Perioperative Right Heart Dysfunction

Payne, David A.; Cleveland, Richard J.

doi:10.1007/978-1-4613-1773-9_16

Developments in Cardiovascular Medicine

1988

DOI: 10.1007/978-1-4613-1773-9_16

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Perioperative Right Heart Dysfunction

David A. Payne¹,

Richard J. Cleveland²

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1989

1990

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Cited by 2 publications

References 109 publications

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Prognostic significance of postinfarction arrhythmias and biventricular dysfunction under stress

Fridrich

1989

Clinical Cardiology

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Summary:The prognostic relevance on mortality of right ventricular dysfunction in comparison with left ventricular function during stress, complex arrhythmias detected by Holter monitoring, and variables of exercise performance, was evaluated via a retrospective follow-up of more than four years for cardiac mortality of all patients in the chronic stage after myocardial infarction who were referred serially during a one-year period to stress radionuclide-ventriculography and 24-h Holter monitoring. A sample of 47% (213) of all patients admitted after myocardial infarction to the rehabilitation center during 1983 was investigated by scintigraphic stress testing and Holter monitoring and were followed up. Subsequent medication and invasive therapeutic interventions were documented. The mortality during a mean follow-up period of 3.9 years in 213 patients (mean age, 56 years) was 14.6%. Significantly decreased values of left and right ventricular ejection fractions during stress scintigraphy (38_+14 versus 50&15%, p=O.OOO and 4 5 k 1 3 versus 54 & 11 % , p=O.OOl, respectively) were revealed in the cardiac deceased patient cohort compared with the remainder. Complex arrhythmias during Holter monitoring occurred twice as often (62 vs. 34%, p=0.0059) in later deceased patients. Lifetable analysis demonstrated that patients with biventricular stress dysfunction had a significantly worse survival prognosis than those with monoventricular dysfunction. Multivariate nonlinear Cox survival analysis revealed that left and right ventricular ejection fraction during stress and arrhythmias were of indepenAddress for reprints:Anichstr. 35 A-6020 Innsbruck, Austria Received: July 6, 1989 Accepted: July 28, 1989 dent prognostic significance compared with multiple clinical variables including those of exercise performance. Thus, apart from left ventricular dysfunction and anhythmias, scintigraphically assessed right ventricular stress dysfunction is a further marker of poor prognosis after myocardial infarction. This reflects the previously neglected pathophysiologic significance of right ventricular performance in patients after myocardial infarction.

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Prognostic significance of postinfarction arrhythmias and biventricular dysfunction under stress

Fridrich

1989

Clinical Cardiology

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The Anesthesiologist's Response to a Low-Output State After Cardiopulmonary Bypass: Etiologies and Remedies

Hug

1990

Journal of Cardiac Surgery

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Artifacts or mechanical problems may cause data which suggest poor myocardial performance during emergence from cardiopulmonary bypass (CPB). Transducer and monitoring equipment malfunctions, damping of the arterial blood pressure tracing, effects of drugs, hypercarbia, inordinately high intrathoracic pressure, cardiac tamponade, and others are all possible culprits. It is important to have a systematic plan for evaluating and interpreting the signs and data that are evident. Causes of hypotension after CPB include low hematocrit, hypercarbia, sympathetic inhibition, vasodilator action, anaphylaxis or anaphylactoid reactions, protamine reactions, and impaired myocardial performance. Impaired myocardial performance can be attributable to rate and rhythm disturbances, inadequate ventricular preload, inappropriately elevated right and left ventricular afterload, and decreased myocardial contractility. Common causes of hypoxemia include a malfunctioning ventilator system, pulmonary problems such as atelectasis and shunt, anemia, and inordinately high utilization of oxygen.

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Perioperative Right Heart Dysfunction

Cited by 2 publications

References 109 publications

Prognostic significance of postinfarction arrhythmias and biventricular dysfunction under stress

Prognostic significance of postinfarction arrhythmias and biventricular dysfunction under stress

The Anesthesiologist's Response to a Low-Output State After Cardiopulmonary Bypass: Etiologies and Remedies

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