short-term mortality (odds ratio: 6.777, 95% confidence interval: 1.118–41.098, p = 0.037), but not for combined short-term mortality and definite right heart failure. No such associations were found for long-term mortality. Right ventricular contraction pressure index had a statistically significant correlation with invasively measured pulmonary capillary wedge pressure, pulmonary vascular resistance, mean pulmonary pressure, and right ventricular stroke work index. Conclusion: Right ventricular contraction pressure index was found as a useful parameter for determining short-term postoperative mortality in patients undergoing continuous-flow left ventricular assist device implantation.

Right Heart Phenotype in Heart Failure With Preserved Ejection Fraction

2021 ◽  
Author(s):  
Marco Guazzi ◽  
Robert Naeije
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Right Ventricular ◽  
Ventricular Dysfunction ◽  
Imaging Techniques ◽  
Treatment Options ◽  
Right Ventricular Dysfunction ◽  
Preserved Ejection Fraction ◽  
Right Heart ◽  
The Right

The health burden of heart failure with preserved ejection fraction is increasingly recognized. Despite improvements in diagnostic algorithms and established knowledge on the clinical trajectory, effective treatment options for heart failure with preserved ejection fraction remain limited, mainly because of the high mechanistic heterogeneity. Diagnostic scores, big data, and phenomapping categorization are proposed as key steps needed for progress. In the meantime, advancements in imaging techniques combined to high-fidelity pressure signaling analysis have uncovered right ventricular dysfunction as a mediator of heart failure with preserved ejection fraction progression and as major independent determinant of poor outcome. This review summarizes the current understanding of the pathophysiology of right ventricular dysfunction in heart failure with preserved ejection fraction covering the different right heart phenotypes and offering perspectives on new treatments targeting the right ventricle in its function and geometry.

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