Perioperative Right Ventricular Pressure Monitoring in Cardiac Surgery

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').…”

Postoperative right ventricular dysfunction—Integrating right heart profiles beyond long-axis function

“…Hemodynamic elements, such as central venous pressure and the mean pulmonary arterial pressure to systemic arterial pressure ratio (yielding insights into both the pulmonary and systemic circulations [13][14][15][16][17] ) are useful to monitor; however, combined pulmonary artery and RV pressure waveform (Figure 1, A) 18 appears to be a promising method for detecting abnormal RV function. 19 The current understanding of RV failure combines the ventricular and the arterial elastance as an index of RVarterial coupling. 20 When this RV-arterial coupling is less than 1, then the RV will enlarge to maintain cardiac output, but at the expense of venous congestion.…”

Commentary to “Right Ventricular Systolic Performance Determined by 2D Speckle-Tracking Echocardiography and Acute Kidney Injury After Cardiac Surgery”

“…Perhaps clinicians should focus on measurements that are easier and faster to obtain and analyze, such as right heart pressure monitoring and extracardiac echocardiography, but this remains to be studied. 3 We have some concerns regarding the inclusion of patients in the study. It is reported that 80 patients were excluded because of inadequate image quality precluding strain analysis, yielding a final study population of 199 patients.…”